Effect of race on patient expectations regarding their primary care physicians.

BACKGROUND: Fulfilment of patients' expectations has been associated with greater patient satisfaction with care and greater adherence to medical advice. However, little is know about how race influences patient expectations. OBJECTIVE: To determine the association between patient race and patient expectations of their primary care physician. METHODS: The design was a cross-sectional study. Setting and participants were sample of 709 primary care patients from four clinic sites at the Philadelphia Veterans Affairs Medical Center and the University of Pennsylvania Health System. The measures were an expectations instrument asking patients to rate the necessity of the physician performing 13 activities during the index visit, self-reported race, demographics, the Rapid Estimate of Adult Literacy in Medicine, the Charlson Comorbidity Index and SF-12. RESULTS: After adjusting for age, sex, education, clinic site, comorbidity, health literacy and health status, African Americans were more likely to report it was absolutely necessary for the physician to refer them to a specialist [AOR 1.55 (95% confidence interval, CI, 1.09-2.21), P = 0.01], order tests [AOR 1.59 (95% CI 1.11-2.27), P = 0.01] and conduct each of the six physical exam components. CONCLUSIONS: African American race is associated with greater expectations of the primary care physicians. More research is needed to confirm the differential expectations by race and determine the reasons for the differential expectations.

Health literacy weakly but consistently predicts primary care patient dissatisfaction.

OBJECTIVES: To study relationships between health literacy and multiple satisfaction domains. Health literacy is related to some domains of patient satisfaction such as communication and understanding, but little is known about relationships of health literacy with other satisfaction domains. Moreover, the importance of health literacy in predicting satisfaction compared with other patient sociodemographics is underexplored. DESIGN: Cross-sectional survey. SETTING: Primary care waiting areas with a Veterans Administration Medical Center and a university health system. PARTICIPANTS: One thousand five hundred and twenty-eight primary care patients. MAIN OUTCOME MEASURES: A brief demographics questionnaire, the Rapid Estimate of Adult Literacy in Medicine, the Veterans Affairs ambulatory care patient satisfaction survey, and an adaptation of the Charlson Comorbidity Index. RESULTS: In unadjusted regression analyses, lower health literacy level was a significant predictor of worse satisfaction in 7 of 10 domains (P < 0.01). When adjusting for patient sociodemographics, predicted relationships remained significant in six of the seven domains (P < 0.05), with each unit change in the 4-stage literacy classification associated with a 3-6 point decrease in dissatisfaction scores (0-100 scale). Health literacy did not predict overall dissatisfaction (P = 0.55). CONCLUSIONS: These results suggest that health literacy, as assessed through a pronunciation exercise that is closely related to more comprehensive measures of literacy, has a consistent, albeit weak relationship with patient satisfaction. Future work is needed to clarify if patients with lower literacy are really receiving different care than those with higher literacy and to pinpoint the sources of their more negative responses.

Assessing health literacy in African American and Caucasian adults: disparities in rapid estimate of adult literacy in medicine (REALM) scores.

BACKGROUND AND OBJECTIVES: The influence of literacy on health and health care is an important area of investigation. Studies with a literacy focus are most valuable when literacy is assessed with psychometrically sound instruments. METHODS: This study used a prospective cohort sample of 1,610 primary care patients. Patients provided sociodemographics and took the Rapid Estimate of Adult Literacy in Medicine (REALM), a 66-item word pronunciation literacy test. RESULTS: The sample was 65% African American; 66% were men; 51% had a high school education or less. REALM scores were significantly related to education, age, and race but not gender. When stratified by education, differences between African Americans and Caucasians remained significant. Using 19 different strategies to shorten the 66-item instrument, reliability coefficients above.80 were maintained. CONCLUSIONS: The REALM is a robust assessment of health literacy. However, the discordance in scores between African Americans and Caucasians with similar educational attainment needs to be further addressed. A much shorter instrument would still have internally consistent scores and potentially be more useful in clinical settings.