审视疼痛与损伤急诊治疗中的种族、民族和性别差异。
Examining Racial, Ethnic, and Gender Disparities in the Treatment of Pain and Injury Emergencies.
作者信息
Wimbish Laurel A, Simpson Janelle R, Gilbert Lauren R, Blackwood Andria, Grant Emily A
机构信息
Wyoming Survey & Analysis Center, University of Wyoming, Laramie, WY.
Health Systems and Population Health Sciences, University of Houston, Houston, TX.
出版信息
HCA Healthc J Med. 2022 Jun 28;3(3):111-118. doi: 10.36518/2689-0216.1425. eCollection 2022.
BACKGROUND
Racial, ethnic, and gender disparities in effective pain management have been well-documented across healthcare settings. However, discrepancies in the treatment of patients in prehospital pain management settings have not been well researched. The objective of this study was to determine whether Wyoming emergency medical service (EMS) providers' use of opioids to treat prehospital pain or injury varies by patient race/ethnicity or gender.
METHODS
This cross-sectional study of EMS records examined 27 448 patient care reports (PCRs) generated during emergency medical responses to pain/injury emergencies in the state of Wyoming between January 2016 and March 2019. We included PCRs in the sample when 1) the primary impression was pain or injury, 2) the type of service was a 911 response, 3) the patient received treatment from and was transported by the EMS unit completing the PCR, and 4) the responding unit included one or more providers authorized to administer opioids.
RESULTS
The analysis identified a disparity in opioid administration by EMS providers during emergency transport (N = 27 448). Logistic regression reveals that EMS providers administered opioids to American Indian/Alaska Native patients (AI/AN) [n = 1610; 5.9%; < .001; OR = 0.44] and those of Hispanic ethnicity (n = 1351; 4.9%; = .001; OR = 0.74) at statistically significant lower rates (n = 14 769; 53.8%; = .004; OR = 0.90) than they administer opioids to White patients. The analysis found EMS providers administer opioids to females at significantly lower rates ( = .004) compared to males.
CONCLUSION
Wyoming EMS providers administer opioids to White and male patients more often than non-White and female patients. Our results do not show a significant difference in the administration of opioids between White and Black patients. However, the data indicate a statistically significant difference between Hispanic, AI/AN, and White patients as well as between male and female patients.
背景
在各个医疗环境中，有效疼痛管理方面的种族、民族和性别差异已有充分记录。然而，院前疼痛管理环境中患者治疗的差异尚未得到充分研究。本研究的目的是确定怀俄明州紧急医疗服务（EMS）提供者使用阿片类药物治疗院前疼痛或损伤是否因患者种族/民族或性别而异。
方法
这项对EMS记录的横断面研究检查了2016年1月至2019年3月期间怀俄明州对疼痛/损伤紧急情况进行紧急医疗响应时生成的27448份患者护理报告（PCR）。当满足以下条件时，我们将PCR纳入样本：1）主要诊断为疼痛或损伤；2）服务类型为911响应；3）患者接受完成PCR的EMS单位的治疗并由其运送；4）响应单位包括一名或多名有权使用阿片类药物的提供者。
结果
分析发现EMS提供者在紧急运输期间使用阿片类药物存在差异（N = 27448）。逻辑回归显示，EMS提供者向美国印第安人/阿拉斯加原住民患者（AI/AN）[n = 1610；5.9%；< .001；OR = 0.44]和西班牙裔患者（n = 1351；4.9%； = .001；OR = 0.74）使用阿片类药物的比例在统计学上显著低于向白人患者使用阿片类药物的比例（n = 14769；53.8%； = .004；OR = 0.90）。分析发现，与男性相比，EMS提供者向女性使用阿片类药物的比例显著较低（ = .004）。
结论
怀俄明州的EMS提供者向白人和男性患者使用阿片类药物的频率高于非白人和女性患者。我们的结果未显示白人和黑人患者在使用阿片类药物方面存在显著差异。然而，数据表明西班牙裔、AI/AN和白人患者之间以及男性和女性患者之间在使用阿片类药物方面存在统计学上的显著差异。
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