Disparities in both health status and access to health care in the United States are widely acknowledged problems that have received much attention from the AAFP and a host of other medical professional organizations across the country.
The timeliness of the topic increases the value of recently published research(link.springer.com) that explores primary care residents' awareness of racial disparities related to a specific disease and how prepared residents say they are to talk about those disparities with their patients.
Residents also were queried about training and resources currently used to improve their preparedness levels, and about what sort of training would be most helpful in the future.
Authors outlined results of their resident survey in an article titled "Awareness of Racial Disparities in Diabetes Among Primary Care Residents and Preparedness to Discuss Disparities With Patients" published July 23 online ahead of print in the Journal of Racial and Ethnic Health Disparities.
Researchers presented statistics on national diabetes rates, calling the disease an "epidemic associated with significant racial and ethnic disparities in quality of care and outcomes."
- Researchers surveyed primary care residents to determine their awareness of racial and ethnic disparities in diabetes, as well as their preparedness to discuss disparities with patients.
- Researchers also asked residents about training and resources currently used to improve their preparedness levels, as well as about what sort of training would be most helpful in the future.
- Study authors found that despite being aware that disparities exist, primary care residents appear to lack the training and communication tools they think would help them identify and address diabetes health disparities among their patients.
They noted that diabetes affects more than 30 million people living in the United States, but that rates vary among racial/ethnic groups; it is more prevalent among American Indians/Alaska Natives (15.1 percent), non-Hispanic blacks (12.7 percent) and Hispanics (12.1 percent) than among non-Hispanic whites (7.4 percent).
Lead author Yhenneko Taylor, Ph.D., director of health services research at the Center for Outcomes Research and Evaluation, Atrium Health (formerly Carolinas HealthCare System), in Charlotte, N.C., discussed the research with AAFP News.
She said authors crafted the training outcome measure based on recommendations from the Accreditation Council for Graduate Medication Education (ACGME) and others.
"The ACGME has specific requirements around health disparities training for residents, and so we were interested in understanding residents' perceptions of the training they had received and also what their preferences were for training methods to help them be better prepared to address health disparities," said Taylor.
Authors surveyed 52 primary care residents affiliated with two North Carolina teaching hospitals -- one in an urban area, the other in a suburban/rural setting.
Residents who completed the 20-question online survey were training in family medicine, internal medicine or pharmacy and provided care for patients with diabetes in an outpatient setting from October 2016 to May 2017.
Specifically, researchers developed the survey to assess residents'
- awareness of health disparities,
- awareness of diabetes-related health disparities,
- access to sources of information regarding health disparities,
- perceptions of preparedness to discuss health disparities with patients, and
- preferences about learning techniques related to identifying and addressing disparities.
Regarding residents' knowledge of disparities between African-Americans and Caucasians,
- more than 80 percent of survey respondents knew that African-Americans were more likely than Caucasians to receive a diagnosis of diabetes, hypertension or end-stage renal disease;
- 62 percent were aware of disparities in diabetic retinopathy; and
- 60 percent were aware of disparities in three health status measures: general health, life expectancy and infant mortality.
Furthermore, 60 percent of residents knew that African-Americans were less likely than Caucasians to receive preventive care, specialty care, routine care and needed health care, and were less able to afford medications.
When it came to their preparedness to discuss diabetes-related disparities, 83 percent of residents were comfortable talking with patients from various cultural, ethnic and economic backgrounds. However, just 31 percent said they were prepared to discuss diabetes disparities, and 58 percent of residents said they didn't have the information they needed to do so.
About 48 percent were not sure how to share information in a patient-friendly manner.
As for identifying methods to increase residents' preparedness to discuss and address disparities, 96 percent of respondents said they'd like to know about interventions to narrow the disparity gap, 90 percent wanted recommendations on practice changes that would help close that gap, and 88 percent requested easy access to health disparities information.
Residents also asked for formal didactic training on how to address disparities (87 percent), instruction on how to discuss health disparities (87 percent) and a method of improving their awareness of diabetes disparities (83 percent).
"Despite being aware that disparities exist, primary care residents appear to lack the training and communication tools that they feel will help them identify and address diabetes health disparities among their patients," wrote the authors.
They noted that "residents ranked cultural competency training as their most preferred method for learning how to identify and address health disparities, followed by experiential learning opportunities."
During her interview with AAFP News, Taylor answered more fully some questions about the research findings. Her responses have been adapted for the following Q&A.
Q. Why are your findings particularly important to family physicians?
A. First of all, the majority of participants in the study, 77 percent, were family medicine residents. These are new doctors who will soon be in their own clinical practices, and understanding what gaps exist in their training regarding health disparities is important for improving health care quality and health care outcomes in their minority patients. Secondly, diabetes is a very common condition that family physicians encounter in their practices.
Q. Was there any particular finding that surprised you and your colleagues?
A. We were surprised that the awareness of health disparities was high; we reported that 83 percent of participants were aware that African-Americans were more likely to have diabetes than whites. Previous research had that percentage at 64 percent.
We were also surprised that residents' preparedness to discuss health disparities with their patients did not differ by the residents' race or by the percentage of African-American patients in their panels.
Q. What's the key point you want readers to take away from this research?
A. Awareness is an essential piece of the puzzle in terms of addressing health disparities. But what our study shows is that awareness is not always equal to preparedness, so there's definitely an opportunity to design and implement training to better prepare resident physicians to really address these disparities.
Q. How can these findings best be used to improve patient care?
A. The CDC reports(www.cdc.gov) that 9.4 percent of U.S. adults had diabetes in 2017, and that percentage is higher for Hispanics, American Indians and for blacks. These patients may benefit from a better understanding of how diabetes affects people who share their racial background and from seeing a variety of approaches used to engage them as partners in their care.
In thinking about improving patient care, our findings show that residents may have some difficulty in having these conversations with patients. So, introducing tools to help facilitate those conversations may be useful to help patients understand how conditions like diabetes are affecting their communities.
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