Patient race and physicians' decisions to prescribe opioids for chronic low back pain
Patient race and physicians' decisions to prescribe opioids for chronic low back pain
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DOI：
10.1016/j.socscimed.2008.09.009
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发表时间：
2008-12-01
影响因子：
5.4
通讯作者：
van Ryn, Michelle
中科院分区：
文献类型：
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作者：
Burgess, Diana Jill;Crowley-Matoka, Megan;van Ryn, Michelle
非白人患者比白人患者的疼痛得到充分治疗的可能性更小。这项研究考察了患者种族和患者的语言和非语言行为对初级保健医生对男性慢性下腰痛治疗决策的影响。我们随机分配医生接受一名慢性疼痛患者的纸质临床小品，这些小品在患者种族(白人与黑人)、语言行为(“挑战性”与“非挑战性”)和非语言行为(自信与沮丧与愤怒)方面存在差异。我们采用受试者间析因设计，从美国医学协会医师档案中随机抽取382名初级保健医师进行调查。主要的依赖性衡量标准是医生决定(S)是否会将患者转换为更大剂量或更强类型的阿片类药物。Logistic回归用于确定患者特征对医生处方决策的影响。在医生开阿片类药物的决定上，患者的言语行为和患者的种族之间存在显著的交互作用。在黑人患者中，医生明显更有可能表示，与那些表现出“非挑战性”行为的患者(55.1%)相比，对于表现出“挑战性”行为(例如，要求特定的麻醉剂、表现出愤怒)的患者，他们会改用更大剂量或更强的阿片类药物。对于白人患者，结果是相反的模式，即医生更有可能对表现出“非挑战性”(64.3%)与“挑战性”(54.5%)言语行为的患者进行升级治疗。结果表明，需要更好地理解非临床特征的复杂相互作用如何影响医生的行为，以提高疼痛管理和其他临床决策的质量。爱思唯尔有限公司出版。
Nonwhite patients are less likely than white patients to have their pain adequately treated. This study examined the influence of patient race and patient verbal and nonverbal behavior on primary care physicians' treatment decisions for chronic low back pain in men. We randomly assigned physicians to receive a paper-based, clinical vignette of a chronic pain patient that differed in terms of patient race (white vs. black), verbal behavior ("challenging" vs. "non-challenging"), and nonverbal behavior (confident vs. dejected vs. angry). We employed a between-subjects factorial design and surveyed primary care physicians (N = 382), randomly selected from the American Medical Association Physician Masterfile. The primary dependent measure was the physician's decision as to whether (s)he would switch the patient to a higher dose or stronger type of opioid. Logistic regression was used to determine the effects of patient characteristics on physicians' prescribing decisions. There was a significant interaction between patient verbal behavior and patient race on physicians' decisions to prescribe opioids. Among black patients, physicians were significantly more likely to state that they would switch to a higher dose or stronger opioid for patients exhibiting "challenging" behaviors (e.g., demanding a specific narcotic, exhibiting anger) compared to those exhibiting "non-challenging" behaviors (55.1%). For white patients there was an opposite pattern of results in which physicians were slightly more likely to escalate treatment for patients exhibiting "non-challenging" (64.3%) vs. "challenging" (54.5%) verbal behaviors. Results point to the need for better understanding of the way a complex interplay of non-clinical characteristics affects physician behavior in order to improve quality of pain management and other clinical decision-making. Published by Elsevier Ltd.