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Patient-Reported Racial/Ethnic Healthcare Provider Discrimination and Medication Intensification in the Diabetes Study of Northern California (DISTANCE)

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Abstract

Background

Racial/ethnic minority patients are more likely to report experiences with discrimination in the healthcare setting, potentially leading to reduced access to appropriate care; however, few studies evaluate reports of discrimination with objectively measured quality of care indicators.

Objective

To evaluate whether patient-reported racial/ethnic discrimination by healthcare providers was associated with evidence of poorer quality care measured by medication intensification.

Research Design and Participants

Baseline data from the Diabetes Study of Northern California (DISTANCE), a random, race-stratified sample from the Kaiser Permanente Diabetes Registry from 2005–2006, including both survey and medical record data.

Main Measures

Self-reported healthcare provider discrimination (from survey data) and medication intensification (from electronic prescription records) for poorly controlled diabetes patients (A1c ≥9.0%; systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg; low-density lipoprotein (LDL) ≥130 mg/dl).

Key Results

Of 10,409 eligible patients, 21% had hyperglycemia, 14% had hyperlipidemia, and 32% had hypertension. Of those with hyperglycemia, 59% had their medications intensified, along with 40% with hyperlipidemia, 33% with hypertension, and 47% in poor control of any risk factor. In adjusted log-binomial GEE models, discrimination was not associated with medication intensification [RR = 0.96 (95% CI: 0.74, 1.24) for hyperglycemia, RR = 1.23 (95% CI: 0.93, 1.63) for hyperlipidemia, RR = 1.06 (95% CI: 0.69, 1.61) for hypertension, and RR = 1.08 (95% CI: 0.88, 1.33) for the composite cohort].

Conclusions

We found no evidence that patient–reported healthcare discrimination was associated with less medication intensification. While not associated with this technical aspect of care, discrimination could still be associated with other aspects of care (e.g., patient-centeredness, communication).

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Acknowledgements

This project was supported by a National Research Service Award, grant number HS013853 from AHRQ, and funds were provided by NIDDK R01 DK65664, NICHD R01 HD46113, and NIDDK R01 DK080726. None of the authors had conflicts of interest, and the funders had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. All authors contributed to the conception and design, and drafting and critical revision of the manuscript, including final approval of the version to be published.

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA

    Courtney R. Lyles PhD, Clarence Spigner DrPH & David Grembowski PhD

  2. Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA

    Andrew J. Karter PhD

  3. VA Puget Sound Health Care System, Seattle, WA, USA

    Bessie A. Young MD, MPH

  4. UCSF, Center for Health and Community, San Francisco, CA, USA

    Nancy Adler PhD

  5. UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA, USA

    Dean Schillinger MD

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  1. Courtney R. Lyles PhD
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Correspondence to Courtney R. Lyles PhD.

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Lyles, C.R., Karter, A.J., Young, B.A. et al. Patient-Reported Racial/Ethnic Healthcare Provider Discrimination and Medication Intensification in the Diabetes Study of Northern California (DISTANCE). J GEN INTERN MED 26, 1138–1144 (2011). https://doi.org/10.1007/s11606-011-1729-2

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  • DOI: https://doi.org/10.1007/s11606-011-1729-2

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