Ethnic inequities in the patterns of Personalised Care Adjustments for ‘Informed Dissent’ and ‘Patient Unsuitable’: A retrospective study using Clinical Practice Research Datalink

Abstract

ABSTRACTObjectivesTo examine patterns of PCA reporting for ‘informed dissent’ and ‘patient unsuitable’, how they vary by ethnic group, and whether ethnic inequities can be explained by socio-demographic factors or comorbidities.DesignA retrospective study using routinely collected electronic health records.SettingIndividual patient data from Clinical Practice Research Datalink collected from UK general practice.ParticipantsPatients with at least one of the 12 Quality and Outcomes Framework (QOF) conditions which had PCA coding options from a random sample of 690,00 patients aged 18+ years on the 1st of Jan 2016.Main outcomes measuresThe associations between ethnicity and two PCA reasons (‘Informed Dissent’ and ‘Patient Unsuitable’) were examined using logistic regressions after adjustment for age, sex, multiple QOF conditions and area-level deprivation.ResultsThe association between ethnicity and the two PCA reasons were in opposite directions. After accounting for age, gender, multiple QOF conditions and area-level deprivation, people of Bangladeshi [OR: 0.69, 95% CI: 0.55 to 0.87], Black African [OR: 0.70, 95% CI: 0.61 to 0.81], Black Caribbean, OR: 0.67, 95% CI: 0.58 to 0.76], Indian [OR: 0.74, 95% CI: 0.66 to 0.83], mixed [OR: 0.86, 95% CI: 0.74 to 0.99], other Asian [OR: 0.74 95% CI: 0.64 to 0.86] and other ethnicity [OR: 0.66, 95% CI: 0.55 to 0.80] were less likely to have a PCA record for ‘informed dissent’ than people of white ethnicity. Only people of Indian ethnicity were significantly less likely than people of white ethnicity to have a PCA record for ‘patient unsuitable’ in fully adjusted models [OR: 0.80, 95% CI: 0.67 to 0.94]. We found ethnic inequities in PCA reporting for ‘patient unsuitable’ among people of Black Caribbean, Black other, Pakistani, and other ethnicity, but these attenuated after adjusting for multiple QOF conditions and/or area level deprivation.ConclusionStudy findings counter the narratives that suggest that people from minoritised ethnic groups often refuse medical intervention. They illuminate the complex relationship between ‘informed dissent’ and (dis)empowerment which requires further scrutiny. They also show ethnic inequalities in PCA reporting for ‘patient unsuitable’ that are linked to clinical and social complexity and should be tackled to improve health outcomes for all.