Associations between aspects of culturally competent care and clinical outcomes among patients with diabetes.
BACKGROUND
Culturally competent care may be associated with clinical outcomes in diabetes management, which requires effective physician-patient collaboration. The recent development and validation of the Consumer Assessment of Healthcare Providers and Systems Cultural Competence tool enables investigation of possible associations.


OBJECTIVE
To assess whether 3 aspects of culturally competent care are associated with glycemic, lipid, and blood pressure control among ethnically diverse patients with diabetes.


METHODS
Survey and chart review study of patients recruited from urban safety net clinics in 2 cities.


METHODS
A total of 600 patients with type 2 diabetes and a primary care physician.


METHODS
We used multivariate logistic regression to assess the independent relationships between the 3 domains of the Consumer Assessment of Healthcare Providers and Systems Cultural Competence (Doctor Communication-Positive Behaviors, Trust, and Doctor Communication-Health Promotion) and glycemic, lipid, and systolic blood pressure control after adjusting for sociodemographic and clinical factors.


RESULTS
In adjusted analysis, high Trust was associated with lower likelihood of poor glycemic control (odds ratio, 0.59; 95% confidence interval, 0.41-0.84) and high Doctor Communication-Health Promotion was associated with a higher likelihood of poor glycemic control (odds ratio, 1.49, 95% CI, 1.02-2.19). None of the 3 aspects of culturally competent care examined were associated with lipid or systolic blood pressure control after adjustment.


CONCLUSIONS
Trust in physician, a core component of culturally competent care, but not doctor communication behavior, was associated with a lower likelihood of poor glycemic control in a safety net population with diabetes. Glycemic control may be more sensitive to patient physician partnership than blood pressure and hyperlipidemia control.
Department of General Internal Medicine, San Francisco General Hospital, San Francisco, CA 94143, USA. afernandez@medsfgh.ucsf.edu
Alicia
A
Fernandez
Hilary
H
Seligman
Judy
J
Quan
Rachel J
RJ
Stern
Elizabeth A
EA
Jacobs
D000328:Adult; D001786:Blood Glucose; D001794:Blood Pressure; D003142:Communication; D054521:Cultural Competency; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology*; D005006:Ethnicity; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010817:Physician-Patient Relations; D044469:Racial Groups; D012959:Socioeconomic Factors; D035502:Trust; D014505:Urban Population / Q000706:statistics & numerical data
D001786:Blood Glucose; D006442:Glycated Hemoglobin