Racial and ethnic disparities in care - The perspectives of cardiologists

Duke University, Durham, North Carolina, United States
Circulation (Impact Factor: 14.43). 04/2005; 111(10):1264-9. DOI: 10.1161/01.CIR.0000157738.12783.71
Source: PubMed


Despite extensive documentation of racial and ethnic disparities in care, provider awareness of disparities has been thought to be low. To be effective, educational efforts for physicians must consider providers' knowledge and beliefs about what causes disparities and what can be done about them.
We conducted a Web-based survey of 344 cardiologists to determine their level of awareness of disparities and views of underlying causes. Responses were assessed by means of 5-point Likert scales. Thirty-four percent of cardiologists agreed that disparities existed in care overall in the US healthcare system, and 33% agreed that disparities existed in cardiovascular care. Only 12% felt disparities existed in their own hospital setting, and even fewer, 5%, thought disparities existed in the care of their own patients. Despite this, most respondents rated the strength of the evidence about disparities as "very strong" or "strong." Respondents identified many potential causes for disparities in care but were more likely to endorse patient and system level factors (eg, insurance status or adherence) rather than provider level factors.
Cardiologists' awareness of disparities in care remains low, and awareness is inversely proportional to proximity to their own practice setting.

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    • "Decreasing health disparities must be a significant goal at the patient, provider, and systems levels.2 Although additional research is needed to fully understand the differences in CVD risk, prevention, and treatment to improve outcomes throughout our increasingly diversified population, greater awareness on the parts of practicing physicians is essential. "
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    ABSTRACT: This is a comprehensive narrative review of the literature on the current science and evidence of population-level differences in risk factors for heart disease among different racial and ethnic population in the US. It begins by discussing the importance of population-level risk assessment of heart disease in light of the growth rate of specific minority populations in the US. It describes the population-level dynamics for racial and ethnic minorities: a higher overall prevalence of risk factors for coronary artery disease that are unrecognized and therefore not treated, which increases their likelihood of experiencing adverse outcomes and, therefore, potentially higher morbidity and mortality. It discusses the rate of acute coronary syndrome (ACS) in minority communities. Minority patients with ACS are at greater risk of myocardial infarction, rehospitalization, and death from ACS. They also are less likely than nonminority patients to receive potentially beneficial treatments such as angiography or percutaneous coronary intervention. This paper looks at the data surrounding the increased rate of congestive heart failure in racial and ethnic minorities, where the risk is related to the prevalence of comorbidities with hypertension or diabetes mellitus, which, in combination with environmental factors, may largely explain congestive heart failure disparity. The conclusion is it is essential that health care providers understand these various communities, including nuances in disease presentation, risk factors, and treatment among different racial and ethnic groups. Awareness of these communities' attributes as well as differences in incidence, risk factor burdens, prognosis, and treatment are necessary to mitigate racial and ethnic disparities in heart disease.
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    • "Similarly, cardiovascular surgeons reported that patient factors, such as adherence to treatment and attitudes toward providers, contributed more to health disparities than system or provider factors (Taylor et al., 2006). Even cardiologists who agreed that minority patients receive dissimilar diagnoses and procedures still identified patient behaviors as equal or stronger contributors to disparities than provider or system factors (Lurie et al., 2005). The responses of medical students, however, were inconsistent with those of the physicians in the studies described above. "
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    ABSTRACT: To determine whether Black and White nurses' beliefs about causes of health disparities differ. Analyses reveal that overall Black nurses perceived external factors to contribute significantly more to health disparities than White nurses. Black nurses considered four specific causes dealing with physician and societal factors, such as "discrimination in society," to be more significant contributors to health disparities than White nurses, whereas White nurses considered genetic factors to be a greater contributor. Different views of the causes of health disparities are discussed, particularly in light of cultural competency training and other efforts to ameliorate health disparities.
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    • "In response to 2003 IOM report on " Unequal Treatment " , many physicians argued that overt racism is relatively rare among people who choose a career in health care (e.g., Epstein, 2005). However, it seems that the potential role of implicit bias is largely unrecognized among providers (Lurie et al., 2005). Thus, as Burgess, van Ryn, Dovidio, and Saha (2007) suggested, interventions directed at physicians may be especially productive if they address the subtle, often unintentional, nature of racial bias. "
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    ABSTRACT: Medical interactions between Black patients and nonBlack physicians are usually less positive and productive than same-race interactions. We investigated the role that physician explicit and implicit biases play in shaping physician and patient reactions in racially discordant medical interactions. We hypothesized that whereas physicians' explicit bias would predict their own reactions, physicians' implicit bias, in combination with physician explicit (self-reported) bias, would predict patients' reactions. Specifically, we predicted that patients would react most negatively when their physician fit the profile of an aversive racist (i.e., low explicit-high implicit bias). The hypothesis about the effects of explicit bias on physicians' reactions was partially supported. The aversive racism hypothesis received support. Black patients had less positive reactions to medical interactions with physicians relatively low in explicit but relatively high in implicit bias than to interactions with physicians who were either (a) low in both explicit and implicit bias, or (b) high in both explicit and implicit bias.
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