Patient-provider communication, concordance, and ratings of care in dermatology: Results of a cross-sectional study

Objective To determine the impact of race concordance on patient perception of quality of dermatologic care. Study design Cross-sectional study. Setting Academic outpatient practices in the Departments of Dermatology of Eastern Virginia Medical School and the Johns Hopkins University School of Medicine. Participants The study cohort comprised 124 participants including 6 providers and 118 established patients. Main Outcome Measures We hypothesized, a priori, that patients in race-discordant dyads would report lower ratings of participatory decision-making (PDM), satisfaction, trust in the provider, and similarities with providers. Results Patients in race-discordant dyads reported less positive ratings on 4 out of 8 participatory decision-making questionnaire items (p values < 0.05), and were significantly more likely to perceive differences with providers in race and culture (p values < 0.05). These differences persisted to varying degrees after controlling for key confounders such as education and income level. Participants in race-concordant and race-discordant dyads did not differ in their perceptions of satisfaction or trust. Conclusions Patient perception of participation in the decision-making process and of shared similarities with their providers is attributable in varying degrees to race concordance. Continued strengthening of cultural competency skills during medical and dermatology residency training as well as increased diversification of the dermatologic workforce could attenuate the adverse influences of race discordance and other socioeconomic factors on patient-provider communication.