Journal of General Internal Medicine

, Volume 23, Issue 5, pp 678–684

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

Summary

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.

KEY WORDS

racial disparities quality of care quality improvement diabetes 

References

  1. 1.
    Virnig BA, Lurie N, Huang Z, Musgrave D, McBean AM, Dowd B. Racial variation in quality of care among Medicare+Choice enrollees. Health Aff. 2002;21:224–30.CrossRefGoogle Scholar
  2. 2.
    Agency for Healthcare Research Quality. National Healthcare Disparities Report. http://www.ahrq.gov/qual/nhdr06/nhdr06.htm. Accessed January 6, 2008.
  3. 3.
    Trivedi AN, Zaslavsky AM, Schneider EC, Ayanian JZ. Trends in the quality of care and racial disparities in Medicare managed care. N Engl J Med. 2005;353:692–700.PubMedCrossRefGoogle Scholar
  4. 4.
    Harris MI, Eastman RC, Cowie CC, Flegal KM, Eberhardt MS. Racial and ethnic differences in glycemic control of adults with type 2 diabetes. Diabetes Care. 1999;22:403–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Kirk JK, D’Agostino RB Jr, Bell RA, et al. Disparities in HbA1c levels between African-American and non-Hispanic white adults with diabetes: a meta-analysis. Diabetes Care. 2006;29:2130–6.PubMedCrossRefGoogle Scholar
  6. 6.
    McBean AM, Huang Z, Virnig BA, Lurie N, Musgrave D. Racial variation in the control of diabetes among elderly medicare managed care beneficiaries. Diabetes Care. 2003;26:3250–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Sequist TD, Adams A, Zhang F, Ross-Degnan D, Ayanian JZ. Effect of quality improvement on racial disparities in diabetes care. Arch Intern Med. 2006;166:675–81.PubMedCrossRefGoogle Scholar
  8. 8.
    Brown AF, Gregg EW, Stevens MR, et al. Race, ethnicity, socioeconomic position, and quality of care for adults with diabetes enrolled in managed care: the Translating Research Into Action for Diabetes (TRIAD) study. Diabetes Care. 2005;28:2864–70.PubMedCrossRefGoogle Scholar
  9. 9.
    Harris MI, Klein R, Cowie CC, Rowland M, Byrd-Holt DD. Is the risk of diabetic retinopathy greater in non-Hispanic blacks and Mexican Americans than in non-Hispanic whites with type 2 diabetes? A U.S. population study. Diabetes Care. 1998;21:1230–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Gornick ME, Eggers PW, Reilly TW, et al. Effects of race and income on mortality and use of services among Medicare beneficiaries. N Engl J Med. 1996;335:791–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Young BA, Maynard C, Reiber G, Boyko EJ. Effects of ethnicity and nephropathy on lower-extremity amputation risk among diabetic veterans. Diabetes Care. 2003;26:495–501.PubMedCrossRefGoogle Scholar
  12. 12.
    Young BA, Maynard C, Boyko EJ. Racial differences in diabetic nephropathy, cardiovascular disease, and mortality in a national population of veterans. Diabetes Care. 2003;26:2392–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Indian Health Service. Trends in Indian Health. Rockville, MD: Indian Health Service, Department of Health and Human Services; 1999.Google Scholar
  14. 14.
    Lanting LC, Joung IM, Mackenbach JP, Lamberts SW, Bootsma AH. Ethnic differences in mortality, end-stage complications, and quality of care among diabetic patients: a review. Diabetes Care. 2005;28:2280–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Sequist TD, Cullen T, Ayanian JZ. Information technology as a tool to improve the quality of American Indian health care. Am J Public Health. 2005;95:2173–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Centers for Disease Control. Diabetes prevalence among American Indians and Alaska Natives and the overall population—United States, 1994–2002. Morb Mortal Wkly Rep. 2003;52:702–4.Google Scholar
  17. 17.
    USRDS. 2007 Annual Report, Atlas of End Stage Renal Disease in the United States. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases; 2007.Google Scholar
  18. 18.
    Institute of Medicine. Unequal Treatment. Confronting Rracial and Ethnic Disparities in Health Care. Washington, DC: National Academies; 2002.Google Scholar
