TY - JOUR
T1 - Influence of patient race on physician prescribing decisions
T2 - A randomized on-line experiment
AU - Rathore, Saif S.
AU - Ketcham, Jonathan
AU - Alexander, G. Caleb
AU - Epstein, Andrew J.
N1 - Funding Information:
Acknowledgments: Harris Interactive implemented the survey and participated in its design. Survey costs and the authors’ time were funded by Pfizer Inc. The authors performed this analysis independently of the funder and retained full control of all aspects of the analysis, including survey design, data analysis and interpretation, preparation of the manuscript, and submission decisions.
PY - 2009/11
Y1 - 2009/11
N2 - Background: Prior research reports black patients have lower medication use for hypercholesterolemia, hypertension, and diabetes. Objective: To assess whether patient race influences physicians' prescribing. Design: Web-based survey including three clinical vignettes (hypercholesterolemia, hypertension, diabetes), with patient race (black, white) randomized across vignettes. Subjects: A total of 716 respondents from 5,141 eligible sampled primary care physicians (14% response rate). Interventions: None Measurements: Medication recommendation (any medication vs none, on-patent branded vs generic, and therapeutic class) and physicians' treatment adherence forecast (10-point Likert scale, 1-definitely not adhere, 10-definitely adhere). Results: Respondents randomized to view black patients (n=371) and white patients (n=345) recommend any medications at comparable rates for hypercholesterolemia (100.0% white vs 99.5% black, P=0.50), hypertension (99.7% white vs 99.5% black, P=1.00), and diabetes (99.7% white vs 99.7% black, P=1.00). Patient race influenced medication class chosen in the hypertension vignette; respondents randomized to view black patients recommended calcium channel blockers more often (20.8% black vs 3.2% white) and angiotensin-converting enzyme inhibitors less often (47.4% black vs 62.6% white) (P<0.001). Patient race did not influence medication class for hypercholesterolemia or diabetes. Respondents randomized to view black patients reported lower forecasted patient adherence for hypertension (P<0.001, mean: 7.3 black vs 7.7 white) and diabetes (P=0.05 mean: 7.4 black vs 7.6 white), but race had no meaningful influence on forecasted adherence for hypercholesterolemia (P=0.15, mean: 7.2 black vs 7.3 white). Conclusion: Racial differences in outpatient prescribing patterns for hypertension, hypercholesterolemia, and diabetes are likely attributable to factors other than prescribing decisions based on patient race.
AB - Background: Prior research reports black patients have lower medication use for hypercholesterolemia, hypertension, and diabetes. Objective: To assess whether patient race influences physicians' prescribing. Design: Web-based survey including three clinical vignettes (hypercholesterolemia, hypertension, diabetes), with patient race (black, white) randomized across vignettes. Subjects: A total of 716 respondents from 5,141 eligible sampled primary care physicians (14% response rate). Interventions: None Measurements: Medication recommendation (any medication vs none, on-patent branded vs generic, and therapeutic class) and physicians' treatment adherence forecast (10-point Likert scale, 1-definitely not adhere, 10-definitely adhere). Results: Respondents randomized to view black patients (n=371) and white patients (n=345) recommend any medications at comparable rates for hypercholesterolemia (100.0% white vs 99.5% black, P=0.50), hypertension (99.7% white vs 99.5% black, P=1.00), and diabetes (99.7% white vs 99.7% black, P=1.00). Patient race influenced medication class chosen in the hypertension vignette; respondents randomized to view black patients recommended calcium channel blockers more often (20.8% black vs 3.2% white) and angiotensin-converting enzyme inhibitors less often (47.4% black vs 62.6% white) (P<0.001). Patient race did not influence medication class for hypercholesterolemia or diabetes. Respondents randomized to view black patients reported lower forecasted patient adherence for hypertension (P<0.001, mean: 7.3 black vs 7.7 white) and diabetes (P=0.05 mean: 7.4 black vs 7.6 white), but race had no meaningful influence on forecasted adherence for hypercholesterolemia (P=0.15, mean: 7.2 black vs 7.3 white). Conclusion: Racial differences in outpatient prescribing patterns for hypertension, hypercholesterolemia, and diabetes are likely attributable to factors other than prescribing decisions based on patient race.
KW - Diabetes
KW - Hypercholesterolemia
KW - Hypertension
KW - Patient race
KW - Prescription medication
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U2 - 10.1007/s11606-009-1077-7
DO - 10.1007/s11606-009-1077-7
M3 - Article
C2 - 19705205
AN - SCOPUS:70449531468
VL - 24
SP - 1183
EP - 1191
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
SN - 0884-8734
IS - 11
ER -
