Critical Race Theory as a Lens for Examining Primary Care Provider Responses to Persistently-Elevated HbA1c

Amy Cunningham, Denine Crittendon, Casey Konys, Geoffrey Mills, Allison Casola, Samantha Kelly, Christine Arenson

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Clinical inertia remains a persistent problem in the treatment of diabetes in clinical care. Primary care provider behavior is thought to be a significant contributor to diabetes clinical inertia. This study used the lens of Critical Race Theory to examine whether provider's diabetes management activities differ by patient race and frame implications for future research. Methods: Chart abstractors retrospectively reviewed a random sample of charts from primary care patients with persistently-elevated HbA1c to assess providers' diabetes management activities in the subsequent year. Provider activities aligned with the American Diabetes Association's standards of medical care and included HbA1c test ordering, documentation of patient medication adherence, counseling on lifestyle modification, lifestyle modification referral, endocrinologist participation in care, and medication titration. Differences in provider actions by patient race (Black, white, or other) were examined using chi-square tests. Results: A total of 188 patient charts were reviewed. For all provider actions, there were statistically-significant differences by patient race. Black patients were least likely to be counseled on dietary changes (72.0%) or physical activity (57.7%) by their primary care provider, but most likely to be referred to an outside specialist for this counseling (46.2%). Black patients were also least likely to have medication adjustments made (72%). Discussion: Study findings showed an association between provider diabetes management behaviors and patient race, Future studies showed explore providers' racial beliefs, attitudes and clinical decision-making, and patients’ experiences with historical exclusion from medical care and racism in healthcare encounters In addition, more research is needed to explore the role of structural racism in clinical inertia.

Original languageEnglish (US)
JournalJournal of the National Medical Association
DOIs
StateAccepted/In press - 2020
Externally publishedYes

Bibliographical note

Funding Information:
This project was supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services Grant Number: T0BHP28581, Title: Accelerating Primary Care Transformation at Jefferson (JeffAPCT). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

Publisher Copyright:
© 2020 National Medical Association

Keywords

  • Critical race theory
  • Diabetes
  • Glycemic control
  • Primary care
  • Racial disparities

PubMed: MeSH publication types

  • Journal Article

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