JAMA: 2009-03-25, Vol. 301, No. 12, Author in the Room™ Audio Interview

Interview with Lisa A. Cooper, MD, author of A 41-Year-Old African American Man With Poorly Controlled Hypertension. Summary Points: 1. Cardiovascular disease accounts for 35% of the excess mortality in African Americans, in large part because of hypertension. 2. Racial disparities in physicians' clinical decision-making and in quality of care for cardiovascular disease have been documented extensively; studies also show racial differences in patient-physician communication, particularly when the patient and physician come from different racial backgrounds, and unconscious racial biases among physicians. 3. A categorical approach that lumps patients of particular cultural backgrounds into groups and outlines their characteristics values, customs and beliefs may lead to over-simplication and stereotyping. Instead, an understanding of broad cultural concepts and skills that emphasize a patient-centered approach are preferred. This approach takes into account the individual patients' explanatory model, illness agenda and behaviors, and social context, and attitudes and skills with regard to negotiating treatment. It also includes participatory behaviors such as asking open-ended questions, using reflective listening, and avoiding arguments in which one tries to change the patient's views. 4. Systematic reviews of interventions to improve patient adherence to treatments for hypertension show that simplifying dosing regimens is most effective; using motivational strategies such as home monitoring, small-group training, counseling by a nurse or other professional, and reminder calls for patients are somewhat effective; and patient education alone is not effective. Quality improvement strategies for hypertension management show team change interventions that include assignment of some responsibilities to a health professional other than the patient's physician (such as a nurse or pharmacist) are associated with the largest reductions in blood pressure. Improvement in patient-physician communication is linked to improved outcomes for mental health; more studies are needed that examine how patient-physician communication may improve hypertension control and other physiologic measures.