AXL Series: Implicit Provider Bias and Substance Use Disorder

Learning Objectives: 

• Explore different types of bias in clinical care.
• Describe implicit bias and its likely effects on SUD outcomes and patient experiences.
• Introduce strategies to mitigate bias in patient interactions and in the clinical system as a whole.
• Formulate a learning and action plan to improve SUD care by reducing bias.

Presenter
Andrea Westby, MD
Vice Chair for Equity, Diversity, and Inclusion
Department of Family Medicine and Community Health
University of Minnesota

Learning Outcome
At the conclusion of this learning activity, (at least 75% of) participants will be able to discuss at least two strategies to mitigate implicit bias that can be incorporated into a plan of care that addresses the overall needs of patients with substance use disorder. 

Disclosure
The activity director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content for this activity have no relevant financial relationship(s)* with ineligible companies to disclose**. 

* A “financial relationship" includes employee, researcher (named as the PI), consultant, advisor, speaker, independent contractor (including contracted research), royalties or patent beneficiary, executive role, and/or an ownership interest (not including stocks owned in a managed portfolio).

** An ineligible company is any entity whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Bibliographic Material

• Burgess DJ, Beach MC, Saha S. Mindfulness practice: a promising approach to reducing the effects of clinician implicit bias on patients. Patient Educ Couns. 2017;100(2):372-376.
  
  
• “Common Cognitive Biases”. Canadian Medical Protective Association. https://www.cmpa- acpm.ca/serve/docs/ela/goodpracticesguide/pages/human_factors/Cognitive_biases/common_cognitive_biases-e.html
  
  
• Cooper L. et al. The Associations of Clinicians’ Implicit Attitudes About Race With Medical Visit Communication and Patient Ratings of Interpersonal Care, American Journal of Public Health 102, no. 5 (May 1, 2012): pp. 979-987.
  
  
• Dalton S, Villagran M. Minimizing and addressing implicit bias in the workplace: be proactive, part one. College & Research Libraries News. 2018;79(9):478.
  
  
• Dovidio, J. Fiske, S. Under the Radar: How Unexamined Biases in Decision-Making Processes in Clinical Interactions Can Contribute to Health Care Disparities, Am J Pub Health 2012;102(5): 945-952.
  
  
• Edgoose J, Quiogue M, Sidhar K. How to identify, understand, and unlearn implicit bias in patient care. Fam Pract Manag. 2019;26(4):29-33.
  
  
• The EveryONE Project Implicit Bias Training Guide. American Academy of Family Physicians (AAFP). https://www.aafp.org/family- physician/patient-care/the-everyone-project/toolkit/implicit-bias.html
  
  
• Hansen H, Siegel C, Wanderling J, DiRocco D. Buprenorphine and methadone treatment for opioid dependence by income, ethnicity and race of neighborhoods in New York City. Drug Alcohol Depend. 2016;164:14-21. doi:10.1016/j.drugalcdep.2016.03.028
  
  
• Holm AL, Rowe Gorosh M, Brady M, White-Perkins D. Recognizing privilege and bias: an interactive exercise to expand health care providers’ personal awareness. Acad Med. 2017;92(3):360-364
  
  
• Johnson, R., Roter D, Powe N, Cooper, L. “Patient Race/Ethnicity and Quality of Patient–Physician Communication During Medical Visits”, American Journal of Public Health 94, no. 12 (December 1, 2004): pp. 2084-2090.
  
  
• Larochelle MR, et al. Disparities in Opioid Overdose Death Trends by Race/Ethnicity, 2018–2019, From the HEALing Communities Study, Am J Pub Health 2021;111(10):1851-1854. https://doi.org/10.2105/AJPH.2021.306431
  
  
• Magura S, Lee SJ, Salsitz EA, Kolodny A, Whitley SD, Taubes T, Seewald R, Joseph H, Kayman DJ, Fong C, Marsch LA, Rosenblum A. Outcomes of buprenorphine maintenance in office-based practice. J Addict Dis. 2007; 26(2):13-23.
  
  
• Maina IW, Belton TD, Ginzberg S, Singh A, Johnson TJ. A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test. Soc Sci Med. 2018;199219–229.
  
  
• The Ohio State University Kirwan Institute for The Study of Race and Ethnicity. Mythbusters: implicit bias edition. http://kirwaninstitute.osu.edu/implicit-bias-training/resources/mythbusters.pdf.
  
  
• Peek ME, Lopez FY, Williams HS, et al. Development of a conceptual framework for understanding shared decision making among African-American LGBT patients and their clinicians. J Gen Intern Med. 2016;31(6):677-687
  
  
• Peeler M et al. Racial and Ethnic Disparities in Maternal and Infant Outcomes Among Opioid-Exposed Mother–Infant Dyads in Massachusetts (2017–2019), Am Journal Pub Health 2020;110(12):1828-1836. https://doi.org/10.2105/AJPH.2020.305888
  
  
• Penner LA, Dovidio JF, West TV, et al. Aversive Racism and Medical Interactions with Black Patients: A Field Study. J Exp Soc Psychol. 2010;46(2):436–440. doi:10.1016/j.jesp.2009.11.004
  
  
• Richard P, et al. Disparities in physician-patient communication by obesity status. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 51 (2014): 0046958014557012
  
  
• SAMHSA Behavioral Health Equity, accessed October 15, 2021. https://www.samhsa.gov/behavioral-health-equity
  
  
• Stanton A, McLeod C, Luckey B, Kissin WB, Sonnefeld LJ. SAMHSA/CSAT evaluation of the buprenorphine waiver program: expanding treatment of opioid dependence: Initial physician and patient experiences with the adoption of buprenorphine. Substance Abuse and Mental Health Services Administration; 2006. Available at: http://buprenorphine.samhsa.gov/ASAM_06_Final_Results.pdf.
  
  
• Sukhera J, Watling C. A framework for integrating implicit bias recognition into health professions education. Acad Med. 2018;93(1):35-40Exposed Mother–Infant Dyads in Massachusetts (2017–2019), Am Journal Pub Health 2020;110(12):1828-1836. https://doi.org/10.2105/AJPH.2020.305888
  

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