Abstract
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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1183-1191 |
| Number of pages | 9 |
| Journal | Journal of General Internal Medicine |
| Volume | 24 |
| Issue number | 11 |
| DOIs | |
| State | Published - Nov 2009 |
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Keywords
- Diabetes
- Hypercholesterolemia
- Hypertension
- Patient race
- Prescription medication
ASJC Scopus subject areas
- Internal Medicine
Cite this
Influence of patient race on physician prescribing decisions : A randomized on-line experiment. / Rathore, Saif S.; Ketcham, Jonathan; Alexander, G. Caleb; Epstein, Andrew J.
In: Journal of General Internal Medicine, Vol. 24, No. 11, 11.2009, p. 1183-1191.Research output: Contribution to journal › Article
}
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.
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
UR - http://www.scopus.com/inward/record.url?scp=70449531468&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=70449531468&partnerID=8YFLogxK
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 -