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According to Beach, racial inequities in health status persist, in part, because of a failure in communication and lack of trust between the physician and the patient - it is a bigger problem than the ability to speak the same language and extends into perceptions of cultural differences, where the patient can feel underappreciated or misunderstood by physicians or nurses.

"We know, for example, that over a broad range of medical conditions and clinical settings, the diagnostic tests performed, and the quality of diagnosis made and treatment options offered are lower for black Americans and other minorities than they are for whites," she says. "All health professionals have a duty to provide good care to patients so that they feel good about their relationship, trust the medical advice provided and want to show up for their next appointment."

In a related study, published in the journal Medical Care in April, the Hopkins team found that cultural competency training significantly improved health care providers' knowledge of patients' different cultures and also improved patients' satisfaction with their physician. However, insufficient evidence was found to prove that training improved how patients took their medicines or followed their physician's advice, or that training improved the health status of patients or saved money.

The researchers reviewed the findings from 34 studies on cultural competency, grading the research for methodology and quality of evidence. The studies were culled from more than 4,000 on the subject of cultural competency produced since 1980, when data first became available. Only the studies with the most rigorous results, ranked first by quality of evidence - with results measured both before and after training - were included in the final analysis.

More than half, 19 of 34, confirmed that knowledge improved. Fourteen studies evaluated patient attitudes and found that trai
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Contact: David March
dmarch1@jhmi.edu
410-955-1534
Johns Hopkins Medical Institutions
25-May-2005