Managing cardiovascular risk factors in different racial, ethnic groups
Based on existing research, how should you treat an older hypertensive woman if she happens to be Hispanic?
The same as any other hypertensive patient, said Michael J. Bloch, ACP Member, during his Thursday session “Racial and Ethnic Disparities in Cardiometabolic Risk: Lessons for Clinical Practice.”
While research has shown that the prevalence of certain cardiovascular risk factors varies based on race and ethnicity—and this should affect one’s approach to screening—it doesn’t affect the therapies one should recommend.
Michael J. Bloch, ACP Member: “We use a patient-centered approach to improve communication between the practitioner and patient.”
“These differences … don’t affect the management or care of individual patients,” Dr. Bloch said. “What may change, however, is how you deliver that care.”
Studies have shown that race and ethnicity affect healthcare outcomes, even when researchers control for income, education, occupation and insurance coverage. The root causes of this are complex, and may include inequities in the health care delivery system, difference in patient behaviors and preferences, and problems with the provider-patient relationship, he said.
Indeed, an observational study published in a 2004 American Journal of Public Health article found that physicians were 23% more verbally dominant, and engaged in 33% less patient-centered communication, with African-American patients than with white patients, regardless of the provider’s own race, Dr. Bloch said.
Some cultural competency programs have used this kind of data as a basis for educating physicians on specific values, customs and beliefs that are thought to be unique to different racial and ethnic groups. But focusing on stereotypes is not the best solution to altering provider behavior, Dr. Bloch said.
“These programs are well-meaning but run the risk of over-simplifying,” Dr. Bloch said. “So we use a patient-centered approach to improve communication between the practitioner and patient.”
Dr. Bloch noted that Joseph Betancourt, MD, et al. have developed a patient-centered approach, called the ESFT (Explanatory, Social, Fears, Treatment) Model, that works well for cross-cultural communication with patients, he said. The model's components involve the patient's:
- Explanation and conceptualization of his/her illness. The provider may ask the patient:
- What do you call your problem?
- What do you think is causing it?
- How does it affect your life? How does your family feel about it?
- What kind of treatment do you think will work?
- Social and financial barriers to adherence
- Does your insurance cover your medications?
- Do you have access to a pharmacy?
- Is it difficult to afford your medications or copayments?
- How are your medications organized at home? Do you have a pill box?
- Fears and concerns about the treatment or its potential side effects
- How do you feel about taking the medication?
- What have you heard about this medication?
- What worries do you have about side effects?
- Do you think the medication will interfere with your life?
- Understanding of his/her treatment regimen
- How do you plan to take the medications?
- How do you feel about your treatment plan?
- Can you repeat the (treatment) instructions back to me in your own words?
“You may not ask every single question, but you can use it as guide in deciding which questions are the most meaningful in a given situation,” Dr. Bloch said. “Best of all, this model works for majority and minority populations.”
Internist Archives Quick Links
Introducing ACP Summer Session
The most popular learning formats from the Internal Medicine meeting offered at only $35 for ACP members! Combine CME and leisure time in San Francisco, CA or Orlando, FL
Need an EHR System?
The EHR Partners Program offers ACP members free advice on selecting and implementing an EHR system for your practice.