Physicians’ Failure To Address Cultural Needs of Patients Leads to Racial Health Care Disparities, According to Study

Physicians' lack of attention to cultural differences among patients might contribute to racial health care disparities, according to a study published on Monday in the Archives of Internal Medicine, the New York Times reports. For the study, Thomas Sequist, an assistant professor of health care policy at Harvard Medical School, and colleagues analyzed electronic health records of 6,814 patients in Massachusetts who were treated for diabetes between 2005 and 2007. The patients were treated by at least one of 90 primary care physicians with Harvard Vanguard Medical Associates, which operates 14 walk-in clinics in the eastern region of the state. Each physician treated at least five white patients and five black patients. Researchers examined the patients' medical data for three standard measures of effective diabetes control: blood pressure, LDL cholesterol levels and hemoglobin A1C, which reflects the blood sugar levels.

The study found that although similar numbers of black and white patients took each test, fewer blacks adequately controlled their levels on the three tests. According to the analysis, 63% of blacks were adequately controlling their blood glucose levels, compared with 71% of white patients. The researchers determined that socioeconomic factors contributed to 13% to 38% of the racial disparities, but they found 66% to 75% of the differences were accounted for among patients who were treated by the same physician, even after adjusting for clinical differences among patients.

Conclusions
The study concluded, "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." Researchers recommended that physicians and other health care providers learn more about minority communities and provide patients with better information to control and prevent diabetes. They wrote, "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."

Sequist said, "It isn't that providers are doing different things for different patients," adding, "It's that we're doing the same thing for every patient and not accounting for individual needs. Our one-size-fits-all approach may leave minority patients with needs that aren't being met." For example, he said, "We may be listing fruits and vegetables that are part of one person's culture but not another," adding, "We're not really giving them information they can use" (Sack, New York Times, 6/10).

An abstract of the study is available online.