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BMJ. 2009 Sep 16;339:b3450. doi: 10.1136/bmj.b3450.

Understanding why some ethnic minority patients evaluate medical care more negatively than white patients: a cross sectional analysis of a routine patient survey in English general practices.

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  • 1NIHR School for Primary Care, University of Manchester, Manchester M13 9PL.



To examine why patients from ethnic minorities give poorer evaluations of primary health care than white patients.


Cross sectional analysis of patient surveys collected in general practice.


1098 English general practices that undertook a routine survey of patients using the General Practice Assessment Questionnaire between April 2005 and March 2006.


188,572 survey respondents, 95.8% of whom identified themselves as "white," "black/black British," "Asian/Asian British," or "Chinese." Analyses were restricted to between 133,441 (71%) and 147,686 (78%) respondents with complete data on relevant variables.


Patient evaluations of waiting times for general practitioner appointments, time spent waiting in surgeries for consultations to start, and continuity of care.


All aspects of care were rated substantially lower by respondents from the three ethnic minority groups than by white patients. Poorer evaluations of time spent waiting for consultations to begin (rated lowest by Asian patients) and continuity of care (rated lowest by Chinese patients) appeared to reflect worse reported experiences by ethnic minority groups. Substantial differences between white and ethnic minority patients' ratings of appointment waiting times persisted, however, even after adjusting for the actual time patients reported waiting. This effect disappeared for Chinese and black respondents after adjusting for evaluations of reception staff and doctors' communication skills, but Asian patients' ratings remained considerably lower than those of white respondents.


Important differences in assessments of care exist in different ethnic minority groups. Some negative evaluations may reflect communication issues. Among Asian patients, lower ratings of waiting times for appointments may also reflect different expectations of care. Adjusting survey results for ethnicity may be justified when comparing healthcare providers; however, health services also have a responsibility to meet legitimate patient expectations.

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