  19. 19.
    Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340:618–26.PubMedCrossRefGoogle Scholar
  20. 20.
    Bach PB, Pham HH, Schrag D, Tate RC, Hargraves JL. Primary care physicians who treat blacks and whites. N Engl J Med. 2004;351:575–84.PubMedCrossRefGoogle Scholar
  21. 21.
    Lurie N, Fremont A, Jain AK, et al. Racial and ethnic disparities in care: the perspectives of cardiologists. Circulation. 2005;111:1264–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Taylor SL, Fremont A, Jain AK, et al. Racial and ethnic disparities in care: the perspectives of cardiovascular surgeons. Ann Thorac Surg. 2006;81:531–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Hasnain-Wynia R, Baker DW. Obtaining data on patient race, ethnicity, and primary language in health care organizations: current challenges and proposed solutions. Health Serv Res. 2006;41:1501–18.PubMedGoogle Scholar
  24. 24.
    Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002;288:1775–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Trivedi AN, Zaslavsky AM, Schneider EC, Ayanian JZ. Relationship between quality of care and racial disparities in Medicare health plans. JAMA. 2006;296:1998–2004.PubMedCrossRefGoogle Scholar
  26. 26.
    Horner RD, Salazar W, Geiger HJ, et al. Changing healthcare professionals’ behaviors to eliminate disparities in healthcare: What do we know? How might we proceed? Am J Manag Care. 2004;10:SP12–9.PubMedGoogle Scholar
  27. 27.
    Chin MH, Walters AE, Cook SC, Huang ES. Interventions to reduce racial and ethnic disparities in health care. Med Care Res Rev. 2007;64:7S–28S.PubMedCrossRefGoogle Scholar
  28. 28.
    Weinick RM, Caglia JM, Friedman E, Flaherty K. Measuring racial and ethnic health care disparities in Massachusetts. Health Aff. 2007;26:1293–302.CrossRefGoogle Scholar
  29. 29.
    Baker DW, Cameron KA, Feinglass J, et al. Patients’ attitudes toward health care providers collecting information about their race and ethnicity. J Gen Intern Med. 2005;20:895–900.PubMedCrossRefGoogle Scholar
  30. 30.
    Baker DW, Cameron KA, Feinglass J, et al. A system for rapidly and accurately collecting patients’ race and ethnicity. Am J Public Health. 2006;96:532–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Ayanian JZ, Cleary PD, Keogh JH, Noonan SJ, David-Kasdan JA, Epstein AM. Physicians’ beliefs about racial differences in referral for renal transplantation. Am J Kidney Dis. 2004;43:350–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Grant R, Adams AS, Trinacty CM, et al. Relationship between patient medication adherence and subsequent clinical inertia in type 2 diabetes glycemic management. Diabetes Care. 2007;30:807–12.PubMedCrossRefGoogle Scholar
  33. 33.
    Adams AS, Mah C, Soumerai SB, Zhang F, Barton MB, Ross-Degnan D. Barriers to self-monitoring of blood glucose among adults with diabetes in an HMO: a cross sectional study. BMC Health Serv Res. 2003;3:6.PubMedCrossRefGoogle Scholar
  34. 34.
    Massing MW, Foley KA, Carter-Edwards L, Sueta CA, Alexander CM, Simpson RJ Jr. Disparities in lipid management for African Americans and Caucasians with coronary artery disease: a national cross-sectional study. BMC Cardiovasc Disord. 2004;4:15.PubMedCrossRefGoogle Scholar
  35. 35.
    Beach MC, Price EG, Gary TL, et al. Cultural competence: a systematic review of health care provider educational interventions. Med Care. 2005;43:356–73.PubMedCrossRefGoogle Scholar
  36. 36.
    Betancourt JR, Green AR, Carrillo JE, Park ER. Cultural competence and health care disparities: key perspectives and trends. Health Aff. 2005;24:499–505.CrossRefGoogle Scholar
  37. 37.
    Blanchard J, Nayar S, Lurie N. Patient-provider and patient-staff racial concordance and perceptions of mistreatment in the health care setting. J Gen Intern Med. 2007;22:1184–9.PubMedCrossRefGoogle Scholar

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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