阿片类药物相关诊断编码下的医院内科就诊中出现污名化记录：队列研究。
Occurrence of Stigmatizing Documentation Among Hospital Medicine Encounters With Opioid-Related Diagnosis Codes: Cohort Study.
机构信息
Division of Infectious Diseases, University of Alabama Birmingham, Birmingham, AL, United States.
School of Nursing, University of Alabama Birmingham, Birmingham, AL, United States.
出版信息
JMIR Form Res. 2024 Oct 24;8:e53510. doi: 10.2196/53510.
BACKGROUND
Physician use of stigmatizing language in the clinical documentation of hospitalized adults with opioid use is common. However, patient factors associated with stigmatizing language in this setting remain poorly characterized.
OBJECTIVE
This study aimed to determine whether specific demographic factors and clinical outcomes are associated with the presence of stigmatizing language by physicians in the clinical documentation of encounters with opioid-related ICD-10 (International Statistical Classification of Diseases, Tenth Revision) codes.
METHODS
Hospital encounters with one or more associated opioid-related ICD-10 admission diagnoses on the hospital medicine service during the 2020 calendar year were analyzed for the presence of stigmatizing language in history and physical and discharge summaries. Multivariable adjusted logistic regression models were used to determine associations of age, race, gender, medication for addiction treatment use, against medical advice discharge, homelessness, comorbid polysubstance use, comorbid psychiatric disorder, comorbid chronic pain, cost, and 30-day readmission with the presence of stigmatizing language.
RESULTS
A total of 221 encounters were identified, of which 64 (29%) encounters had stigmatizing language present in physician documentation. Most stigmatizing language was due to use of "substance abuse" rather than the preferred term "substance use" (63/66 instances). Polysubstance use and homelessness were independently associated with the presence of stigmatizing language (adjusted odds ratio [aOR] 7.83; 95% CI 3.42-19.24 and aOR 2.44; 95% CI 1.03-5.90) when controlling for chronic pain and other covariates.
CONCLUSIONS
Among hospital medicine encounters with an opioid-related diagnosis, stigmatizing language by physicians in clinical documentation was common and independently associated with comorbid polysubstance use and homelessness.
背景
在住院的阿片类药物使用者的临床文档中，医生使用污名化语言的情况很常见。然而，在这种情况下，与污名化语言相关的患者因素仍未得到充分描述。
目的
本研究旨在确定特定的人口统计学因素和临床结局是否与医生在与阿片类药物相关的 ICD-10（国际疾病分类，第十版）代码相关的就诊记录中的污名化语言的存在有关。
方法
对 2020 年全年在医院内科服务中出现一个或多个与阿片类药物相关的 ICD-10 入院诊断的住院就诊记录进行分析，以确定病史、体检和出院小结中是否存在污名化语言。采用多变量调整逻辑回归模型，确定年龄、种族、性别、阿片类药物治疗药物使用、未经医嘱出院、无家可归、共患多种物质使用障碍、共患精神障碍、共患慢性疼痛、费用和 30 天再入院与污名化语言存在的关联。
结果
共确定了 221 次就诊，其中 64 次（29%）就诊记录中医生的记录中有污名化语言。大多数污名化语言是由于使用了“药物滥用”而不是首选术语“药物使用”（66 例中的 63 例）。共患多种物质使用障碍和无家可归与污名化语言的存在独立相关（调整后的优势比[aOR] 7.83；95%置信区间[CI] 3.42-19.24 和 aOR 2.44；95%CI 1.03-5.90），在控制慢性疼痛和其他混杂因素后。
结论
在与阿片类药物相关诊断相关的内科就诊中，医生在临床记录中使用污名化语言很常见，并且与共患多种物质使用障碍和无家可归独立相关。
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