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Kiefe CI, McDonell MB, Martin D, Fihn S. Patient satisfaction and perceived health status: general and coronary artery disease specific racial differences among veterans [abstract]. [Abstract]. Abstract book / Annual Meeting. Association for Health Services Research. Meeting. 1997 Oct 15; 14P70:70.
RESEARCH OBJECTIVES: Racial differences in the management of disease are well known and poorly understood. For coronary artery disease (CAD), several studies document less intense management of African Americans (AA) compared to Whites, even within the socioeconomically fairly homogeneous patient population of the Department of Veterans Affairs (DVA). Our main objective was to study AA vs. White differences in self-perceived health status and patient satisfaction in the DVA. STUDY DESIGN: Cross-sectional analysis of surveys mailed to all veterans meeting inclusion criteria, followed at the Boston, MA, Seattle, WA, and White River Junction, VT, VA Medical Centers (response rate = 67%). Initial survey information included socioeconomic factors; the Medical Outcomes Studies (MOS) SF-36; a satisfaction with humanistic aspects of care instrument developed and published by the American Board of Internal Medicine; a satisfaction with the system of care instrument adapted from the MOS; and questions to identify the presence of CAD and other chronic conditions. These data are available on 4,203 AA or White respondents; 7% of respondents were AAs; 1,844 of these patients had CAD, and were mailed the Seattle Angine Questionnaire (SAQ): 1,269 (69%) responded, including 70 AAs (6% of SAQ respondents). The SAQ is a published and well validated instrument which includes domains of satisfaction with anginal care, perception of burden of disease, physical limitation, anginal stability, and anginal frequency. PRINCIPAL FINDINGS: African Americans compared to Whites were somewhat younger (63.6 years vs. 65.9, p < 0.01), more likely to live alone (37% vs. 30%, p < 0.01), less likely to also use non-VA health care (22% vs. 31%, p < 0.1) and likelier to have an annual income below $10,000 (42% vs. 34%, p < 0.01). AAs were also likelier to smoke (61% vs. 38%, p < 0.001), to have diabetes mellitus (39% vs. 25%, p < 0.001) and hypertension (65% vs. 51%, p < 0.01), but had lower prevalence of angine than Whites (41% vs. 48%, p < 0.05). AAs perceive themselves as better off on 7 out of the 8 scales of the SF-36 (only in role functioning-emotional did Whites score higher than AAs) and statistacally significantly so in 5 (p < 0.05): general health (45 vs. 42), physical functioning (61 vs. 55), role functioning-physical (52 vs. 38), bodily pain (54 vs. 49), and vitality (48 vs. 40). All scales are normalized to range from 0 (worst) to 100 (best). While there were no racial differences in satisfaction with the system of care, there were marked differences in satisfaction with humanistic aspects of care (69 for AAs vs. 74 for Whites) and with satisfaction with angina-specific care (76 vs. 82). Most differences persisted after multivariable adjustment for age, income, education and marital status: e.g., angina treatment satisfaction was 6.0 points lower for AAs unadjusted (p < 0.05) and 6.2 points lower after adjustment (p < 0.05). CONCLUSIONS: AAs compared to Whites in this DVA sample had poorer socioeconomic circumstances but better self-reported health status, both general and specific to CAD. However, despite better functional status, AAs were less satisfied with the medical care they received in general and specifically with respect to their CAD. These differences persisted after adjustment for age and other socioeconomic factors. RELEVANCE TO CLINICAL PRACTICE AND POLICY: Racial differences in treatment coexist with racial differences in health status perception and satisfaction with care. Longitudinal analyses need to explore whether and how these differences in patient satisfaction and perception contribute to known racial disparities in treatment