Health Disparities Unit, Social and Behavioral Research Branch, Division of Intramural Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD.
Genetics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Ethn Dis. 2019 Jan 17;29(1):1-8. doi: 10.18865/ed.29.1.1. eCollection 2019 Winter.
The debate over use of race as a proxy for genetic risk of disease continues, but little is known about how primary care providers (nurse practitioners and general internal medicine physicians) currently use race in their clinical practice. Our study investigates primary care providers' use of race in clinical practice.
Survey data from three cross-sectional parent studies were used. A total of 178 nurse practitioners (NPs) and 759 general internal medicine physicians were included. The outcome of interest was the Racial Attributes in Clinical Evaluation (RACE) scale, which measures explicit use of race in clinical decision-making. Predictor variables included the Genetic Variation Knowledge Assessment Index (GKAI), which measures the providers' knowledge of human genetic variation.
In the final multivariable model, NPs had an average RACE score that was 1.60 points higher than the physicians' score (P=.03). The GKAI score was not significantly associated with the RACE outcome in the final model (P=.67).
Physicians had more knowledge of genetic variation and used patients' race less in the clinical decision-making process than NPs. We speculate that these differences may be related to differences in discipline-specific clinical training and approaches to clinical care. Further exploration of these differences is needed, including examination of physicians' and NPs' beliefs about race, how they use race in disease screening and treatment, and if the use of race is contributing to health care disparities.
关于将种族用作疾病遗传风险的替代指标的争论仍在继续，但人们对初级保健提供者（护士从业者和普通内科医生）如何在临床实践中使用种族知之甚少。我们的研究调查了初级保健提供者在临床实践中使用种族的情况。
使用三项横断面母研究的调查数据。共纳入 178 名护士从业者（NP）和 759 名普通内科医生。感兴趣的结果是种族在临床评估中的属性（RACE）量表，它衡量种族在临床决策中的明确使用。预测变量包括遗传变异知识评估指数（GKAI），它衡量提供者对人类遗传变异的了解。
在最终的多变量模型中，NP 的平均 RACE 评分比医生的评分高 1.60 分（P=.03）。在最终模型中，GKAI 评分与 RACE 结果无显著相关性（P=.67）。
与 NP 相比，医生对遗传变异的了解更多，在临床决策过程中较少使用患者的种族。我们推测，这些差异可能与特定学科的临床培训和临床护理方法的差异有关。需要进一步探讨这些差异，包括检查医生和 NP 对种族的看法、他们如何在疾病筛查和治疗中使用种族，以及种族的使用是否导致医疗保健差异。
