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Health care discrimination, processes of care, and diabetes patients' health status.

Piette JD, Bibbins-Domingo K, Schillinger D. Health care discrimination, processes of care, and diabetes patients' health status. Patient education and counseling. 2006 Jan 1; 60(1):41-8.

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OBJECTIVE: We examined whether diabetes patients report discrimination when seeking health care, whether problems with interpersonal processes of care (IPC) were associated with discrimination reports, and the linkage between discrimination and patients' health. METHODS: 810 diabetes patients were surveyed. Surveys were linked to hemoglobin A1c (A1C) and total cholesterol test results. RESULTS: 14% of participants reported experiencing discrimination in health care during the prior year, including discrimination due to their race (8%), education or income (9%), age (7%), and gender (10% of women). Patients with poorer than average ratings of their IPC had 2-8 times greater risk of reporting health care discrimination. Patients reporting health care discrimination had A1C levels that were higher than other patients (P = 0.002), more symptoms (P < 0.01), and poorer physical functioning (P = 0.007). CONCLUSIONS: Diabetes patients' reports of health care discrimination are strongly linked to the quality of their interactions with providers as well as multiple health outcomes. PRACTICE IMPLICATIONS: Physicians exert control over the clinical encounter and should endeavor to reduce patients' perceptions of discrimination during outpatient visits. Such efforts may result in more satisfied patients as well as improved health outcomes.

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