College of Applied Health Sciences, University of Illinois at Urbana-Champaign, USA.
College of Applied Health Sciences, University of Illinois at Urbana-Champaign, USA.
Am J Emerg Med. 2022 May;55:167-173. doi: 10.1016/j.ajem.2022.02.043. Epub 2022 Feb 25.
To investigate the holistic characteristics of patients administered or prescribed opioids to treat pain in the emergency department (ED).
We used National Hospital Ambulatory Medical Care Survey (NHAMCS) data for 2018 to examine the administration and prescribing of opioids for pain-related ED visits. Weighted logistic regression models were developed to evaluate the association between opioid administration and prescribing (OAP) in the ED and patients' pain/severity of conditions, demographic/socioeconomic factors, behavioral factors, contextual factors, and organizational factors. Then, subgroup analyses were conducted by type of pain.
Nearly 55% of the ED visits in 2018 involved pain as a main reason for visiting the ED. The odds of receiving opioids were 45% less in black patients than in white patients when other covariates were adjusted (OR: 0.55; CI: 0.430-0.703). Compared to patients with private insurance, Medicaid beneficiaries and uninsured/self-pay patients had a 45% (OR: 0.55; CI: 0.423-0.706) and 44% (OR: 0.56; CI: 0.386-0.813) lower chance of receiving or being prescribed opioids for a pain-related ED visit when all covariates were adjusted. Other significant predictors of OAP for pain in EDs included older age, higher pain level, ED arrival by ambulance, admission to hospital, ED arrival during a night shift, geographic region of the ED. Behavioral factors, such as ED return within 72 h and whether a patient has substance/alcohol abuse or dependence, were not significantly associated with OAP. The subgroup analysis indicated that black patients had lower odds of OAP than their white counterparts only for certain pain categories.
Despite increasing awareness of potential implicit bias in managing pain in the ED, racial disparities in OAP still existed. More education and training on implicit bias would help with reduce the disparities. Also, our study result indicated that non-clinical factors may play a role in emergency physicians' decision making in OAP. Increased recognition of the variation and systemic efforts to address factors affecting the variability are needed.
调查在急诊科（ED）接受或开具阿片类药物治疗疼痛的患者的整体特征。
我们使用 2018 年国家医院门诊医疗调查（NHAMCS）数据，检查 ED 中与疼痛相关的就诊时阿片类药物的管理和开具情况。采用加权逻辑回归模型评估 ED 中阿片类药物管理和开具（OAP）与患者疼痛/病情严重程度、人口统计学/社会经济因素、行为因素、环境因素和组织因素之间的关联。然后，按疼痛类型进行亚组分析。
2018 年，近 55%的 ED 就诊是因为疼痛作为就诊的主要原因。在调整其他协变量后，黑人患者接受阿片类药物的可能性比白人患者低 45%（OR：0.55；95%CI：0.430-0.703）。与有私人保险的患者相比，医疗补助受益人和无保险/自付的患者在调整所有协变量后，接受或开具阿片类药物治疗与疼痛相关的 ED 就诊的可能性分别降低了 45%（OR：0.55；95%CI：0.423-0.706）和 44%（OR：0.56；95%CI：0.386-0.813）。ED 中 OAP 的其他显著预测因素包括年龄较大、疼痛程度较高、乘坐救护车到达 ED、住院、夜间 shift 到达 ED、ED 所在地区。行为因素，如 72 小时内 ED 复诊以及患者是否有物质/酒精滥用或依赖，与 OAP 无显著关联。亚组分析表明，只有在某些疼痛类别中，黑人患者接受 OAP 的可能性才低于白人患者。
尽管人们越来越意识到在 ED 管理疼痛方面可能存在潜在的隐性偏见，但 OAP 方面仍存在种族差异。更多关于隐性偏见的教育和培训将有助于减少这种差异。此外，我们的研究结果表明，非临床因素可能在急诊医生的 OAP 决策中发挥作用。需要进一步认识到这种变异性，并系统地努力解决影响变异性的因素。
