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Racial/Ethnic Disparities in Primary Care

The Role of Physician-Patient Concordance

Strumpf, Erin C., PhD*,†

doi: 10.1097/MLR.0b013e31820fbee4
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Background Research suggests that racial/ethnic concordance (matching) between patients and physicians improves quality of care for minority patients by reducing discrimination in the clinical encounter.

Objective Examine the impacts of patient and physician race/ethnicity, and racial/ethnic concordance, on primary care outcomes including blood pressure, tobacco use, and cholesterol screening and tobacco use counseling.

Research Design Multivariate regression analysis of 8160 visits by white and minority patients to 661 primary care physicians using the 2001 to 2003 National Ambulatory Medical Care Survey. I estimated models based on physicians who see both white and minority patients and include physician fixed-effects to correctly measure the contribution of concordance.

Results Conditional on accessing a primary care physician, patient race does not explain differences in rates of these guideline-recommended preventive screenings. Concordance is generally not an important predictor of outcomes, though it is associated with rates of cholesterol screening 2 to 3 times higher among black and Hispanic men compared with whites. In contrast, practice patterns vary quite markedly by physicians' race/ethnicity.

Conclusions Given that physician race is a more powerful predictor of preventive screening than patient-physician concordance, minority patients may receive some guideline-recommended care at lower rates in concordant pairs. Addressing physician education and training to ensure practice that is consistent with preventive care guidelines may be important. Forms of discrimination in the clinical encounter thought to be modified by concordance do not appear to drive disparities in these outcomes.

Departments of *Epidemiology, Biostatistics, and Occupational Health

Economics, McGill University, Montreal, Canada

Funding from the National Institute on Aging, Grant Number T32-AG00186 and the National Institute of Mental Health, Grant Number M11147-101, is gratefully acknowledged.

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's web site (www.lww-medicalcare.com).

Reprints: Erin C. Strumpf, PhD, Department of Epidemiology, Biostatistics, and Occupational Health and Department of Economics, McGill University, 855 Sherbrooke St. West, Montreal, QC H3A 2T7, Canada. E-mail: erin.strumpf@mcgill.ca.

© 2011 Lippincott Williams & Wilkins, Inc.