Better health care doesn't erase racial gap

NEW YORK, Apr 8: Efforts to improve health care quality can help reduce some -- but not all -- of the inequalities in medical care provided to black patients compared with whites, a new study shows.

Four years after launching a program to improve the quality of diabetes care, a large Boston-based physician group found that racial disparities in cholesterol screening were reduced, but blacks remained less likely than whites to be taking statins to get their LDL (''bad'') cholesterol down, or to have their blood sugar under long-term control.

''While improving quality in general does result in reduction of disparities, what we found was that the more important measures of quality, which were the outcomes ... those things tended to have more persistent disparities,'' Dr Thomas D Sequist of Harvard Medical School in Boston, the study's lead author, told Reuters Health.

Sequist and his colleagues looked at 7,088 patients with diabetes -- 28 per cent of whom were black -- who received care at Harvard Vanguard Medical Associates, to investigate the effect of quality improvement efforts on ethnic disparities in care. The initiative included patient outreach and electronic reminders sent to physicians.

As they report in the Archives of Internal Medicine, the team found that from 1997 to 2001, the percentage of patients who had their LDL cholesterol checked every year rose from 39 percent to 64 per cent, while the disparity between blacks and whites fell from 14 per cent to 4 percent.

During that same time period, the percentage of diabetic patients with their LDL cholesterol under effective control rose from 15 per cent to 43 per cent, with the racial disparity falling from 9 per cent to 6 per cent. While the per cent of patients taking cholesterol-lowering statins rose from 20 per cent to 37 per cent, there was no change in the disparity between blacks and whites taking the drugs, the researchers found.

Many factors could be at work here, Sequist noted. Physicians may be less likely to prescribe the drugs to black patients, or black patients could be less likely to fill the prescriptions, for example.

The percentage of patients with their blood sugar under long-term control remained at 31 per cent throughout the study period. Racial disparities did not budge for this measurement; 24 percent of black patients had their blood sugar under long-term control, compared to 34 per cent of whites.

Sequist and his colleagues point out that blood glucose control is a much more complex issue than lowering cholesterol, given that it may require changes in diet, exercise, and multiple medications.

It likely will be necessary for physicians to develop focused efforts to effectively address differences in care between blacks and whites in their own practices, Sequist told Reuters Health.

''A lot of health care disparities or the underlying reasons driving health care disparities do occur in a physician's office,'' he said.

REUTERS