City Research Online

Ethnic inequities in the patterns of personalized care adjustments for ‘informed dissent’ and ‘patient unsuitable’: a retrospective study using Clinical Practice Research Datalink

Hayanga, B. ORCID: 0000-0003-0696-0064, Stafford, M., Ashworth, M. , Hughes, J. & Bécares, L. (2023). Ethnic inequities in the patterns of personalized care adjustments for ‘informed dissent’ and ‘patient unsuitable’: a retrospective study using Clinical Practice Research Datalink. Journal of Public Health, 45(4), e692-e701. doi: 10.1093/pubmed/fdad104


In England, general practitioners voluntarily take part in the Quality and Outcomes Framework, which is a program that seeks to improve care by rewarding good practice. They can make personalized care adjustments (PCAs), e.g. if patients choose not to have the treatment/intervention offered (‘informed dissent’) or because they are considered to be clinically ‘unsuitable’.

Using data from the Clinical Practice Research Datalink (Aurum), this study examined patterns of PCA reporting for ‘informed dissent’ and ‘patient unsuitable’, how they vary across ethnic groups and whether ethnic inequities were explained by sociodemographic factors or co-morbidities.

The odds of having a PCA record for ‘informed dissent’ were lower for 7 of the 10 minoritized ethnic groups studied. Indian patients were less likely than white patients to have a PCA record for ‘patient unsuitable’. The higher likelihood of reporting for ‘patient unsuitable’ among people from Black Caribbean, Black Other, Pakistani and other ethnic groups was explained by co-morbidities and/or area-level deprivation.

The findings counter narratives that suggest that people from minoritized ethnic groups often refuse medical intervention/treatment. The findings also illustrate ethnic inequities in PCA reporting for ‘patient unsuitable’, which are linked to clinical and social complexity and should be tackled to improve health outcomes for all.

Publication Type: Article
Additional Information: © The Author(s) 2023. Published by Oxford University Press on behalf of Faculty of Public Health. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Publisher Keywords: ethnicity, primary care, personalized care adjustments, quality
Subjects: G Geography. Anthropology. Recreation > GF Human ecology. Anthropogeography
H Social Sciences > HN Social history and conditions. Social problems. Social reform
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments: School of Health & Psychological Sciences
School of Health & Psychological Sciences > Healthcare Services Research & Management
SWORD Depositor:
[thumbnail of Hayanga et al 2023.pdf]
Text - Published Version
Available under License Creative Commons: Attribution International Public License 4.0.

Download (476kB) | Preview


Add to AnyAdd to TwitterAdd to FacebookAdd to LinkedinAdd to PinterestAdd to Email


Downloads per month over past year

View more statistics

Actions (login required)

Admin Login Admin Login