Journal
PATIENT EDUCATION AND COUNSELING
Volume 90, Issue 3, Pages 392-398Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.pec.2011.07.019
Keywords
Patient-physician communication; Interpersonal processes of care; Patient satisfaction; Perceived social position; Subjective socioeconomic status; Diabetes
Funding
- National Institute of Diabetes, Digestive and Kidney Diseases [R01 DK65664, DK081796, DK080726]
- National Institute of Child Health and Human Development [R01 HD046113]
- UCSF
- Department of Health and Human Services, Health Resources and Services Administration [D55HP05165]
- National Research Service Award
- Agency for Healthcare Research and Quality [HS013853]
- NIH Clinical and Translational Science Award [ULRR024131]
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Objective: A patient's sense of his/her standing in the social hierarchy may impact interpersonal processes of care (IPC) within the patient-provider encounter. We investigated the association of perceived social position with patient-reported IPC. Methods: We used survey data from the Diabetes Study of Northern California (DISTANCE), studying 11,105 insured patients with diabetes cared for in an integrated healthcare delivery system. Perceived social position was based on the MacArthur subjective social status ladder. Patient-reported IPC was based on a combined scale adapted from the Consumer Assessment of Health Plans Study provider communication subscale and the Trust in Physicians scale. Results: Lower perceived social position was associated with poorer reported IPC (p < 0.001). The relationship remained statistically significant after controlling for age, sex, race/ethnicity, depressive symptoms, physical functioning, income and education. Conclusion: Beyond objective measures of SES, patients' sense of where they fall in the social hierarchy may represent a pathway between social position and patient satisfaction with the quality of patient-provider communication in chronic disease. Practice implications: Interventions to address disparities in communication in primary care should incorporate notions of patients' social position. (C) 2011 Elsevier Ireland Ltd. All rights reserved.
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