PURPOSEWe investigated whether clinicians' explicit and implicit ethnic/racial bias is related to black and Latino patients' perceptions of their care in established clinical relationships. METHODSWe administered a telephone survey to 2,908 patients, stratifi ed by ethnicity/race, and randomly selected from the patient panels of 134 clinicians who had previously completed tests of explicit and implicit ethnic/racial bias. Patients completed the Primary Care Assessment Survey, which addressed their clinicians' interpersonal treatment, communication, trust, and contextual knowledge. We created a composite measure of patient-centered care from the 4 subscales.RESULTS Levels of explicit bias were low among clinicians and unrelated to patients' perceptions. Levels of implicit bias varied among clinicians, and those with greater implicit bias were rated lower in patient-centered care by their black patients as compared with a reference group of white patients (P = .04). Latino patients gave the clinicians lower ratings than did other groups (P <.0001), and this did not depend on the clinicians' implicit bias (P = .98).CONCLUSIONS This is among the fi rst studies to investigate clinicians' implicit bias and communication processes in ongoing clinical relationships. Our fi ndings suggest that clinicians' implicit bias may jeopardize their clinical relationships with black patients, which could have negative effects on other care processes. As such, this fi nding supports the Institute of Medicine's suggestion that clinician bias may contribute to health disparities. Latinos' overall greater concerns about their clinicians appear to be based on aspects of care other than clinician bias. Ann Fam Med 2013;11:43-52. doi:10.1370/afm.1442. INTRODUCTIONP rimary care clinicians serve as the cornerstone of the health care system and are required to possess many skills. Patient-centeredness is 1 of 6 key dimensions of high-quality health care, 1 and if clinicians are to provide such care, they must be able to engage patients in a collaborative partnership.The importance of the clinician-patient relationship is underscored by demonstrated links between the quality of the relationship and a number of processes and outcomes of care, including patients' adherence to medical advice, [2][3][4][5][6] decision to remain with a clinician, 7 satisfaction with care, 3 and clinical outcomes of care. 3,8,9 Ethnic/racial minorities appear to be at a disadvantage in this aspect of health care. [10][11][12][13][14][15][16][17] In addition to cultural and language barriers, there have been long-standing concerns that clinician bias may contribute to lowerquality clinical relationships. 44 CL INICIA NS' BIA S PR EDIC T S C A R E PERCEP T IONSBut also, "[there is] strong but circumstantial evidence for the role of bias, stereotyping, prejudice, and clinical uncertainty" in the genesis of health disparities. The observation that clinicians are unlikely to directly express ethnic/racial bias yet may still deliver care that is infl uenced by...

A strong and statistically significant association between antidepressant use and diabetes risk in the PLB and ILS arms was not accounted for by measured confounders or mediators. If future research finds that antidepressant use independently predicts diabetes risk, efforts to minimize the negative effects of antidepressant agents on glycemic control should be pursued.

Clinicians expressed concerns about competing priorities and the need for organizational leadership involvement for successful SBIRT implementation. A unique suggestion for successful implementation is to utilize existing primary care clinic-based psychologists to conduct brief intervention and facilitate referral to treatment. Patient stakeholders supported universal screening, but cultural differences in opinions and current experience were noted, indicating the importance of including this perspective when evaluating implementation potential.

Objectives This study assessed implicit and explicit bias against both Latinos and African Americans, among experienced primary care providers (PCPs) and community members (CMs) in the same geographic area. Methods 210 PCPs and 190 CMs from three health care organizations in the Denver metro area completed Implicit Association Tests and self-report measures of implicit and explicit bias, respectively. Results With a 60% participation rate, the PCPs demonstrated substantial implicit bias against both Latinos and African Americans, but this was no different from CMs. Explicit bias was largely absent in both groups. Adjustment for background characteristics showed the PCPs to have slightly weaker ethnic/racial bias than CMs. Conclusions This research provides the first evidence of implicit bias against Latinos in health care, as well as confirming prior findings of implicit bias against African Americans. The lack of substantive differences in bias between the experienced PCPs and CMs suggests a wider societal problem. At the same time, the wide range of implicit bias suggests that bias in healthcare is neither uniform nor inevitable, and important lessons may be learned from providers who do not exhibit bias.

Based on limited published data, improvements in renal dosing guideline compliance are needed in all settings where data are available. Research is needed to further assess the appropriateness of renal dosing in ambulatory settings and inform quality improvement efforts in all settings.