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Racial Disparities in Lipid Screening Among Patients With Coronary Artery Disease Narrowed in Primary Care Settings
Heather Brom1, Lusine Poghosyan2, Jacqueline Nikpour3
1Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia.
Insights
Improving nurse practitioner (NP) practice environments can reduce racial disparities in coronary artery disease (CAD) care. Supportive environments increase lipid screening rates for Black patients with CAD.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Health Equity
Background:
- Coronary artery disease (CAD) is a leading cause of heart disease in the U.S., with higher prevalence in Black populations compared to White.
- Regular primary care and effective dyslipidemia management are crucial for optimal CAD patient outcomes.
- Nurse practitioners (NPs) are vital in primary care, but unsupportive practice settings can hinder their effectiveness.
Purpose of the Study:
- To investigate the association between NP practice environment supportiveness and disparities in lipid screening between Black and White patients with CAD.
- To determine if NP practice environment scores correlate with differences in lipid screening rates among CAD patients of different races.
Main Methods:
- Utilized cross-sectional survey data from NPs and linked Medicare claims for 111,911 CAD patients across 456 primary care practices in four states.
- Assessed NP practice environment supportiveness using the NP-Primary Care Organizational Climate Questionnaire.
- Employed multilevel regression models, controlling for patient and practice factors, to analyze the study aim.
Main Results:
- Black patients with CAD received annual lipid screening less frequently than White patients (70.6% vs. 77.0%).
- Each standard deviation increase in NP practice environment score was associated with a 5% increase in the odds of lipid screening for Black patients with CAD.
Conclusions:
- Enhancing the NP practice environment, by boosting NP visibility and interprofessional collaboration, may help reduce racial disparities in CAD management.
- Investing in supportive NP practice settings is a potential strategy to improve equitable care for cardiovascular disease.
Background:
Coronary artery disease (CAD) is the most prevalent heart disease in the United States, and it disproportionately affects Black compared to White patients. Regular primary care and dyslipidemia screening and management are essential for optimal CAD care. Nurse practitioners (NPs) increasingly provide primary care services, though unsupportive practice environments may constrain their ability to do so.
Purpose:
To examine whether disparities in lipid screening between Black and White patients with CAD were associated with the NP practice environment scores.
Methods:
Cross-sectional survey data from NPs in primary care practices and Medicare claims were linked to evaluate outcomes among 111,911 CAD patients (94% White, 6% Black) across 456 primary care practices in four states (California, Florida, New Jersey, and Pennsylvania) in 2016. The NP-Primary Care Organizational Climate Questionnaire, which provides a score on the supportiveness of a respondent's practice, was used to evaluate the NP practice environment. Multilevel regression models that accounted for patient and practice characteristics were used to evaluate the study aim.
Results:
Compared to White patients with CAD, Black patients with CAD less frequently received annual lipid screening (77.0% vs. 70.6%; p < .001). In logistic regression models accounting for patient and practice characteristics, for every standard deviation increase in the practice environment score, Black patients experienced a 5% increase in odds of receiving lipid screening.
Conclusion:
Investing in the NP practice environment, including increasing NP role visibility and strengthening relationships with physicians and administrators, may narrow racial disparities in CAD management.
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