title: Influence of patient race on physician prescribing decisions: a randomized on-line experiment.
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.
  
  
  METHODS
  Web-based survey including three clinical vignettes (hypercholesterolemia, hypertension, diabetes), with patient race (black, white) randomized across vignettes.
  
  
  METHODS
  A total of 716 respondents from 5,141 eligible sampled primary care physicians (14% response rate).
  
  
  METHODS
  None
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  Racial differences in outpatient prescribing patterns for hypertension, hypercholesterolemia, and diabetes are likely attributable to factors other than prescribing decisions based on patient race.
authors.affiliation: Yale University School of Medicine, New Haven, CT 06520-8025, USA. saif.rathore@yale.edu
authors.forename: Saif S
authors.initials: SS
authors.lastname: Rathore
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Ketcham
authors.forename: G Caleb
authors.initials: GC
authors.lastname: Alexander
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Epstein
mesh_terms: D000368:Aged; D044383:Black People / Q000208:ethnology / Q000523:psychology; D003625:Data Collection / Q000379:methods*; D011307:Drug Prescriptions; D005260:Female; D006630:Hispanic or Latino / Q000208:ethnology / Q000523:psychology; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010775:Photic Stimulation / Q000379:methods; D010818:Practice Patterns, Physicians'; D044469:Racial Groups / Q000208:ethnology* / Q000523:psychology; D044465:White People / Q000208:ethnology / Q000523:psychology
references.citation: Ann Intern Med. 2004 Oct 19;141(8):635-8
references.pmid: 15492343
references.citation: Arch Intern Med. 2003 Mar 10;163(5):525-41
references.pmid: 12622600
references.citation: Health Serv Res. 2005 Feb;40(1):227-52
references.pmid: 15663711
references.citation: J Gen Intern Med. 2008 Jan;23(1):81-6
references.pmid: 18040744
references.citation: Am J Med. 2000 May;108(7):561-6
references.pmid: 10806285
references.citation: Am J Hypertens. 2004 Oct;17(10):963-70
references.pmid: 15485761
references.citation: N Engl J Med. 2004 Aug 5;351(6):575-84
references.pmid: 15295050
references.citation: JAMA. 2000 Apr 5;283(13):1715-22
references.pmid: 10755498
references.citation: Am J Public Health. 1996 Dec;86(12):1805-8
references.pmid: 9003143
references.citation: J Gen Intern Med. 2007 Nov;22(11):1572-8
references.pmid: 17882499
references.citation: N Engl J Med. 2005 Aug 18;353(7):692-700
references.pmid: 16107622
references.citation: Arch Intern Med. 2002 Apr 22;162(8):929-35
references.pmid: 11966345
references.citation: Health Aff (Millwood). 2002 Nov-Dec;21(6):224-30
references.pmid: 12442860
references.citation: J Gen Intern Med. 2001 Apr;16(4):211-7
references.pmid: 11318921
references.citation: Circulation. 2004 Jul 13;110(2):227-39
references.pmid: 15249516
references.citation: Med Care. 2002 Jan;40(1 Suppl):I140-51
references.pmid: 11789627
references.citation: Hypertension. 2004 Mar;43(3):566-72
references.pmid: 14757779
references.citation: Am J Manag Care. 2008 Nov;14(11 Suppl):SP5-13
references.pmid: 18991482
references.citation: JAMA. 2003 May 21;289(19):2560-72
references.pmid: 12748199
references.citation: Am J Med Qual. 2005 May-Jun;20(3):151-7
references.pmid: 15951521
references.citation: Arch Intern Med. 2008 Jun 9;168(11):1145-51
references.pmid: 18541821
references.citation: N Engl J Med. 1999 Feb 25;340(8):618-26
references.pmid: 10029647