title: Patient-reported racial/ethnic healthcare provider discrimination and medication intensification in the Diabetes Study of Northern California (DISTANCE).
abstract: BACKGROUND
  Racial/ethnic minority patients are more likely to report experiences with discrimination in the healthcare setting, potentially leading to reduced access to appropriate care; however, few studies evaluate reports of discrimination with objectively measured quality of care indicators.
  
  
  OBJECTIVE
  To evaluate whether patient-reported racial/ethnic discrimination by healthcare providers was associated with evidence of poorer quality care measured by medication intensification.
  
  
  METHODS
  Baseline data from the Diabetes Study of Northern California (DISTANCE), a random, race-stratified sample from the Kaiser Permanente Diabetes Registry from 2005-2006, including both survey and medical record data.
  
  
  METHODS
  Self-reported healthcare provider discrimination (from survey data) and medication intensification (from electronic prescription records) for poorly controlled diabetes patients (A1c ≥9.0%; systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg; low-density lipoprotein (LDL) ≥130 mg/dl).
  
  
  RESULTS
  Of 10,409 eligible patients, 21% had hyperglycemia, 14% had hyperlipidemia, and 32% had hypertension. Of those with hyperglycemia, 59% had their medications intensified, along with 40% with hyperlipidemia, 33% with hypertension, and 47% in poor control of any risk factor. In adjusted log-binomial GEE models, discrimination was not associated with medication intensification [RR = 0.96 (95% CI: 0.74, 1.24) for hyperglycemia, RR = 1.23 (95% CI: 0.93, 1.63) for hyperlipidemia, RR = 1.06 (95% CI: 0.69, 1.61) for hypertension, and RR = 1.08 (95% CI: 0.88, 1.33) for the composite cohort].
  
  
  CONCLUSIONS
  We found no evidence that patient-reported healthcare discrimination was associated with less medication intensification. While not associated with this technical aspect of care, discrimination could still be associated with other aspects of care (e.g., patient-centeredness, communication).
authors.affiliation: Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA. crees@u.washington.edu
authors.forename: Courtney R
authors.initials: CR
authors.lastname: Lyles
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
authors.forename: Bessie A
authors.initials: BA
authors.lastname: Young
authors.forename: Clarence
authors.initials: C
authors.lastname: Spigner
authors.forename: David
authors.initials: D
authors.lastname: Grembowski
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.forename: Nancy
authors.initials: N
authors.lastname: Adler
mesh_terms: D000328:Adult; D000368:Aged; D002140:California / Q000208:ethnology; D003625:Data Collection / Q000379:methods; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000523:psychology / Q000628:therapy*; D057286:Electronic Health Records / Q000592:standards; D055695:Electronic Prescribing / Q000592:standards; D005006:Ethnicity / Q000208:ethnology / Q000523:psychology; D005260:Female; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000208:ethnology*; D011287:Prejudice; D011787:Quality of Health Care / Q000592:standards; D044469:Racial Groups / Q000208:ethnology / Q000523:psychology