, Volume 24, Issue 11, pp 1183-1191
Date: 25 Aug 2009

Influence of Patient Race on Physician Prescribing Decisions: A Randomized On-Line Experiment

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

ABSTRACT

BACKGROUND

Prior research reports black patients have lower medication use for hypercholesterolemia, hypertension, and diabetes.

OBJECTIVE

To assess whether patient race influences physicians’ prescribing.

DESIGN

Web-based survey including three clinical vignettes (hypercholesterolemia, hypertension, diabetes), with patient race (black, white) randomized across vignettes.

SUBJECTS

A total of 716 respondents from 5,141 eligible sampled primary care physicians (14% response rate).

INTERVENTIONS

None

MEASUREMENTS

Medication recommendation (any medication vs none, on-patent branded vs generic, and therapeutic class) and physicians’ treatment adherence forecast (10-point Likert scale, 1—definitely not adhere, 10—definitely adhere).

RESULTS

Respondents randomized to view black patients (n = 371) and white patients (n = 345) recommend any medications at comparable rates for hypercholesterolemia (100.0% white vs 99.5% black, P = 0.50), hypertension (99.7% white vs 99.5% black, P = 1.00), and diabetes (99.7% white vs 99.7% black, P = 1.00). Patient race influenced medication class chosen in the hypertension vignette; respondents randomized to view black patients recommended calcium channel blockers more often (20.8% black vs 3.2% white) and angiotensin-converting enzyme inhibitors less often (47.4% black vs 62.6% white) (P < 0.001). Patient race did not influence medication class for hypercholesterolemia or diabetes. Respondents randomized to view black patients reported lower forecasted patient adherence for hypertension (P < 0.001, mean: 7.3 black vs 7.7 white) and diabetes (P = 0.05 mean: 7.4 black vs 7.6 white), but race had no meaningful influence on forecasted adherence for hypercholesterolemia (P = 0.15, mean: 7.2 black vs 7.3 white).

CONCLUSION

Racial differences in outpatient prescribing patterns for hypertension, hypercholesterolemia, and diabetes are likely attributable to factors other than prescribing decisions based on patient race.