Communication patterns may impact racial disparity in joint replacement utilization

WASHINGTON — Published data going back to 1993 have indicated that black and Hispanic patients are significantly less likely to undergo joint replacement surgery than white patients. One investigator's new preliminary work suggests differences in doctor/patient communication patterns might be factors in this disparity seen in patients with an expressed interest in joint replacement.

"Patients' medical information as communicated to the physician is highly associated with the likelihood of getting a joint replacement recommendation," Said A. Ibrahim, MD, MPH, noted. "If patients are willing to talk about the severity of their disease and how it is impacting their quality of life, they are more likely to get a recommendation for joint replacement than if they don't talk about that."

In discussing the racial disparity of joint replacement utilization at the J. Robert Gladden Orthopaedic Society 2008 Biennial Meeting, here, Ibrahim presented preliminary data that showed black patients were significantly less likely to engage in sharing medical information with their physician, and that they were also 70% less likely to be recommended for joint replacement.

"This ongoing study is the first in the nation to actually link the observed racial variation in the utilization of knee and hip elective joint replacement to orthopedic doctor and patient communication and decision making," Ibrahim said.

"The indications for joint replacement are quality-of-life issues and severity of disease," he added. "They are the things that orthopedists are looking for in their communication with their patient. If someone is not telling them that, it could be an issue in terms of recommendation for the treatment."

Ibrahim and colleagues used the Roter Interaction Analysis System to evaluate physician and patient communication patterns made during office visits. They used demographically similar patient groups in the Pittsburgh and Cleveland Veterans Affairs systems and grouped these statements according to socioemotional, biomedical or practical categories. They also computed whether a conversation was patient-centric or physician-dominated.

In addition, Ibrahim presented data from his published studies evaluating other factors, such as those at the system or patient level, which may play a role in disability.

For more information:
Ibrahim SA. Understanding racial disparity in joint replacement utilization. Presented at the J. Robert Gladden Orthopaedic Society 2008 Biennial Meeting. April 25-27, 2008. Washington.