RAND Study Finds That Just One-Third of Cardiologists Agree Racial Disparities Exist in Cardiac Care
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March 15, 2005
Just one-third of cardiologists participating in a national survey believe there are ethnic or racial disparities in the care given to heart patients in the United States, despite overwhelming evidence that such disparities routinely occur, according to a RAND Corporation study issued today.
In addition, only 12 percent of the cardiologists said that racial disparities exist in their own hospital and just 5 percent believe that the disparities exist in the care provided to their own patients, according to the study by RAND Health researchers published in the March edition of the journal Circulation.
However, researchers found that African American and female physicians — in addition to those who treat a large number of minority patients in their practices — are more likely than other cardiologists to report that racial and ethnic disparities frequently occur. Black physicians are five times more likely than white doctors to agree that the disparities exist. Women physicians are more than twice as likely as male doctors to agree that there are disparities
“It's striking how few cardiologists believe there are disparities in the nation's cardiovascular care, given the amount of attention to the subject,” said Dr. Nicole Lurie, the study's lead author. “Numerous papers and several major national committees have identified this as a significant issue.”
Lurie said that the most disturbing finding was the seeming disconnect between those who said disparities were a national problem, and those who said disparities existed in their own hospital or practice settings.
“For disparities to be occurring at the magnitude they are, they can't all be somebody else's patients,” said Lurie, the Paul O'Neill Alcoa Professor of Public Policy at RAND. “If we really want to reduce these disparities, helping physicians figure out whether there are disparities in their own practices and hospitals is critical. Then we can have a realistic discussion about what to do about them.”
Most of the cardiologists expressed the belief that there are disparities in health care based upon insurance. The study found that 69 percent of the cardiologists surveyed agree that people receive different care based on whether they are insured. And 58 percent believe there are disparities based on the type of a patient's insurance. However, studies have shown that there are racial and ethnic disparities even among similarly insured patients.
Many studies have documented disparities in the quality of health care provided to people based upon their ethnic or racial status. While these disparities have been found in many parts of medicine, much of the evidence comes from the field of cardiovascular care.
Studies have also shown that both women and members of certain racial groups are less likely than white men to receive treatments such as cardiac angioplasty, coronary angiograms and medications that can help dissolve blood clots.
Groups such as the American College of Cardiology, the American Heart Association and the Henry J. Kaiser Family Foundation have undertaken efforts to educate cardiologists about the disparities in cardiac care in the hope that the physicians would change their practice habits.
Researchers from RAND Health conducted their study by e-mailing invitations to take part in a Web-based survey to 871 members of the American College of Cardiology, American Heart Association and the Association of Black Cardiologists.
A total of 344 practicing cardiologists completed the survey. The cardiologists who responded were predominately white men, with nearly three quarters graduating from medical school before 1985. About 40 percent of them work in settings where minority patients represent more than a quarter of the patients.
Researchers found that more than 60 percent of the cardiologists surveyed rate the evidence documenting racial and ethnic disparities in cardiovascular care as “strong” or “very strong.” Among the same group, 34 percent agree there are disparities in care in the overall U.S. healthcare system.
The factors cardiologists most commonly cited to explain disparities involved the health care system (insurance and lack of time) and the patients themselves (failure to adhere to treatment, health behaviors, attitudes towards doctors, and understanding of treatment), according to the study.
Few of the cardiologists cited factors relating to physicians. About 40 percent said that miscommunication contributes greatly to disparities, and just 25 percent considered physician attitudes to be important.
In order to overcome disparities, 59 percent of the cardiologists recommended increasing patient's self-management skills and 53 percent said that expanding health insurance would be effective. In contrast, fewer than 30 percent of cardiologists said increasing physician awareness or improving cultural competence of either the health provider or the institution would be useful in addressing disparities.
The RAND Health article, titled “Racial and Ethnic Disparities in Care: The Perspectives of Cardiologists,” appears in a special edition of Circulation devoted to research reports about disparities in cardiovascular care.
Support for the study was provided by the Robert Wood Johnson Foundation. Other authors of the report are Allen Fremont, Arvind K. Jain, Stephanie L. Taylor and Rebecca McLaughlin, all of RAND; Eric Peterson of the American College of Cardiology; B. Waine Kong of the Association of Black Cardiologists; and T. Bruce Ferguson, Jr. of Louisiana State University and the Society of Thoracic Surgeons.
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