An Investigation of Associations Between Clinicians' Ethnic or Racial Bias and Hypertension Treatment, Medication Adherence and Blood Pressure Control
An Investigation of Associations Between Clinicians' Ethnic or Racial Bias and Hypertension Treatment, Medication Adherence and Blood Pressure Control
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DOI：
10.1007/s11606-014-2795-z
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发表时间：
2014-07-01
影响因子：
5.7
通讯作者：
Havranek, Edward P.
中科院分区：
文献类型：
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作者：
Blair, Irene V.;Steiner, John F.;Havranek, Edward P.
很少有研究直接调查临床医生的隐式（无意识）偏见与医疗保健的差异在临床settings.To确定如果临床医生的隐式种族或种族偏见与黑人和拉丁美洲患者的高血压治疗过程和结果相关，相对于白色患者，初级保健临床医生完成了种族和种族偏见的隐式关联测试。查询电子病历，以分层随机抽样临床医生的黑人，拉丁美洲人和白色患者，以评估治疗强化，依从性和控制高血压。多水平随机系数模型评估了临床医生的内隐偏见与高血压治疗和结局的种族或人种差异之间的关系。高血压的控制是通过在初级保健就诊期间记录的患者达到血压目标的时间百分比来评估的。138名初级保健临床医生和4,794名高血压患者参与了研究。黑人患者接受了等效的强化治疗，但与白色患者相比，药物依从性较低，高血压控制较差;拉丁美洲患者接受了等效的强化治疗，高血压控制相似，但与白色患者相比，药物依从性较低。黑人患者（分别为P = 0.85、P = 0.06和P = 0.31）和拉丁美洲患者（分别为P = 0.55、P = 0.40和P = 0.79）在治疗强化、药物依从性和高血压控制方面的差异与临床医生的隐性偏倚无关。对于黑人和拉丁裔患者，临床医生偏差从平均到强的增加与所有结果的相对变化小于5%相关。内隐偏差不影响临床医生对少数族裔患者的护理，也不影响患者的结果。确定医疗保健环境中的偏见不影响结果可以帮助患者和临床医生在他们的努力，建立信任和伙伴关系。
Few studies have directly investigated the association of clinicians' implicit (unconscious) bias with health care disparities in clinical settings.To determine if clinicians' implicit ethnic or racial bias is associated with processes and outcomes of treatment for hypertension among black and Latino patients, relative to white patients.Primary care clinicians completed Implicit Association Tests of ethnic and racial bias. Electronic medical records were queried for a stratified, random sample of the clinicians' black, Latino and white patients to assess treatment intensification, adherence and control of hypertension. Multilevel random coefficient models assessed the associations between clinicians' implicit biases and ethnic or racial differences in hypertension care and outcomes.Standard measures of treatment intensification and medication adherence were calculated from pharmacy refills. Hypertension control was assessed by the percentage of time that patients met blood pressure goals recorded during primary care visits.One hundred and thirty-eight primary care clinicians and 4,794 patients with hypertension participated. Black patients received equivalent treatment intensification, but had lower medication adherence and worse hypertension control than white patients; Latino patients received equivalent treatment intensification and had similar hypertension control, but lower medication adherence than white patients. Differences in treatment intensification, medication adherence and hypertension control were unrelated to clinician implicit bias for black patients (P = 0.85, P = 0.06 and P = 0.31, respectively) and for Latino patients (P = 0.55, P = 0.40 and P = 0.79, respectively). An increase in clinician bias from average to strong was associated with a relative change of less than 5 % in all outcomes for black and Latino patients.Implicit bias did not affect clinicians' provision of care to their minority patients, nor did it affect the patients' outcomes. The identification of health care contexts in which bias does not impact outcomes can assist both patients and clinicians in their efforts to build trust and partnership.