Health and healthcare disparities based on one’s race/ethnicity, gender, age, and other sociological factors continue to persist. As the U.S. becomes increasingly diverse, there are likely challenges that will arise with treating diverse patient populations.
While there is a vast body of literature that demonstrates the continued existence of disparities, data consistently show that providers have minimal awareness of any differences in care among these diverse groups.
CardioSurve and the Coalition to Reduce Disparities in CVD Outcomes (credo) surveyed cardiologists about racial and ethnic disparities in cardiovascular disease care. Previous studies have shown that physicians, in general, have little awareness of or response to disparities in care based on race or ethnicity.
"A physician is obligated to consider more than a diseased organ, more even than the whole man - he must view the man in his world." — Harvey Cushing
From the cardiologist perspective, in terms of the factors leading to differences in care, more than two out of three (69%) clinicians cite litigation fears and almost as many (64%) feel that a lack of time are the primary obstacles leading to disparities in care and place race/ethnicity (21%) and gender (8%) near the bottom of the list.
However, a majority (68%) of cardiologists believe that minority patients in the U.S. generally receive lower quality care than white patients. Additionally, nearly three out of four cardiologists (72%) feel that some minorities with heart disease are less likely than whites with heart disease to get specialized medical procedures and surgery; and they also agree that whites with heart disease are more likely than some minorities with heart disease to get the newest medicines and treatments.
Health literacy, economic status, and adherence behaviors are among the patient factors identified by more than half the respondents as significantly reducing quality of care. Leading physician factors include lack of time, provider bias, and lack of research to guide care for a given population; one out of five (19%) cardiologists highlight the need for cultural competence training.
When compared to primary care physicians, a higher percentage of cardiologists believe that disparities in care exist. Furthermore, nearly two-thirds (63%) feel as though they could make a difference in the quality of care for minorities. However, in terms of the reflection and empowerment aspects of addressing the situation, cardiologists do not feel quite as strongly about their ability/inclination to impact the disparity situation as the generalists.
Additionally, only one out of ten (12%) cardiologists indicate that they have recently participated in a quality improvement project at work to increase the quality of care for minority patients. When asked which initiatives the ACC should implement to reduce cardiovascular disease treatment and outcomes disparities, providing patient education tools for diverse patient populations (69%) was the most important one cited among cardiologists, followed by identifying resources for treating patients whose primary language is not English or differs from the health care provider (55%), and then providing data concerning cardiovascular disease treatment, stratified by race and ethnicity, for your own hospital or practice (51%).
Based on the findings, credo will focus on identifying and developing education, tools, and practice strategies to assist cardiologists in eliminating barriers to quality care among their diverse patient populations and monitor progress in recognizing and reducing care disparities for cardiology practices.