University of Pennsylvania School of Nursing.
Duke University School of Nursing.
J Am Assoc Nurse Pract. 2022 Jul 1;34(7):883-890. doi: 10.1097/JXX.0000000000000728.
Evidence exists on racial and gender disparities in chronic pain management among veterans. Most literature has described physicians' disparate opioid prescribing patterns, although it is unknown if prescribing disparities exist among nurse practitioners (NPs) and physician assistants (PAs) or among prescription of nonopioid analgesic strategies.
To identify patient characteristics associated with opioid and nonopioid prescriptions among Veterans Affairs (VA) chronic pain patients by primary care physicians, NPs, and PAs.
We used data from the VA's Survey of Health care Experience of Patients and Corporate Data Warehouse from October 2015 to September 2016. Outcomes included opioid and nonopioid analgesic prescriptions. Patient characteristics included race/ethnicity, gender, education level, age, and clinical characteristics (comorbidities, self-reported health, and self-reported mental health). Logistic regression was performed to test for associations of patient characteristics with outcomes.
Patients who were White, male, age 41-64 years, and with no postsecondary education had higher odds of receiving an opioid prescription (all p -values ≤ .01), whereas patients who were Black, female, and <65 years old had higher odds of a nonopioid prescription (all p -values < .01). Having 5+ comorbidities and fair/poor self-reported health increased the odds of opioid and nonopioid prescriptions (all p -values < .01).
Disparities in race, gender, and educational level significantly affect how primary care NPs, PAs, and physicians manage chronic pain.
NPs and other primary care providers should pursue training opportunities to identify and mitigate potential biases that may affect their practice. Future research should take an intersectional lens in examining the source of chronic pain disparities.
退伍军人的慢性疼痛管理中存在种族和性别差异的证据。大多数文献描述了医生之间差异很大的阿片类药物处方模式，尽管尚不清楚在执业护士（NP）和医师助理（PA）或非阿片类镇痛策略的处方中是否存在差异。
通过初级保健医生、NP 和 PA 确定与退伍军人事务部（VA）慢性疼痛患者的阿片类药物和非阿片类药物处方相关的患者特征。
我们使用了 VA 患者健康体验调查和公司数据仓库的数据，时间从 2015 年 10 月至 2016 年 9 月。结果包括阿片类药物和非阿片类药物镇痛处方。患者特征包括种族/民族、性别、教育程度、年龄和临床特征（合并症、自我报告的健康状况和自我报告的心理健康状况）。进行逻辑回归以检验患者特征与结果之间的关联。
白人、男性、41-64 岁、没有中学后教育的患者接受阿片类药物处方的可能性更高（所有 p 值均≤.01），而黑人、女性和<65 岁的患者接受非阿片类药物处方的可能性更高（所有 p 值均<.01）。有 5 种或更多合并症和健康状况自评一般/差会增加阿片类药物和非阿片类药物处方的可能性（所有 p 值均<.01）。
种族、性别和教育水平的差异显著影响初级保健 NP、PA 和医生管理慢性疼痛的方式。
NP 和其他初级保健提供者应寻求培训机会，以识别和减轻可能影响其实践的潜在偏见。未来的研究应从交叉视角审视慢性疼痛差异的根源。
