Inequalities in patient experience of communication by ethnic group: new evidence

If you have even a passing concern about inequalities in health care, you’re likely to be familiar with the idea that minority ethnic groups tend to report more negative experiences of health care compared to their counterparts in the majority ethnic group. In the UK, this means that people identifying, particularly, as being of South Asian or Chinese background report poorer quality of care, especially around communication, across both primary and secondary care settings. Previous work by our group has shown, using GP Patient Survey data, that doctor-patient communication ratings for those from South Asian backgrounds range from 6 to 9 percentage points below those of the White British group (1). Around half of this difference in reported experience is in fact explained by the concentration of South Asian patients in GP practices with generally low scores. However, the other half of the difference in scores arises because South Asian patients report less positive experiences than White patients in the same practices as them.

Our latest analysis, published in BJGP today, adds further detail to this picture (2). Using recent GP Patient Survey data, we point out that there is strong evidence that the effect of ethnicity on reported GP-patient communication varies by both age and gender. The difference in scores between White British and other respondents on doctor-patient communication items is largest for older, female Pakistani and Bangladeshi respondents, and for younger respondents who described their ethnicity as ‘Any Other White’. For example, the difference in reported communication scores between a White British 75-84 year old woman and a Bangladeshi woman of the same age was -8.23 points on 0-100 scale (after controlling for all the usual important things). And the difference in reported communication score between a White British 35-44 year old woman and an ‘Any Other White’ woman of the same age was -5.30 points.

So, what does this all mean? Broadly, that the drivers of these variations in care (particularly provider- or system-side factors) are not embedded in reactions to ethnicity alone, but are derived from the inter-relationship between ethnicity, gender and age. It is the combination of these factors which may identify groups with particular needs, such as those patients with the lowest levels of English proficiency. Our focus should therefore be not just on differences between groups but also on differences within them, considering how ethnicity, gender, age and other categories of social identity interact with each other to create different experiences and outcomes of care.

 

References
  1. Lyratzopoulos G, Elliott M, Barbiere JM et al. Understanding ethnic and other socio-demographic differences in patient experience of primary care: evidence from the English General Practice Patient Survey. BMJ Qual Saf 2012; 21: 21–9
  2. Burt J, Lloyd C, Campbell J, Roland M, Abel G. Variations in GP–patient communication by ethnicity, age and gender: evidence from a national primary care patient survey. BJGP 2015
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  • The Cambridge Centre for Health Services Research (CCHSR) is a thriving collaboration between the University of Cambridge and RAND Europe. We aim to inform health policy and practice by conducting research and evaluation studies of organisation and delivery of healthcare, including safety, effectiveness, efficiency and patient experience.