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

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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.

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Acknowledgments

Harris Interactive implemented the survey and participated in its design. Survey costs and the authors’ time were funded by Pfizer Inc. The authors performed this analysis independently of the funder and retained full control of all aspects of the analysis, including survey design, data analysis and interpretation, preparation of the manuscript, and submission decisions.

Dr. Alexander has career development awards from the Agency for Healthcare Research and Quality (K08 HS15699-01A1) and the Robert Wood Johnson Physician Faculty Scholars Program.

The funding sources had no role in the design and conduct of the study, analysis or interpretation of the data; and preparation or final approval of the manuscript prior to publication.

The authors have no conflicts of interest to report.

Author information

Authors and Affiliations

  1. MD/PhD Program, SHM IE-61, Yale University School of Medicine, PO Box 208025, New Haven, CT, 06520-8025, USA

    Saif S. Rathore MPH

  2. W.P. Carey School of Business, Arizona State University, Tempe, AZ, USA

    Jonathan D. Ketcham PhD

  3. Center for Health and Social Sciences, University of Chicago, Chicago, IL, USA

    G. Caleb Alexander MD, MS

  4. General Internal Medicine Section, Department of Medicine, University of Chicago, Chicago, IL, USA

    G. Caleb Alexander MD, MS

  5. MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL, USA

    G. Caleb Alexander MD, MS

  6. Department of Pharmacy Practice, University of Illinois at Chicago School of Pharmacy, Chicago, IL, USA

    G. Caleb Alexander MD, MS

  7. Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA

    Andrew J. Epstein PhD MPP

  8. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA

    Andrew J. Epstein PhD MPP

Authors
  1. Saif S. Rathore MPH
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  2. Jonathan D. Ketcham PhD
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  3. G. Caleb Alexander MD, MS
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  4. Andrew J. Epstein PhD MPP
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Corresponding author

Correspondence to Saif S. Rathore MPH.

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Rathore, S.S., Ketcham, J.D., Alexander, G.C. et al. Influence of Patient Race on Physician Prescribing Decisions: A Randomized On-Line Experiment. J GEN INTERN MED 24, 1183–1191 (2009). https://doi.org/10.1007/s11606-009-1077-7

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  • DOI: https://doi.org/10.1007/s11606-009-1077-7

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