Monday, April 21
Grant Miller: Managerial Incentives in Public Service Delivery
Ratanawongsa, Neda, Brian J. Zikmund-Fisher, Mick P. Couper, John Van Hoewyk, and Neil R. Powe. 2010. "Race, Ethnicity, and Shared Decision Making for Hyperlipidemia and Hypertension Treatment: The DECISIONS Survey." Medical Decision Making, 30(Suppl. 5): 65S-76S.
Background. Racial/ethnic differences in shared decision making about cardiovascular risk-reduction therapy could affect health disparities. Objective. To investigate whether patient race/ethnicity is associated with experiences discussing cardiovascular risk-reduction therapy with health care providers. Setting. National sample of US adults identified by random-digit dialing. Design. Cross-sectional survey conducted in November 2006 to May 2007. Participants. Among participants in the National Survey of Medical Decisions (DECISIONS), a nationally representative sample of English-speaking US adults aged 40 and older, the authors analyzed respondents who reported discussing hyperlipidemia or hypertension medications with a health care provider in the previous 2 years. Measurements. In multivariate linear and logistic regressions adjusting for age, gender, income, insurance status, perceived health, and current therapy, they assessed the relation between race/ethnicity (black/Hispanic v. white) and decision making: knowledge, discussion of pros and cons of therapy, discussion of patient preference, who made the final decision, preferred involvement, and confidence in the decision. Results. Of respondents who discussed high cholesterol (N = 738) or hypertension (N = 745) medications, 88% were white, 9% black, and 4% Hispanic. Minorities had lower knowledge scores than whites for hyperlipidemia (42% v. 52%, difference -10% [95% confidence interval (CI): 15, -5], P < 0.001), but not for hypertension. For hyperlipidemia, minorities were more likely than whites to report that the health care provider made the final decision for treatment (31.7% v. 12.3% whites, difference 19.4% [95% CI: 6.9, 33.1%], P < 0.01); this was not true for hypertension. Limitations. Possible limitations include the small percentage of minorities in the sample and potential recall bias. Conclusions. Minorities considering hyperlipidemia therapy may be less informed about and less involved in the final decision-making process.
Country of focus: United States.