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

• Published in: Journal of general internal medicine : JGIM 2011-10, Vol.26 (10), p.1138-1144
• Main Authors: Lyles, Courtney R., Karter, Andrew J., Young, Bessie A., Spigner, Clarence, Grembowski, David, Schillinger, Dean, Adler, Nancy
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; California - ethnology; Continental Population Groups - ethnology; Continental Population Groups - psychology; Data Collection - methods; Diabetes; Diabetes Mellitus - ethnology; Diabetes Mellitus - psychology; Diabetes Mellitus - therapy; Diabetes. Impaired glucose tolerance; Discrimination; Electronic Health Records - standards; Electronic Prescribing - standards; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Ethnic Groups - ethnology; Ethnic Groups - psychology; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; General aspects; Health care delivery; Health Personnel - psychology; Humans; Internal Medicine; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Original Research; Patient Satisfaction - ethnology; Patients; Prejudice; Quality of care; Quality of Health Care - standards
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-011-1729-2

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).