Journal of General Internal Medicine

, Volume 23, Issue 5, pp 678–684 | Cite as

Primary-care Clinician Perceptions of Racial Disparities in Diabetes Care

  • Thomas D. Sequist
  • John Z. Ayanian
  • Richard Marshall
  • Garret M. Fitzmaurice
  • Dana Gelb Safran
Original Article



Primary-care clinicians can play an important role in reducing racial disparities in diabetes care.


The objective of the study is to determine the views of primary-care clinicians regarding racial disparities in diabetes care.


The design of the study is through a survey of primary-care clinicians (response rate = 86%).


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%).


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.


racial disparities quality of care quality improvement diabetes 



This study was funded by the Robert Wood Johnson Foundation Finding Answers: Disparities Research for Change national program. The authors would like to thank Nicole Lurie, MD at RAND for her willingness to share the original survey instrument used to develop our survey, as well as Amy Marston at Harvard Vanguard Medical Associates for her efforts regarding project management.

Conflict of Interest

Dr. Sequist serves as a consultant on the Aetna External Advisory Committee for Racial and Ethnic Equality. Dr. Ayanian serves as a consultant to RTI International and DxCG.


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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Thomas D. Sequist
    • 1
    • 2
    • 3
  • John Z. Ayanian
    • 1
    • 3
  • Richard Marshall
    • 2
  • Garret M. Fitzmaurice
    • 1
  • Dana Gelb Safran
    • 4
    • 5
    • 6
  1. 1.Division of General Medicine and Primary CareBrigham and Women’s HospitalBostonUSA
  2. 2.Harvard Vanguard Medical AssociatesBostonUSA
  3. 3.Department of Health Care PolicyHarvard Medical SchoolBostonUSA
  4. 4.The Health Institute, Institute for Clinical Research and Health Policy StudiesTufts-New England Medical CenterBostonUSA
  5. 5.Department of MedicineTufts University School of MedicineBostonUSA
  6. 6.Blue Cross Blue Shield of MassachusettsBostonUSA

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