Racial-Ethnic Disparities in Opioid Prescriptions at Emergency Department Visits for Conditions Commonly Associated with Prescription Drug Abuse
Racial-Ethnic Disparities in Opioid Prescriptions at Emergency Department Visits for Conditions Commonly Associated with Prescription Drug Abuse
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DOI：
10.1371/journal.pone.0159224
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发表时间：
2016-08-08
期刊：
影响因子：
3.7
通讯作者：
Hsia, Renee Y.
中科院分区：
文献类型：
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作者：
Singhal, Astha;Tien, Yu-Yu;Hsia, Renee Y.
处方药滥用在全国范围内是一个日益严重的问题。为了遏制这个问题，急诊医生在为与疼痛相关的投诉开阿片类药物处方时，尤其是在通常与寻求药物行为相关的情况下，可能会在不知不觉中依赖种族等主观线索。之前的研究调查了急诊科（ED）阿片类药物配药的种族差异，并没有区分出院时的处方和急诊室的药物管理。我们检查了急诊科就诊时因疼痛相关主诉（通常与寻药行为相关）阿片类药物处方的种族差异，并将其与客观与疼痛相关的情况进行了对比。我们先验假设，对于与非医疗用途相关的疾病，阿片类药物处方中将存在种族差异，但对于客观的疼痛相关疾病则不会。使用全国医院流动医疗调查五年（2007-2011）的数据，对 18-65 岁的非老年人因“非明确”病症（牙痛、背痛和腹痛）或“明确”病症（长骨骨折和肾结石）在急诊就诊期间开阿片类药物的几率进行了建模。出院时的阿片类药物处方和急诊科的阿片类药物给药是主要结果。我们发现存在显着的种族差异，调整其他协变量后，与非西班牙裔白人相比，与非西班牙裔白人相比，非西班牙裔黑人在出院时因背痛和腹痛而接受阿片类药物处方的可能性较小（调整后的比值比范围为 0.56-0.67，p 值 < 0.05），但对于牙痛、骨折和肾结石则不然。按种族对阿片类药物的不同处方可能会导致现有健康差异的扩大，并可能对白人中阿片类药物滥用的不成比例的负担产生影响。研究结果对医疗提供者教育具有重要意义，包括针对其固有偏见的敏感性练习，使他们能够在定义其实践行为时有意识地避免这些偏见。
Prescription drug abuse is a growing problem nationally. In an effort to curb this problem, emergency physicians might rely on subjective cues such as race-ethnicity, often unknowingly, when prescribing opioids for pain-related complaints, especially for conditions that are often associated with drug-seeking behavior. Previous studies that examined racial-ethnic disparities in opioid dispensing at emergency departments (EDs) did not differentiate between prescriptions at discharge and drug administration in the ED. We examined racialethnic disparities in opioid prescription at ED visits for pain-related complaints often associated with drug-seeking behavior and contrasted them with conditions objectively associated with pain. We hypothesized a priori that racial-ethnic disparities will be present among opioid prescriptions for conditions associated with non-medical use, but not for objective pain-related conditions. Using data from the National Hospital Ambulatory Medical Care Survey for 5 years (2007-2011), the odds of opioid prescription during ED visits made by non-elderly adults aged 18-65 for 'non-definitive' conditions (toothache, back pain and abdominal pain) or 'definitive' conditions (long-bone fracture and kidney stones) were modeled. Opioid prescription at discharge and opioid administration at the ED were the primary outcomes. We found significant racial-ethnic disparities, with non-Hispanic Blacks being less likely (adjusted odds ratio ranging from 0.56-0.67, p-value < 0.05) to receive opioid prescription at discharge during ED visits for back pain and abdominal pain, but not for toothache, fractures and kidney stones, compared to non-Hispanic whites after adjusting for other covariates. Differential prescription of opioids by race-ethnicity could lead to widening of existing disparities in health, and may have implications for disproportionate burden of opioid abuse among whites. The findings have important implications for medical provider education to include sensitization exercises towards their inherent biases, to enable them to consciously avoid these biases from defining their practice behavior.