title: Patient-physician racial/ethnic concordance and blood pressure control: the role of trust and medication adherence.
abstract: OBJECTIVE
  To examine the associations between racial/ethnic concordance and blood pressure (BP) control, and to determine whether patient trust and medication adherence mediate these associations.
  
  
  METHODS
  Cross-sectional study of 723 hypertensive African-American and white patients receiving care from 205 white and African-American providers at 119 primary care clinics, from 2001 to 2005. Racial/ethnic concordance was characterized as dyads where both the patient and physician were of the same race/ethnicity; discordance occurred in dyads where the patient was African-American and the physician was white. Patient perceptions of trust and medication adherence were assessed with self-report measures. The BP readings were abstracted from patients' medical charts using standardized procedures.
  
  
  RESULTS
  Six hundred thirty-seven patients were in race/ethnic-concordant relationships; 86 were in race/ethnic-discordant relationships. Concordance had no association with BP control. White patients in race/ethnic-concordant relationships were more likely to report better adherence than African-American patients in race/ethnic-discordant relationships (OR: 1.27, 95% CI: 1.01, 1.61, p = 0.04). Little difference in adherence was found for African-American patients in race/ethnic-concordant vs. discordant relationships. Increasing trust was associated with significantly better adherence (OR: 1.17, 95% CI: 1.04, 1.31, p < 0.01) and a trend toward better BP control among all patients (OR: 1.26, 95% CI: 0.97, 1.63, p = 0.07).
  
  
  CONCLUSIONS
  Patient trust may influence medication adherence and BP control regardless of patient-physician racial/ethnic composition.
authors.affiliation: a Department of Population Health , NYU School of Medicine , New York , NY , USA.
authors.forename: Antoinette
authors.initials: A
authors.lastname: Schoenthaler
authors.forename: Enid
authors.initials: E
authors.lastname: Montague
authors.forename: Linda
authors.initials: L
authors.lastname: Baier Manwell
authors.forename: Roger
authors.initials: R
authors.lastname: Brown
authors.forename: Mark D
authors.initials: MD
authors.lastname: Schwartz
authors.forename: Mark
authors.initials: M
authors.lastname: Linzer
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002641:Chicago; D003430:Cross-Sectional Studies; D005194:Family Practice; D005260:Female; D058006:General Practice; D019538:Health Care Surveys; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology / Q000523:psychology; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D055118:Medication Adherence / Q000208:ethnology* / Q000523:psychology; D008875:Middle Aged; D009519:New York City; D010817:Physician-Patient Relations; D057566:Self Report; D016896:Treatment Outcome; D035502:Trust; D044465:White People; D014922:Wisconsin; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents
keywords: blood pressure control; medication adherence; racial/ethnic concordance; trust