Can Non-medical Factors Contribute to Disparities in Coronary Heart Disease Treatments?

Abstract

Racial/ethnic and sex disparities in coronary heart disease treatment exist. We previously reported that physicians perceive non-clinical variables, such as a patient's desire for a second opinion, as affecting revascularization decisions. The results of that study are further examined here, using factor analysis to identify significant interrelationships among the non-clinical variables, which could contribute to disparities in coronary revascularization (i.e., percutaneous transluminal coronary angioplasty [PTCA] or coronary artery bypass graft [CABG]). Five content themes emerged using factor analysis; these are related to the patient's socioeconomic/lifestyle status, treatment preference, physician interaction, health-assertiveness, and aggressiveness. For the lifestyle theme, family physicians had higher mean scores (14.8) than internists, cardiologists, and cardiothoracic surgeons (13.7, 13.6, and 12.6, respectively; overall p=.001); women had higher mean scores than men (15.0 vs. 13.7; p=.009). This implies that family medicine and female physicians perceived variables pertaining to patients' socioeconomic status or lifestyle (e.g., financial barriers, unlikely to adopt healthy behaviors) as precluding some patients from being revascularized. Additionally, female, more than male, physicians (15.0 vs.13.6; p=.006) perceived health assertive patients (e.g., involved in treatment decisions, will quit smoking) as having easier access to the procedures. The results of the present analysis suggest that disparities in cardiac care arise from complex psychosocial interactions, which are influenced by characteristics of the physician as well as the patient.

Cardiovascular Disease Risk Among the Poor and Homeless – What We Know So Far

“…Disparities appear to be influenced by characteristics of the physician as well as the homeless patient [74]. …”

“…Major determinants, many of which apply to the homeless, include not only healthcare insurance access but language preference, patient health literacy, mistrust of providers with or without feelings of discrimination, medication non adherence, patient preferences, doubts about self-efficacy [74-81] and refusal, inability or delay in seeking and adhering to treatment. As a result of such factors, many homeless have a very high rate of sporadic and ineffective health care utilization, such as at emergency rooms or walk-in clinics where continuity of care and prevention are not the focus [82, 83].…”

Access to percutaneous transluminal coronary angioplasty and 30-day mortality in patients with incident STEMI: Differentials by educational level and gender over 11 years

“…Coronary risk factors, refusal to give consent for the intervention, misinterpretation of symptoms, and therefore delays in medical assistance, have been invoked as possible explanations of such differences [31, 32, 33]. The spread-out of revascularization procedures over time may have played a role in the reduction of such differentials.…”

CARDIAC PATIENTS’ CAUSAL ATTRIBUTIONS FOR CORONARY HEART DISEASE

“…Patient and system factors such as low health literacy, low education level, inaccessibility of information, cultural barriers (Hafizi, 2005) as well as the absence of national guidelines to address and guide patient-physician communications are some possible contributory factor to the limited awareness of personal risk factors among this population. Health professionals' limited skills in risk factor modification, understanding patients' perspectives on CHD risk and the challenge of engaging patients in risk reducing behaviours have been related to adverse CHD risk factor profile of patients (Barnhart et al, 2006). Nevertheless, there is compelling evidence for health providers to communicate risks to patients and assist them to gain a clear understanding of their individual risk factor burden (Davison et al, 1991;Wilcox and Stefanick, 1999;Brooks et al, 2000).…”