In Reply: We agree with Dr. Adetunji and colleagues that interpretation of our findings is complicated and that our results may have been influenced by a variety of factors. In our discussion section, we speculated about factors that could have influenced the ethnic differences that we found in prescribing practices—and there certainly may be other factors that explain these differences.
Our study did not provide information about why the prescribing disparities existed. Although cultural competence among health care professionals might decrease such disparities, information needed to address this issue is not typically captured in administrative claims databases. Furthermore, we have not seen any empirical evidence that cultural competency training decreases disparities in prescribing practices. Future research using primary data collection techniques could address the degree to which discrimination, cultural competence, disease severity, and other factors play a role in prescribing disparities.