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Cited by 92Blood Pressure and Hypertension StudiesRacial and Ethnic Identity ResearchMedication Adherence and Compliance

An Investigation of Associations Between Clinicians’ Ethnic or Racial Bias and Hypertension Treatment, Medication Adherence and Blood Pressure Control

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Blair, Irene V., Steiner, John F., Hanratty, Rebecca, Price, David W., Fairclough, Diane L., Daugherty, Stacie L., Bronsert, Michael, Magid, David J. +1 more·2014·Journal of General Internal Medicine
DOI 10.1007/s11606-014-2795-zPMC PMC4061371
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Abstract

Background Few studies have directly investigated the association of clinicians' implicit (unconscious) bias with health care disparities in clinical settings. Objective To determine if clinicians' implicit ethnic or racial bias is associated with processes and outcomes of treatment for hypertension among black and Latino patients, relative to white patients. Research design and participants Primary care clinicians completed Implicit Association Tests of ethnic and racial bias. Electronic medical records were queried for a stratified, random sample of the clinicians' black, Latino and white patients to assess treatment intensification, adherence and control of hypertension. Multilevel random coefficient models assessed the associations between clinicians' implicit biases and ethnic or racial differences in hypertension care and outcomes. Main measures Standard measures of treatment intensification and medication adherence were calculated from pharmacy refills. Hypertension control was assessed by the percentage of time that patients met blood pressure goals recorded during primary care visits. Key results One hundred and thirty-eight primary care clinicians and 4,794 patients with hypertension participated. Black patients received equivalent treatment intensification, but had lower medication adherence and worse hypertension control than white patients; Latino patients received equivalent treatment intensification and had similar hypertension control, but lower medication adherence than white patients. Differences in treatment intensification, medication adherence and hypertension control were unrelated to clinician implicit bias for black patients (P = 0.85, P = 0.06 and P = 0.31, respectively) and for Latino patients (P = 0.55, P = 0.40 and P = 0.79, respectively). An increase in clinician bias from average to strong was associated with a relative change of less than 5 % in all outcomes for black and Latino patients. Conclusions Implicit bias did not affect clinicians' provision of care to their minority patients, nor did it affect the patients' outcomes. The identification of health care contexts in which bias does not impact outcomes can assist both patients and clinicians in their efforts to build trust and partnership.

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  • Several studies published after 2013 indicated a null relationship between levels of implicit bias and clinical decision-making.

    “Several studies post 2013 (thus after our cut-off date) have also indicated a null relationship between levels of implicit bias and clinical decision-making [52–54].”

    From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [53]

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Authors
Blair, I. V., Steiner, J. F., Hanratty, R., Price, D. W., Fairclough, D. L., Daugherty, S. L., Bronsert, M., Magid, D. J., & Havranek, E. P.
Affiliations
  • University of Colorado Boulder (US)
  • Kaiser Permanente (US)
  • Denver Health Medical Center (US)
  • University of Colorado Denver (US)
Corresponding author
Blair, Irene V.
ORCID
Venue
Journal of General Internal Medicine
Publisher
Springer Science and Business Media LLC
Published
2014-02-19
Volume
29
Issue
7
Pages
987-995
ISSN
  • 0884-8734 (ISSN-L)
  • 1525-1497
DOI
10.1007/s11606-014-2795-z
PMC
PMC4061371
OpenAlex
W2076251075
Cited by
92
References
5
Citations by year
2026: 5 · 2025: 4 · 2024: 7 · 2023: 9 · 2022: 9 · 2021: 10 · 2020: 8 · 2019: 6 · 2018: 8 · 2017: 11 · 2016: 9 · 2015: 4 · 2014: 2
FWCI
5.55
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Journal of General Internal Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Kaiser Permanente
  • National Institutes of Health (UL1TR001082)
  • University of Colorado Boulder
  • National Heart, Lung, and Blood Institute (K08HL103776, HL088198, HL103776, R01HL088198)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
Keywords
implicit bias, racial bias, ethnic prejudice, hypertension, medication adherence, blood pressure control, treatment intensification, health care disparities, Black patients, Hispanic patients, primary care providers, Implicit Association Test, racial and ethnic minorities
MeSH terms
Antihypertensive Agents, Blood Pressure, Blood Pressure Determination, Colorado, Ethnicity, Female, Follow-Up Studies, Humans, Hypertension, Male, Middle Aged, Pilot Projects, Primary Health Care, Retrospective Studies, Prevalence, Healthcare Disparities, Medication Adherence

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