Okelo Sande O, Wu Albert W, Merriman Barry, Krishnan Jerry A, Diette Gregory B
Department of Pediatrics, Johns Hopkins University, 200 N. Wolfe Street, Suite 3025, Baltimore, MD 21287, USA.
J Gen Intern Med. 2007 Jul;22(7):976-81. doi: 10.1007/s11606-007-0209-1. Epub 2007 Apr 24.
Racial differences in asthma care are not fully explained by socioeconomic status, care access, and insurance status. Appropriate care requires accurate physician estimates of severity. It is unknown if accuracy of physician estimates differs between black and white patients, and how this relates to asthma care disparities.
We hypothesized that: 1) physician underestimation of asthma severity is more frequent among black patients; 2) among black patients, physician underestimation of severity is associated with poorer quality asthma care.
DESIGN, SETTING AND PATIENTS: We conducted a cross-sectional survey among adult patients with asthma cared for in 15 managed care organizations in the United States. We collected physicians' estimates of their patients' asthma severity. Physicians' estimates of patients' asthma as being less severe than patient-reported symptoms were classified as underestimates of severity.
Frequency of underestimation, asthma care, and communication.
Three thousand four hundred and ninety-four patients participated (13% were black). Blacks were significantly more likely than white patients to have their asthma severity underestimated (OR = 1.39, 95% CI 1.08-1.79). Among black patients, underestimation was associated with less use of daily inhaled corticosteroids (13% vs 20%, p < .05), less physician instruction on management of asthma flare-ups (33% vs 41%, p < .0001), and lower ratings of asthma care (p = .01) and physician communication (p = .04).
Biased estimates of asthma severity may contribute to racially disparate asthma care. Interventions to improve physicians' assessments of asthma severity and patient-physician communication may minimize racial disparities in asthma care.
哮喘治疗中的种族差异不能完全由社会经济地位、医疗可及性和保险状况来解释。恰当的治疗需要医生准确评估病情严重程度。目前尚不清楚医生对病情严重程度的评估准确性在黑人和白人患者之间是否存在差异，以及这与哮喘治疗差异有何关系。
我们假设：1）黑人患者中医生低估哮喘严重程度的情况更常见；2）在黑人患者中，医生对严重程度的低估与哮喘治疗质量较差有关。
设计、背景和患者：我们在美国15个管理式医疗组织中对成年哮喘患者进行了一项横断面调查。我们收集了医生对其患者哮喘严重程度的评估。医生将患者哮喘评估为比患者报告的症状轻的情况被归类为对严重程度的低估。
低估的频率、哮喘治疗和沟通情况。
3494名患者参与了研究（13%为黑人）。黑人患者的哮喘严重程度被低估的可能性显著高于白人患者（比值比=1.39，95%置信区间1.08-1.79）。在黑人患者中，低估与每日吸入糖皮质激素的使用较少（13%对20%，p<.05）、医生对哮喘发作管理的指导较少（33%对41%，p<.0001）以及哮喘治疗评分较低（p=.01）和医生沟通评分较低（p=.04）相关。
对哮喘严重程度的偏差评估可能导致哮喘治疗中的种族差异。改善医生对哮喘严重程度评估和医患沟通的干预措施可能会最大限度地减少哮喘治疗中的种族差异。
