Patient-physician social concordance, medical visit communication and patients' perceptions of health care quality

Abstract

Social characteristics (e.g. race, gender, age, education) are associated with health care disparities. We introduce social concordance, a composite measure of shared social characteristics between patients and physicians.

Objective: To determine whether social concordance predicts differences in medical visit communication and patients' perceptions of care.

Methods: Regression analyses were used to determine the association of patient-provider social concordance with medical visit communication and patients' perceptions of care using data from two observational studies involving 64 primary care physicians and 489 of their patients from the Baltimore, MD/Washington, DC/Northern Virginia area.

Results: Lower patient-physician social concordance was associated with less positive patient perceptions of care and lower positive patient affect. Patient-physician dyads with low vs. high social concordance reported lower ratings of global satisfaction with office visits (OR=0.64 vs. OR=1.37, p=0.036) and were less likely to recommend their physician to a friend (OR=0.61 vs. OR=1.37, p=0.035). A graded-response was observed for social concordance with patient positive affect and patient perceptions of care.

Conclusion: Patient-physician concordance across multiple social characteristics may have cumulative effects on patient-physician communication and perceptions of care.

Practice implications: Research should move beyond one-dimensional measures of patient-physician concordance to understand how multiple social characteristics influence health care quality.

Figure 1

Proportion of Concordant vs. Discordant Patient-Physician Dyads with Respect to Each Social Characteristic Included in the Social Concordance Score