The goal of this career development award is to develop theoretical and methodological expertise in patient-provider communication to facilitate the candidate's development into a leader in research to improve patient-provider communication with an emphasis on its relation to health disparities in patients with chronic disease. Building on her training and experience in cardiovascular behavioral medicine and minority health, the candidate has identified four core-training areas to further develop the skills needed to become an independent investigator: 1) interaction with a multidisciplinary mentorship team in cardiovascular disease, health disparities research, patient-provider communication, and behavioral medicine;2) coursework and didactic training to develop expertise in methodological and analytical principles of minority and cardiovascular health research;3) rigorous hands-on training in the use of qualitative analysis and an objective interaction analysis system to elucidate how patient-provider communication relates to patient outcomes, and;4) participation in seminars/workshops to gain the fundamental knowledge needed to develop an intervention to improve patient-provider communication. Despite the mounting evidence that racial differences in patient- provider communication affects patient care, many of these studies have examined processes of care such as patient satisfaction with little attention to intermediate outcomes such as medication adherence. Further, studies examining racial differences in patient-provider communication have not adequately captured the mutual influence the patient and provider may have on one another during the interaction. Thus, the potential pathways through which patient-provider communication contribute to hypertension-related disparities is not clearly understood. This proposed two-phase, mixed-methods study, provides a unique opportunity to address these gaps by elucidating the effect of patient's race on patient-provider communication and medication adherence among 120 hypertensive black and white patients receiving care at the Bellevue Ambulatory Care Practice in New York City. Specifically, findings from a qualitative analysis of patient-provider communication (Phase 1) will inform the development of a conceptual model that will be used to quantitatively evaluate the relationship between patient's race, patient-provider communication and medication adherence (Phase 2). In addition, patient-, provider-, and clinic-level characteristics will be evaluated as covariates to examine potential confounders of the relationship between patient-provider communication and medication adherence. The proposed career development plan and research project, along with the support of an established mentorship team and access to a well-resourced institution, will be instrumental in launching the candidate's academic research trajectory into an independent investigator with a focus in behavioral medicine and cardiovascular health disparities. The knowledge gained from this award will provide invaluable information for developing interventions to reduce the disparate rates of cardiovascular mortality and morbidity in high-risk populations.
According to the Institute of Medicine report Unequal Treatment, patient-provider communication may play a vital role in disparate health outcomes between blacks and whites. With increasing evidence that provider communication behaviors are potentially modifiable, and enduring, it is critical to understand the effect of patient-provider communication on intermediate patient outcomes such as medication adherence. Identifying the potential pathways through which interpersonal processes in the patient-provider relationship differentially affect medication adherence in black patients compared to whites will provide needed information for developing targeted interventions to improve patient-provider communication, thus reducing the racial disparities in cardiovascular mortality and morbidity.
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