Primary-care Clinician Perceptions of Racial Disparities in Diabetes Care

Abstract

BACKGROUND: Primary-care clinicians can play an important role in reducing racial disparities in diabetes care. OBJECTIVE:The objective of the study is to determine the views of primary-care clinicians regarding racial disparities in diabetes care. DESIGN:The design of the study is through a survey of primary-care clinicians (response rate=86%). PARTICIPANTS:The participants of the study were 115 physicians and 54 nurse practitioners and physician assistants within a multisite group practice in 2007. MEASUREMENTS AND MAIN RESULTS:We identified sociodemographic characteristics of each clinician's diabetic patient panel. We fit multivariable logistic regression models to identify predictors of supporting the collection of data on patients' race and acknowledging the existence of racial disparities among patients personally treated. Among respondents, 79% supported the collection of data on patients' race. Whereas 88% acknowledged the existence of racial disparities in diabetes care within the U.S. health system, only 40% reported their presence among patients personally treated. Clinicians caring for greater than or equal to 50% minority patients were more likely to support collection of patient race data (adjusted odds ratio [OR] 9.0; 95% confidence interval [CI] 1.2-65.0) and report the presence of racial disparities within their patient panel (adjusted OR 12.0; 95% CI 2.5-57.7). Clinicians were more likely to perceive patient factors than physician or health system factors as mediators of racial disparities; however, most supported interventions such as increasing clinician awareness (84%) and cultural competency training (88%). CONCLUSIONS:Most primary-care clinicians support the collection of data on patients' race, but increased awareness about racial disparities at the local level is needed as part of a targeted effort to improve health care for minority patients. INTRODUCTIONRacial disparities in the quality of diabetes care are persistent across all sectors of the U.S. health care system. Black patients with diabetes are less likely than white patients to receive appropriate hemoglobin A1c and lipid testing 1,2 and less likely to achieve treatment goals including glycemic, cholesterol, and blood pressure control. [3][4][5][6][7][8] Blacks also experience worse long-term diabetes-related outcomes than whites, including diabetic retinopathy, 9 lower extremity amputations, 2,10,11 and chronic kidney disease. 12 Hispanics and Native Americans have also been found to receive lower-quality diabetes care, with Native Americans experiencing disproportionately high rates of lower extremity amputations, chronic kidney disease, and diabetes-related mortality. 2,[13][14][15][16][17] The etiology of these racial disparities is multifactorial involving health system, provider, and patient factors, all within the context of broader social issues. 18 Physicians can play an important role in addressing racial disparities in care through their direct interface with patients and the health care system. For example, clinica...

The Future of Health Disparities Research: 2008 and Beyond

“…Sequist et al 4 recommend two strategies to expose health care providers to the issue of racial disparities in diabetes care, including provider feedback regarding disparities as well as cultural competency training to improve communication skills. However, recent data suggest that in the business world, mandatory cultural competency is not efficient, and if anything, potentially detrimental.…”

“…[2][3][4][5] In this editorial, we will attempt to synthesize the results of these studies and make recommendations on how to shape future research to reduce, but preferably to completely eliminate, healthcare disparities. These recommendations should be useful to clinicians, researchers, administrations, and policy makers.…”

“…Sequist et al 4 examined views of primary care clinicians regarding racial disparities in diabetes care. Using a large sample (115 physicians and 54 nurse practitioners and physician assistants) with an excellent response rate (86%), the investigators reported that 79% of respondents supported collection of data on patients' race.…”

Addressing Racial Healthcare Disparities: How Can We Shift the Focus from Patients to Providers?

“…17 This dominant framing of disparities is also consistent with the views of many providers, who believe that disparities are due mainly to patient factors rather than provider factors. [18][19][20] For example, in a study of primary care clinicians by Sequist et al published in JGIM in 2008, among the 52% who reported that racial disparities in the quality of diabetes care existed in their own health care system, less than 10% attributed these disparities to provider differences in prescribing medications and differences in referral to specialists and about 20% attributed disparities to providers' miscommunication with patients. By contrast, about 40% attributed disparities to patient preferences; 45% to patient attitudes and beliefs about the provider; and over 70% to patient health behaviors.…”

“…13,14 Indications that providers may be threatened by the existence of racial inequality are findings that, while a sizable percentage of providers do not believe that disparities exist, even fewer acknowledge the existence of disparities in their own practice. [18][19][20]23,24 For example, in a survey of cardiologists, 33%…”