(50) Medical Mistrust and Care Expectations Among Black Patients Seeking Addiction Treatment

Background:

Black patients seeking addiction treatment in the United States experience health related disparities including delayed presentation to treatment, reduced access to treatment, unequal retention in treatment, and poorer post-treatment outcomes when compared to White patients. Black patients also have higher rates of group-based medical mistrust when compared to White patients, which has been associated with poorer health outcomes including reduced healthcare utilization, less treatment adherence, and poorer physical and mental health. Additionally, group-based medical mistrust is also associated with increased experiences of racial discrimination across multiple healthcare contexts. The relationship between group-based medical mistrust and expectations for addiction treatment in Black patients remains unexamined.

Methods:

A total of 143 self-identified Black, African-American, or Multiracial participants were recruited from two treatment centers in Columbus, Ohio. Participants completed the Group Based Medical Mistrust Scale (GBMMS), answered questions related to expectations of addiction medicine care in the face of discrimination, and were asked whether they had personally experienced racial discrimination within healthcare. Descriptive analysis and Spearman’s rho correlations were performed to assess for relationships between group-based medical mistrust, experiences of discrimination, and expectations of care.

Results:

Group-based medical mistrust in Black patients was associated with self-reported delay in accessing addiction treatment, anticipation of racial discrimination during addiction treatment, non-adherence to addiction treatment, and discrimination-precipitated relapse. However, non-adherence to treatment was the least strongly correlated with group-based medical mistrust demonstrating an opportunity for engagement. Personal experiences of healthcare discrimination were also associated with expectations of addiction medicine care, as well as higher rates of group-based medical mistrust.

Specifically, delayed care seeking was moderately associated with total GBMMS and subscales measuring perceived lack of support by healthcare workers, suspicion towards healthcare and medicine, and awareness of group-based health disparities. Anticipation of discrimination during addiction treatment was strongly associated with prior experiences of discrimination within healthcare and moderately associated with total GBMMS, lack of support, suspicion, and disparities subscales. Concern for discrimination-precipitated relapse was moderately correlated with total GBMMS, suspicion, and personal history of racial discrimination by healthcare workers. Treatment non-adherence was moderately associated with lack of support subscale and prior experiences of discrimination within healthcare, but only weakly associated with total GBMMS, suspicion, and disparities subscales.

Conclusion:

Group-based medical mistrust is associated with negative care expectations of Black patients seeking addiction treatment. Ultimately, the GBMMS can be utilized by providers to increase understanding of how structural and interpersonal racism stand as important barriers to addiction treatment for Black patients, and by addressing these obstacles providers can offer more equitable care.

References:

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Hall, O.T., Jordan, A., Teater, J., Dixon-Shambley, K., McKiever, M.E., Baek, M., Garcia, S., Rood, K.M., Fielin, D.A., 2021. Experiences of racial discrimination in the medical setting and associations with medical mistrust and expectations of care among black patients seeking addiction treatment. J Subst Abuse Treat, 108551.

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