Exploring Discrimination and Other Potential Predictors of Patient Satisfaction among African Americans in the Deep South

Objectives: Patient satisfaction, often regarded as a quality of care measure, mirrors the preferences of patients and the care patients receive. Studies have linked patient satisfaction with better compliance and termination of patient-provider relationships. Few studies have examined the factors that contribute to patient satisfaction among vulnerable populations; additionally we do not understand how race-based discrimination is related to patient satisfaction. Methods: Data were obtained from the Alabama Collaboration for Cardiovascular Equality, 2007-2008. The dependent variable was self-reported general patient satisfaction (Patient Satisfaction Questionnaire III-Short-form). The patient satisfaction scale ranges from 1 to 5, and was used as a continuous variable. The main independent variable was discrimination based on race (Krieger Experience of Discrimination scale), other independent variables included self-reported trust (Hall General Trust Scale), comorbidities (Medical Outcomes Student), income and education. Associations were quantified using ordinal logistic regression. Results: Our sample consisted of 229 males and 558 females, with an average satisfaction score of 3.58 and an average age of 53.7 +/- 9.8 years. Adjusted analysis indicated trust (OR: 1.16, p-value: <0.001), attending college (OR: 1.21, p: 0.037) and fewer comorbidities (OR: 1.16, p-value: <0.001) predicted greater satisfaction. While discrimination (OR: 0.972, p-value: 0.026) was associated with lower satisfaction. Conclusion: Among our cohort of African Americans receiving care at a safety-net clinic in Birmingham, Alabama we found greater trust, greater educational attainment, and fewer comorbidities predicted patient satisfaction. Discrimination was found to erode patient trust and satisfaction. Our findings highlight the importance of the negative and lasting effects of experiencing discrimination.