Physicians' perceptions of patients' social and behavioral characteristics and race disparities in treatment recommendations for men with coronary artery disease
Physicians' perceptions of patients' social and behavioral characteristics and race disparities in treatment recommendations for men with coronary artery disease
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DOI：
10.2105/ajph.2004.041806
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发表时间：
2006-02-01
影响因子：
12.7
通讯作者：
Griffin, J
中科院分区：
文献类型：
--
作者：
van Ryn, M;Burgess, D;Griffin, J
目标.越来越多的证据表明，提供者的决策有助于种族/民族的差异，在照顾。我们研究了影响患者种族/民族与提供者对冠状动脉旁路移植术的建议之间关系的因素。对包括病历、血管造影片和供应商调查数据的数据集进行分析，这些数据集涉及血管造影后遇到的被归类为冠状动脉旁路移植术合适候选人的患者。在男性患者中，种族显著影响医生的推荐，但对女性患者无影响。医生对患者的教育和体力活动偏好的看法是他们的建议的重要预测因素，独立于临床因素，适当性，付款人和医生特征。此外，这些变量介导的影响，病人的种族对提供者的解释。结论。我们的研究结果指出了研究和干预策略的重要性，这些策略解决了提供者对患者的信念介导治疗差异的方式。此外，他们强调需要对社会因素在临床决策中的作用进行讨论和达成共识。
Objectives. A growing body of evidence suggests that provider decisionmaking contributes to racial/ethnic disparities in care. We examined the factors mediating the relationship between patient race/ethnicity and provider recommendations for coronary artery bypass graft surgery.Methods. Analyses were conducted with a data set that included medical record, angiogram, and provider survey data on postangiogram encounters with patients who were categorized as appropriate candidates for coronary artery bypass graft surgery.Results. Race significantly influenced physician recommendations among male, but not female, patients. Physicians' perceptions of patients' education and physical activity preferences were significant predictors of their recommendations, independent of clinical factors, appropriateness, payer, and physician characteristics. Furthermore, these variables mediated the effects of patient race on provider recommendations.Conclusions. Our findings point to the importance of research and intervention strategies addressing the ways in which providers' beliefs about patients mediate disparities in treatment. In addition, they highlight the need for discourse and consensus development on the role of social factors in clinical decisionmaking.