Influence of Patient Race on Physician Prescribing Decisions: A Randomized On-Line Experiment
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Prior research reports black patients have lower medication use for hypercholesterolemia, hypertension, and diabetes.
To assess whether patient race influences physicians’ prescribing.
Web-based survey including three clinical vignettes (hypercholesterolemia, hypertension, diabetes), with patient race (black, white) randomized across vignettes.
A total of 716 respondents from 5,141 eligible sampled primary care physicians (14% response rate).
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).
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).
Racial differences in outpatient prescribing patterns for hypertension, hypercholesterolemia, and diabetes are likely attributable to factors other than prescribing decisions based on patient race.
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- Influence of Patient Race on Physician Prescribing Decisions: A Randomized On-Line Experiment
Journal of General Internal Medicine
Volume 24, Issue 11 , pp 1183-1191
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- patient race
- prescription medication
- Industry Sectors
- Author Affiliations
- 1. MD/PhD Program, SHM IE-61, Yale University School of Medicine, PO Box 208025, New Haven, CT, 06520-8025, USA
- 2. W.P. Carey School of Business, Arizona State University, Tempe, AZ, USA
- 3. Center for Health and Social Sciences, University of Chicago, Chicago, IL, USA
- 4. General Internal Medicine Section, Department of Medicine, University of Chicago, Chicago, IL, USA
- 5. MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL, USA
- 6. Department of Pharmacy Practice, University of Illinois at Chicago School of Pharmacy, Chicago, IL, USA
- 7. Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA
- 8. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA