The Incidence and Disparities in Use of Stigmatizing Language in Clinical Notes for Patients With Substance Use Disorder.
The Incidence and Disparities in Use of Stigmatizing Language in Clinical Notes for Patients With Substance Use Disorder.
复制标题
药物使用障碍患者临床记录中使用污名化语言的发生率和差异。
DOI：
10.1097/adm.0000000000001145
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发表时间：
2023
影响因子：
5.5
通讯作者：
Wakeman,SarahE
中科院分区：
文献类型：
--
作者：
Weiner,ScottG;Lo,Ying-Chih;Carroll,AletaD;Zhou,Li;Ngo,Ashley;Hathaway,DavidB;Rodriguez,ClaudiaP;Wakeman,SarahE
目的用来描述物质使用障碍患者的语言冲击污名并影响临床决策。本研究评估了临床记录中污名化语言(SL)的存在，并检测了患者和提供者级别的差异。方法纳入2020年12月至2021年11月期间大型卫生系统为与物质相关的诊断患者生成的所有自由文本笔记。结果30,391例患者共收到546,309条笔记，其中100,792条(18.4%)含有SL。共有18,727名患者(61.6%)至少有一项SL记录。最常见的SLS是“滥用”和“物质滥用”。护士使用SL的可能性最小(4.1%)，而医生助理使用SL的可能性最大(46.9%)。男性患者比女性患者更有可能在他们的笔记中患有SL(调整后的优势比[AOR]，1.17；95%可信区间[CI]，1.11-1.23)，18-24岁的年轻患者比45-54岁的患者更不可能患有SL(AOR，0.55；95%CI，0.50-0.61)，亚洲患者比白人患者更不可能患有SL(AOR，0.45；95%CI，0.36~0.56)，西班牙裔患者比非西班牙裔患者更少发生SL(AOR，0.88；95%CI，0.80~0.98)。结论大多数有物质相关诊断的患者至少有一个笔记包含SL。也有几个患者的特征差异与患者的笔记中的SL有关。这项工作表明，临床医生需要对SL的使用进行更多的干预。
ObjectiveThe language used to describe people with substance use disorder impacts stigma and influences clinical decision making. This study evaluates the presence of stigmatizing language (SL) in clinical notes and detects patient-and provider-level differences.MethodsAll free-text notes generated in a large health system for patients with substance-related diagnoses between December 2020 and November 2021 were included. A natural language processing algorithm using the National Institute on Drug Abuse’s “Words Matter” list was developed to identify use of SL in context.ResultsThere were 546,309 notes for 30,391 patients, of which 100,792 (18.4%) contained SL. A total of 18,727 patients (61.6%) had at least one note with SL. The most common SLs used were “abuse” and “substance abuse.” Nurses were least likely to use SL (4.1%) while physician assistants were most likely (46.9%). Male patients were more likely than female patients to have SL in their notes (adjusted odds ratio [aOR], 1.17; 95% confidence internal [CI], 1.11–1.23), younger patients aged 18 to 24 were less likely to have SL than patients 45 to 54 years (aOR, 0.55; 95% CI, 0.50–0.61), Asian patients were less likely to have SL than White patients (aOR, 0.45; 95% CI, 0.36–0.56), and Hispanic patients were less likely to have SL than non-Hispanic patients (aOR, 0.88; 95% CI, 0.80–0.98).ConclusionsThe majority of patients with substance-related diagnoses had at least one note containing SL. There were also several patient characteristic disparities associated with patients having SL in their notes. The work suggests that more clinician interventions about use of SL are needed.