Primary-care clinician perceptions of racial disparities in diabetes care

Abstract

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.

Figure 1

Proportion of primary-care clinicians responding that quality of diabetes care differs by race and ethnicity among clinically similar patients. Data were missing for small numbers of those who did not respond to the questions regarding the U.S. health system (n = 8), all HVMA health centers (n = 15), the local health center (n = 8), and patients personally treated (n = 7).

Figure 2

Proportion of primary-care clinicians indicating that patient, physician, and health systems factors contribute a “great deal” to racial and ethnic differences in the quality of diabetes care. Responses are among the 80 clinicians who reported the presence of racial and ethnic disparities in diabetes care within Harvard Vanguard Medical Associates, defined as differences in achieving control of HbA1c, LDL cholesterol, and blood pressure.

Figure 3

Proportion of primary-care clinicians reporting the effectiveness of various strategies to reduce racial and ethnic differences in the quality of diabetes care. Non-Targeted QI refers to quality improvement with no specific focus on providing care for minority patients. Clinician Awareness refers to increasing recognition of the importance of race in diabetes care among clinicians, and Cultural Competence refers to increasing the cultural competency of clinicians.