The diabetes care studies of senior scientist Andrew Karter, PhD, are emblematic of the Division of Research's (DOR) commitment to disparities research. Kaiser Permanente Northern California, with its highly diverse and representative membership, provides an ideal setting for studying health disparities and for identifying how care can be improved for all members.
"Our research suggests that worse diabetes health outcomes are frequently associated with lower levels of education and with problems understanding or communicating with health providers," said Dr. Karter.
Dr. Karter and collaborators from the University of California, San Francisco, have advanced our understanding with several recent publications. In the January 2011 Journal of General Internal Medicine, he and his co-authors shed light on how controlling diabetes is made more difficult for some patients by language barriers.
Researchers showed that patients who cannot talk about their diabetes with their doctor in their own language have poorer control of their diabetes. Among Latino diabetes patients with limited English skills, those seen by doctors who did not speak Spanish were nearly twice as likely to have poor blood sugar control compared to those whose doctors did speak Spanish.
In another study published in 2010, in Patient Education and Counseling, they found that Spanish-speaking patients seen by physicians who did not speak Spanish reported less satisfactory patient-doctor communication and had less trust in their provider than those patients seen by doctors who spoke the patient's primary language .
In the May 2010 issue of Journal of General Internal Medicine, Dr. Karter and his colleagues examined safety concerns for another potential cause of diabetes care disparities. This study showed that patients whose limited health literacy made it difficult to obtain, process and understand the basic health information and services needed to make appropriate health decisions were at a higher risk for severe hypoglycemia or low blood sugar, a serious safety concern for those taking insulin.
"These studies contribute additional evidence that the quality of communication between physician and patient is an important component of successful diabetes care," said Dr. Karter.
Data collection and analyses for the diabetes studies above were conducted by the Diabetes Study of Northern California (DISTANCE), which surveyed more than 20,000 members of Kaiser Permanente Northern California's diabetes registry. Dr. Karter is principal investigator for DISTANCE, which is funded by the National Institutes of Health.
Joe Selby, MD, DOR director, is also leading a diabetes care research study, Translating Research into Action for Diabetes. Known as TRIAD, Dr. Selby's current study, funded by the Centers for Disease Control and Prevention, will also look at how the common predictors of poor diabetes control may operate differently in various racial and ethnic groups.
Kaiser Permanente Northern California's close productive relationship with the DOR is part of what drew disparities investigator Alyce Adams, PhD, to the DOR team. An investigator at the DOR since 2008, her research interests include understanding and addressing underuse of clinically effective therapies to treat chronic illnesses such as diabetes, depression and cancer.
"There are few places in this country where you find a large health care system so closely partnered with a large research group toward the common goal of reducing health care disparities," said Dr. Adams.
She is the principal investigator on several studies examining aspects of how Medicare Part D drug benefits affect disparities. Study funders include the National Institute on Aging, the National Institute of Mental Health and the Agency for Healthcare Research and Quality.
"We are investigating disparities in treatment adherence before and after changes in drug coverage policy that may have differentially affected low-income, minority populations," said Dr. Adams. "Examining changes in disparities over time, and in the context of changes in policy, can inform the development of more effective strategies to improve patient care and outcomes."