attending physician looks on
Credit: NCI
Research has shown that many patients with sickle cell disease (SCD) do not consistently follow their doctor’s orders, and a new study suggests discrimination may be partly to blame.
Patients who felt they experienced discrimination because of their race or health status were 53% more likely than their peers to disregard physician recommendations.
However, reports of discrimination were also common among patients who said they followed doctors’ orders to the letter.
Carlton Haywood Jr, PhD, of the Johns Hopkins School of Medicine in Baltimore, Maryland, and his colleagues conducted this research and detailed the results in the Journal of General Internal Medicine.
Dr Haywood’s team monitored the experiences of 291 SCD patients (aged 15 and older) who were participating in the Improving Patient Outcomes with Respect and Trust (IMPORT) study.
Patients completed surveys to report perceived discrimination from healthcare providers and their adherence to physician recommendations.
More than a third of patients (36%) reported non-adherence to a doctor’s recommendations in the 2 years prior to completing the survey.
Fifty-eight percent of the non-adherent patients and 43% of the adherent group reported at least 1 incident of discrimination due to their race or health status.
Patients who had experienced discrimination were 53% more likely than their peers to follow physicians’ recommendations inconsistently.
Trust in medical professionals appeared to mediate the discrimination/non-adherence relationship. It accounted for 50% of the excess prevalence of non-adherence among patients who reported incidents of discrimination.
The researchers said these findings are consistent with previous studies among other chronically ill patient groups. They also show how discrimination affects a patient’s trust in the healthcare system, as well as the person’s subsequent willingness to follow prescribed treatment regimens.
Dr Haywood believes the perceptions and experiences of discrimination may increase the chances that SCD patients will not fully benefit from the care available to them.
“A good relationship between the patient and provider can facilitate adherence, while a problematic relationship can negatively impact patient adherence,” he said.
“Improving relationships between healthcare providers and such patients may improve their trust in medical professionals, which, in turn, may improve other outcomes among this underserved patient population.”
