number of minority patients in their practices were more likely than other cardiologists to report that disparities occur often. Females were more than twice as likely to agree that there are disparities compared to males, and black physicians were five times more likely to agree, compared to white physicians.

Most physicians agreed with the statement that people receive different care based on whether they are insured (69 percent) or on the type of insurance they have (58 percent).

"Although insurance is important, disparities in access to care and quality of care exist independent of insurance," Lurie said.

Interestingly, Lurie said, more than 60 percent of the providers surveyed rated the evidence documenting racial and ethnic disparities in cardiovascular care as "strong" or "very strong." But researchers couldn't explain why physicians' ratings of the strength of the evidence did not match provider's beliefs about the existence of disparities.

The top factors cardiologists cited to explain disparities involved the health care system (insurance and lack of time) and the patients themselves (failure to adhere to treatment, health behaviors, attitudes towards doctors, and understanding of treatment). Few respondents cited physician factors: about 40 percent of the physicians thought that miscommunication contributed greatly to disparity, and only 25 percent considered physician attitudes to be important.

To overcome disparities, 59 percent felt that increasing patients' self-management skills would be effective and 53 percent felt that expanding health insurance would help. In contrast, fewer than 30 percent of cardiologists felt increasing physician awareness or improving cultural competence of either the health provider or the institution would be useful in addressing disparities.

"Many of the physicians see a patient's attitude and ability to understand and follow treatment advice as important factors in explaining disparities
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Contact: Carole Bullock
carole.bullock@heart.org
214-706-1279
American Heart Association
15-Mar-2005

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