When beginning new treatments, it's important to ask patients what they understand about the medication, what their expectations are, what barriers might exist to remaining on this agent, and what they value most out of their treatment plan.
Lifelong Learning in Clinical Excellence | February 13, 2019 | 2 min read
By Utibe Essien, MD, MPH, University of Pittsburgh School of Medicine
For decades, researchers and scientists have suggested that race impacts the receipt of medical treatment in the US. From pain medications to cardiac catheterization, race, and specifically black race, has been associated with less or lower quality care. Several explanations have been made for these differences – poorer access to healthcare through insurance, and lower socioeconomic status, including metrics for education, employment, and income.
The social determinants of health, often unmeasured in the clinical setting, have gained attention for their role in disparities – with housing stability, food security, immigration status, and criminal justice emerging as leading issues impacting the health of minority individuals. Yet the concern still remains: if many, or all, of these factors are addressed, will racial differences still exist in the way patients are treated?
Racial disparities in the treatment of atrial fibrillation
This concern is what led me as a health disparities researcher and a primary care physician to study racial disparities in chronic disease treatment, specifically examining the condition atrial fibrillation (AFib). With cardiology societies promoting guidelines that incorporate the use of novel direct-oral anticoagulants (DOACs) along with traditional Warfarin for stroke prevention, we were interested in knowing whether uptake of novel treatments was slower in minority patients. In a study recently published in JAMA Cardiology, we found that black patients had 25% lower odds of receiving any anticoagulants. When they were prescribed anticoagulants, they had 37% lower odds of receiving the newer class of DOACs compared to white patients. These findings persisted even when we controlled for socioeconomic factors – income, level of education, and insurance status.
As clinicians, we daily care for patients in unique spaces – clinic offices or hospital wards, often far removed from the environments in which our patients live and work. Developing practical tools to improve shared decision-making that incorporates the diverse aspects of our patients lived experiences into treatment decisions are important next steps to improve the quality and equity of care for all patients with chronic illness.
What we can do:
When beginning new treatments, it’s important to ask patients what they understand about the medication, what their expectations are, what barriers might exist to remaining on this agent, and what they value most out of their treatment plan. These conversations are not brief or simple, but can be helpful to prevent concerns with medication continuation and negative health outcomes in the long run.