Patient and provider assessments of adherence and the sources of disparities: Evidence from diabetes care

Objective. To (1) compare diabetes patients' self-assessments of adherence with their providers' assessments; (2) determine whether there are systematic differences between the two for certain types of patients; and (3) consider how the cognitive processing that providers use to assess adherence might explain these differences. Data Sources/Study Setting. Primary survey data were collected in 1998 from 156 patient provider pairs in two subspecialty endocrinology clinics in a large Midwestern city. Study Design. Data were collected in a cross-sectional survey study design. Providers were surveyed immediately after seeing each diabetes patient, and patients were surveyed via telephone within 1 week of clinic visits. Data Collection/Extraction Methods. Bivariate descriptive results and multivariate regression analyses are used to examine how patient characteristics relate to four measures of overall adherence assessments: (1) patients' self-assessments; (2) providers' assessments of patient adherence; (3) differences between those assessments; and (4) absolute values of those differences. Principal Findings. Patient self-assessments are almost entirely independent of observable characteristics such as sex, race, and age. Provider assessments vary with observable characteristics such as patient race and age but not with less readily observable factors such as education and income. For black patients, we observe that relative to white patients, providers' assessments are significantly farther away from-although not systematically farther above or below-patients' self-assessments. Conclusions. Providers appear to rely on observable cues, particularly age and race, to make inferences about an individual patient's adherence. These findings point to a need for further research of various types of provider cognitive processing, particularly in terms of distinguishing between prejudice and uncertainty. If disparities in assessment stem more from information and communication problems than from provider prejudice, policy interventions should facilitate providers' systematic acquisition and processing of information, particularly for some types of patients.