Black And White Diabetes Patients Being Treated Differently By Same Physicians

According to a study published in the Archives of Internal
Medicine, physicians are treating black
diabetes patients differently than white diabetes patients. Thomas D.
Sequist, M.D., M.P.H. (Harvard Vanguard Medical Associates, Boston) and
colleagues found that black patients are less likely to achieve
long-term control of their blood glucose, blood
cholesterol and blood pressure levels compared to their white
counterparts - even if the same physician is presiding over the
treatment.



In previous studies, researchers have noted differences among races in
the quality of diabetes treatment. For example, it is documented that
black
patients are not as likely as white patients to receive standard
diabetes tests, such as hemoglobin A1C testing
(HbA1C, measures blood glucose control over time) and lipid
testing. They are also less likely to achieve the
treatment goals of controlling levels of blood pressure, cholesterol
and
blood glucose. Further, when comparing rates of developing eye and
kidney diseases related to diabetes and rates of amputations of the
lower extremities due to diabetes, black patients fare worse than white
patients. Sequist and colleagues note that, "Identifying the
underlying reasons and potential solutions for these differences in
quality of care and outcomes is a high priority."



To further investigate the relationship between diabetes treatment and
race, Sequist and colleagues analyzed electronic medical
records
from 4,556 white patients and 2,258 black patients who were 18 years of
age or older and had seen a physician in the last two years. All of the
patients had diabetes,
and they were treated by 90 primary care physicians in eastern
Massachusetts who treated at least five black and five white patients.



The researchers found similar rates of testing for low-density
lipoprotein cholesterol (LDL, also known as "bad" cholesterol) and
HbA1C among black and white patients. There was a noted difference,
however, in the likelihoods of reaching the commonly accepted
benchmarks for controlling the important aforementioned levels. About
47% of white patients white patients and 39% of black patients achieved
control of HbA1C, 57% and 45%, respectively achieved control of LDL
cholesterol, and 30% and 24%, respectively, achieved control of blood
pressure.



Statistical models revealed that, "Patient sociodemographic factors
explained 13 percent to 38 percent of
the racial differences in these measures, whereas within-physician
effects accounted for 66 percent to 75 percent of the differences."
According to the authors, this indicates that, "Racial differences in
outcomes were not related
to black patients differentially receiving care from physicians who
provide a lower quality of care, but rather that black patients
experienced less ideal or even adequate outcomes than white patients
within the same physician panel."



"Our data suggest that the problem of racial disparities
is not characterized by only a few physicians providing markedly
unequal care, but that such differences in care are spread across the
entire system, requiring the implementation of system-wide solutions,"
conclude the authors. "Efforts to eliminate these disparities,
including
race-stratified performance reports and programs to enhance care for
minority patients, should be addressed to all physicians."



An accompanying editorial, written by Carolyn Clancy, M.D. (Agency for
Healthcare Research and Quality, Rockville, Md.), describes the
findings by Sequist and colleagues as "important" and "provocative".
She writes:



"They now have an opportunity to examine physicians' reactions and how
care changes when physicians are provided feedback on their
performance. Eliminating disparities in health
care will require that all patients have access to care, as well as
physician leadership to assure that the care provided is
evidence-based, patient-centered, effective, consistent and equitable."



Physician Performance and Racial Disparities in Diabetes
Mellitus Care

Thomas D. Sequist; Garrett M. Fitzmaurice; Richard Marshall; Shimon
Shaykevich; Dana Gelb Safran; John Z. Ayanian

Archives of Internal Medicine (2008). 168[11]:1145
- 1151.

Click
Here to View Abstract



Written by: Peter M Crosta