Emiley Chang1,2,3, Victor Lin4, Regine Goh5, Canossa Chan6, Michael K Ong7,8, Edward Hui7, Catherine Sarkisian7,9. 1. Department of Medicine, Harbor-UCLA Medical Center, Los Angeles, CA, USA. emiley.chang@lundquist.org. 2. Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA. emiley.chang@lundquist.org. 3. The Lundquist Institute, Torrance, CA, USA. emiley.chang@lundquist.org. 4. Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. 5. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. 6. American Cancer Society (Eastern Division), New York, NY, USA. 7. Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA. 8. Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA. 9. Geriatric Research Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Abstract
BACKGROUND: Though patient-physician racial concordance correlates with better perceived shared decision-making, Chinese immigrants report low quality of care and have undertreated hypertension regardless of concordance. OBJECTIVE: To inform efforts to change physician behavior and improve quality of hypertension care, we used role theory to explore differences between Chinese American seniors' descriptions of current and desired physician roles in hypertension management. DESIGN: Qualitative interviews. PARTICIPANTS: Immigrant Chinese Americans with hypertension age ≥ 65 years in Los Angeles County. APPROACH: We recruited 15 participants from a senior wellness center for language-matched interviews and blood pressure (BP) checks. Participants described current and desired physician activities for hypertension management. Bilingual research assistants translated audio recordings. Using thematic analysis, a three-member team independently reviewed and coded transcripts to identify themes regarding physician roles in hypertension management; discrepancies were discussed to achieve consensus. Themes were checked for validity in four subsequent focus groups. RESULTS: We completed interviews in 2014. Interviewees' mean age was 70.6 years; seven were female and five had a systolic BP over 150 mmHg. All interviewees reported having race- and language-concordant primary care providers, were prescribed at least one BP medication, and had Medicare. Three major themes encompassed current and desired physician roles in hypertension management: technical expert, empathetic health steward, and health educator. Descriptions of current and desired physician roles differed for all themes, most prominently for empathetic health steward and health educator. Participants desired but did not consistently experience interpersonal engagement or receive hypertension lifestyle counseling, citing visit time pressures. CONCLUSIONS: Among these Chinese American seniors, there remains a gap between current and desired physician roles in hypertension management, particularly interpersonal behaviors and education. Seniors deprioritized these roles in response to perceived physician role strain. Increased attention to the impact of perceived physician role strain might improve shared decision-making and hypertension management.
BACKGROUND: Though patient-physician racial concordance correlates with better perceived shared decision-making, Chinese immigrants report low quality of care and have undertreated hypertension regardless of concordance. OBJECTIVE: To inform efforts to change physician behavior and improve quality of hypertension care, we used role theory to explore differences between Chinese American seniors' descriptions of current and desired physician roles in hypertension management. DESIGN: Qualitative interviews. PARTICIPANTS: Immigrant Chinese Americans with hypertension age ≥ 65 years in Los Angeles County. APPROACH: We recruited 15 participants from a senior wellness center for language-matched interviews and blood pressure (BP) checks. Participants described current and desired physician activities for hypertension management. Bilingual research assistants translated audio recordings. Using thematic analysis, a three-member team independently reviewed and coded transcripts to identify themes regarding physician roles in hypertension management; discrepancies were discussed to achieve consensus. Themes were checked for validity in four subsequent focus groups. RESULTS: We completed interviews in 2014. Interviewees' mean age was 70.6 years; seven were female and five had a systolic BP over 150 mmHg. All interviewees reported having race- and language-concordant primary care providers, were prescribed at least one BP medication, and had Medicare. Three major themes encompassed current and desired physician roles in hypertension management: technical expert, empathetic health steward, and health educator. Descriptions of current and desired physician roles differed for all themes, most prominently for empathetic health steward and health educator. Participants desired but did not consistently experience interpersonal engagement or receive hypertension lifestyle counseling, citing visit time pressures. CONCLUSIONS: Among these Chinese American seniors, there remains a gap between current and desired physician roles in hypertension management, particularly interpersonal behaviors and education. Seniors deprioritized these roles in response to perceived physician role strain. Increased attention to the impact of perceived physician role strain might improve shared decision-making and hypertension management.
Entities:
Keywords:
Chinese Americans; hypertension; lifestyle counseling; medication counseling; physician roles
Authors: William R Doucette; Elizabeth H Chang; Jane F Pendergast; Kara B Wright; Elizabeth A Chrischilles; Karen B Farris Journal: Clin Ther Date: 2013-03-01 Impact factor: 3.393
Authors: Barry L Carter; Christopher S Coffey; Gail Ardery; Liz Uribe; Dixie Ecklund; Paul James; Brent Egan; Mark Vander Weg; Elizabeth Chrischilles; Thomas Vaughn Journal: Circ Cardiovasc Qual Outcomes Date: 2015-03-24
Authors: Ana H Traylor; Julie A Schmittdiel; Connie S Uratsu; Carol M Mangione; Usha Subramanian Journal: J Gen Intern Med Date: 2010-06-23 Impact factor: 5.128
Authors: Antoinette Schoenthaler; Enid Montague; Linda Baier Manwell; Roger Brown; Mark D Schwartz; Mark Linzer Journal: Ethn Health Date: 2013-11-22 Impact factor: 2.772
Authors: Ronald G Victor; Ciantel A Blyler; Ning Li; Kathleen Lynch; Norma B Moy; Mohamad Rashid; L Cindy Chang; Joel Handler; Jeffrey Brettler; Florian Rader; Robert M Elashoff Journal: Circulation Date: 2019-01-02 Impact factor: 29.690
Authors: Judy Huei-Yu Wang; Inez F Adams; Rena J Pasick; Scarlett L Gomez; Laura Allen; Grace X Ma; Michael X Lee; Ellen Huang Journal: Support Care Cancer Date: 2013-08-01 Impact factor: 3.359