Disparities in analgesia and opioid prescribing practices for patients with musculoskeletal pain in the emergency department
Disparities in analgesia and opioid prescribing practices for patients with musculoskeletal pain in the emergency department
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DOI：
10.1016/j.jen.2006.01.010
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发表时间：
2006-06-01
影响因子：
1.7
通讯作者：
Mishra, Satya
中科院分区：
文献类型：
--
作者：
Heins, Janet Kaye;Heins, Alan;Mishra, Satya
前言：《2010年健康人口》力求消除保健方面的种族和族裔差异；然而，由于年龄和种族的差异，已经描述了急诊科的疼痛治疗。虽然疼痛是急诊科常见的病人主诉，但许多人没有接受止痛治疗。本研究考察了患者和提供者特征对急症和出院镇痛以及阿片类药物处方做法的影响。方法：本描述性研究对18岁及以上出现肌肉骨骼疼痛并接受核心ED治疗的ED患者的选定变量进行了图表回顾。进行逻辑回归分析，以确定是否存在镇痛和阿片类药物处方差异，并受患者和提供者特征的影响。结果：共检查病例868例。医生的特点和实践中的广泛差异是急诊室镇痛药处方差异的唯一来源，但包括种族、年龄、慢性疼痛和创伤在内的患者特征影响了急诊科阿片类药物和出院镇痛药的处方。没有发现性别或经济状况的差异。黑人患者的阿片类药物和出院镇痛药处方少于白人患者。与老年患者和无创伤或慢性疼痛的患者相比，年轻患者、有创伤的患者和有慢性疼痛的患者使用更多的阿片类药物和出院镇痛药。完成急诊医学实习且经验不足3年的医生在急诊科开了更多的镇痛药。讨论：我们急诊科的疼痛管理有很大的差异，根据病人和医生的特点有一些差异。需要多中心前瞻性研究来验证这些发现，并检查关于疼痛及其管理的知识和态度的发展。护士发起的镇痛方案可能有助于改善和规范ED疼痛护理。
Introduction: Healthy People 2010 seeks to eliminate racial and ethnic disparities in health care; however, disparities due to age and race have been described in emergency department pain treatment. Although pain is a common patient complaint in emergency departments, many people receive no analgesia. This study examined the influence of patient and provider characteristics on ED and discharge analgesia and opioid prescribing practices.Methods: This descriptive study used chart review of selected variables from ED patients 18 years and older who presented with musculoskeletal pain and were treated by core ED faculty. Logistic regression analyses were performed to determine whether analgesia- and opioid-prescribing disparities existed and were influenced by patient and provider characteristics.Results: A total of 868 patient records were examined. Physician characteristics and wide variation in practice were the only sources of disparities in the prescription of analgesics in the emergency department, but patient characteristics including race, age, chronic pain, and trauma influenced prescription of ED opioids and discharge analgesics. No gender or financial status disparities were found. Fewer opioids and discharge analgesics were prescribed for black patients than for white patients. Younger patients, those with trauma, and those with chronic pain received more opioids and discharge analgesics compared with older patients and those without trauma or chronic pain. Providers who completed emergency medicine residencies and had fewer than 3 years' experience prescribed more analgesics in the emergency department.Discussion: Pain management in our emergency department is widely variable, with some disparities based on patient and physician characteristics. Multicenter prospective studies are needed to validate these findings and examine knowledge and attitude development about pain and its management. Protocols for nurse-initiated analgesia may help improve and standardize ED pain care.