Primary-care clinician perceptions of racial disparities in diabetes care

Thomas D Sequist, John Z Ayanian, Richard Marshall, Garret M Fitzmaurice, Dana Gelb Safran
Journal of General Internal Medicine 2008, 23 (5): 678-84

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.

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