This article was originally published here
J Diabetes Sci Technol. 2021, April 15: 19322968211006476. doi: 10.1177 / 19322968211006476. Online before printing.
ABSTRACT
BACKGROUND: The use of diabetes technology has been linked to beneficial outcomes in type 1 diabetes (T1D). American adolescents with public insurance, an advocate for low socioeconomic status, use less diabetes technology than those with private insurance. We wanted to assess the role of the implicit bias of insurance-mediated providers, defined as systematic discrimination against adolescents with public insurance, in relation to recommendations on diabetes technology for adolescents with T1D in the US.
METHODS: Multidisciplinary pediatric diabetes providers performed a bias assessment consisting of a clinical vignette and ranking exercises (n = 39). Provider bias was defined as: (1) recommending more technology to private insurers compared to public insurers, or (2) placing insurers in the top 2 of 7 reasons to offer technology. Bias and provider characteristics were analyzed using descriptive statistics, group comparisons and multivariate logistic regression.
Results: The majority of providers [44.1 ± 10.0 years old, 83% female, 79% non-Hispanic white, 49% physician, 12.2 ± 10.0 practice-years] showed bias (n = 33/39, 84.6%). Compared to the group without bias, the group with bias had exercised longer (13.4 ± 10.4 years versus 5.7 ± 3.6 years, P = 0.003), but otherwise had similar characteristics including age (44.4 ± 10.2 versus 42.6 ± 10.1, p = 0.701). . In the logistic regression, the years of practice remained significant (OR = 1.47, 95% CI [1.02,2.13];; P = 0.007), if age, gender, race / ethnicity, provider role, percentage of insured persons and location at work were taken into account.
CONCLUSIONS: The tendency for providers to recommend insurance-based technologies was widespread in our cohort and increased over the years in practice. There are likely many reasons for this finding, including health system drivers. However, as the gatekeeper of diabetes technology, providers can contribute to inequalities in pediatric T1D in the United States.
PMID: 33858206 | DOI: 10.1177 / 19322968211006476
