Browsing by Subject "Social Class"

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    Patient Race/Ethnicity and Patient-Physician Race/Ethnicity Concordance in the Management of Cardiovascular Disease Risk Factors for Patients With Diabetes
    (American Diabetes Association, 2010-03) Traylor, Ana H.; Subramanian, Usha; Uratsu, Connie S.; Mangione, Carol M.; Selby, Joe V.; Schmittdiel, Julie A.; Medicine, School of Medicine
    OBJECTIVE Patient-physician race/ethnicity concordance can improve care for minority patients. However, its effect on cardiovascular disease (CVD) care and prevention is unknown. We examined associations of patient race/ethnicity and patient-physician race/ethnicity concordance on CVD risk factor levels and appropriate modification of treatment in response to high risk factor values (treatment intensification) in a large cohort of diabetic patients. RESEARCH DESIGN AND METHODS The study population included 108,555 adult diabetic patients in Kaiser Permanente Northern California in 2005. Probit models assessed the effect of patient race/ethnicity on risk factor control and treatment intensification after adjusting for patient and physician-level characteristics. RESULTS African American patients were less likely than whites to have A1C <8.0% (64 vs. 69%, P < 0.0001), LDL cholesterol <100 mg/dl (40 vs. 47%, P < 0.0001), and systolic blood pressure (SBP) <140 mmHg (70 vs. 78%, P < 0.0001). Hispanic patients were less likely than whites to have A1C <8% (62 vs. 69%, P < 0.0001). African American patients were less likely than whites to have A1C treatment intensification (73 vs. 77%, P < 0.0001; odds ratio [OR] 0.8 [95% CI 0.7–0.9]) but more likely to receive treatment intensification for SBP (78 vs. 71%, P < 0.0001; 1.5 [1.3–1.7]). Hispanic patients were more likely to have LDL cholesterol treatment intensification (47 vs. 45%, P < 0.05; 1.1 [1.0–1.2]). Patient-physician race/ethnicity concordance was not significantly associated with risk factor control or treatment intensification. CONCLUSIONS Patient race/ethnicity is associated with risk factor control and treatment intensification, but patient-physician race/ethnicity concordance was not. Further research should investigate other potential drivers of disparities in CVD care.
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    A randomized controlled trial testing a virtual perspective-taking intervention to reduce race and socioeconomic status disparities in pain care
    (Wolters Kluwer, 2019-10-01) Hirsh, Adam T.; Miller, Megan M.; Hollingshead, Nicole A.; Anastas, Tracy; Carnell, Stephanie T.; Lok, Benjamin C.; Chu, Chenghao; Zhang, Ying; Robinson, Michael E.; Kroenke, Kurt; Ashburn-Nardo, Leslie; Psychology, School of Science
    We conducted a randomized controlled trial of an individually-tailored, virtual perspective-taking intervention to reduce race and socioeconomic (SES) disparities in providers’ pain treatment decisions. Physician residents and fellows (n=436) were recruited from across the United States for this two-part online study. Providers first completed a bias assessment task in which they made treatment decisions for virtual patients with chronic pain who varied by race (Black/White) and SES (low/high). Providers who demonstrated a treatment bias were randomized to the intervention or control group. The intervention consisted of personalized feedback about their bias, real-time dynamic interactions with virtual patients, and videos depicting how pain impacts the patients’ lives. Treatment bias was re-assessed one week later. Compared to the control group, providers who received the tailored intervention had 85% lower odds of demonstrating a treatment bias against Black patients and 76% lower odds of demonstrating a treatment bias against low SES patients at follow-up. Providers who received the intervention for racial bias also showed increased compassion for patients compared to providers in the control condition. Group differences did not emerge for provider comfort in treating patients. Results suggest an online intervention that is tailored to providers according to their individual treatment biases, delivers feedback about these biases, and provides opportunities for increased contact with Black and low SES patients, can produce substantial changes in providers’ treatment decisions, resulting in more equitable pain care. Future studies should examine how these effects translate to real-world patient care, and the optimal timing/dose of the intervention.