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07-09-2011 | Legal medicine | Article

Large difference in healthcare reported by UK ethnic minorities

Abstract

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MedWire News: Minority ethnic groups in the UK report significant differences in their primary care experiences, despite living in a country with universal healthcare provision, report researchers.

Data from over 2 million respondents to the 2009 English General Practice Patient Survey show that South Asian and Chinese patients, as well as young patients and those in poor health reported a less positive primary care experience than their counterparts who were White, older, and in better health.

"Our findings have clear policy implications," write Georgios Lyratzopoulos (University of Cambridge, UK) and colleagues in the BMJ Quality and Safety.

"Providers could seek to mitigate potential ethnic inequalities by introducing measures such as access to translation or interpreting services for non-native speaker patients, and interventions to increase the cultural competency of healthcare professionals," they add.

The team examined associations between patient characteristics and measures of patient-reported experiences with primary care including healthcare professional communication, access to care, continuity of care, and overall satisfaction with care.

Responses took the form of yes/no answers and ratings on a 0-100-point Likert scale, and a total of 2,163,456 patients from 8267 UK general practices were included in analysis.

The researchers report that for all measures of patient experience, there were significant differences in mean scores of patients with different ages, health statuses, and ethnicities. In contrast, gender, area deprivation, and presence of longstanding psychological or emotional conditions had small and inconsistent effects on patient experience.

Specifically, Bangladeshi, Pakistani, Indian, and Chinese patients reported physician-communication experiences that were -9, -7, -6, and -8 percentile points less (more negative) than White respondents, respectively.

The concentration of ethnic minorities living in areas with overall low-scoring healthcare practices accounted for 50% of the difference in experience for South Asian, and 14% of the difference for Chinese patients compared with their White counterparts.

However, even after adjusting for this effect, the within-practice differences for these two nationalities in areas of low-scoring practices remained large.

Despite this, the variation in experience by practice was great, with some South Asian and Chinese patients reporting more positive experiences than White patients cared for by the same practice, with -13 to +4 and -18 to +1 percentile-point differences, respectively, note Lyratzopoulos et al.

Age-related differences were consistent across practices, they observe, with more positive responses received as patients increased in age, with the exception of the oldest group (85 years and older) who reported worse experiences than their slightly younger (75-84 years) peers.

Similarly, patients with poorer self-reported health had worse experiences than their more well counterparts with a typical, -10 percentile-point difference between patients reporting "poor" and "excellent" health. The within-practice difference among these two groups of patients was -12 to 0 percentile points.

Lyratzopoulos and co-authors suggest that overall improvement of low-performing practices as well as ethnic-specific improvements per practice would improve minority ethnic patient experiences, with those practices providing uniformly positive experiences to all patient groups acting as possible "models for quality improvement."

By Sarah Guy

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