Racial Differences in Opiate Administration for Pain Relief at an Academic Emergency Department
Introduction: The decision to treat pain in the emergency department (ED) is a complex, idiosyncratic process. Prior studies have shown that EDs undertreat pain. Several studies demonstrate an association between analgesia administration and race. This is the first Midwest single institution study t...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
eScholarship Publishing, University of California
2015-05-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | http://escholarship.org/uc/item/9nq4v967 |
| _version_ | 1817968864525287424 |
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| author | Dickason, R. Myles Chauhan, Vijai Mor, Astha Ibler, Erin Kuehnle, Sarah Mahoney, Daren Armbrecht, Eric Dalawari, Preeti |
| author_facet | Dickason, R. Myles Chauhan, Vijai Mor, Astha Ibler, Erin Kuehnle, Sarah Mahoney, Daren Armbrecht, Eric Dalawari, Preeti |
| author_sort | Dickason, R. Myles |
| collection | DOAJ |
| description | Introduction: The decision to treat pain in the emergency department (ED) is a complex, idiosyncratic process. Prior studies have shown that EDs undertreat pain. Several studies demonstrate an association between analgesia administration and race. This is the first Midwest single institution study to address the question of race and analgesia, in addition to examining the effects of both patient and physician characteristics on race-based disparities in analgesia administration.
Methods: This was a retrospective chart review of patients presenting to an urban academic ED with an isolated diagnosis of back pain, migraine, or long bone fracture (LBF) from January 1, 2007 to December 31, 2011. Demographic and medication administration information was collected from patient charts by trained data collectors blinded to the hypothesis of the study. The primary outcome was the proportion of African-Americans who received analgesia and opiates, as compared to Caucasians, using Pearson’s chi-squared test. We developed a multiple logistic regression model to identify which physician and patient characteristics correlated with increased opiate administration.
Results: Of the 2,461 patients meeting inclusion criteria, 57% were African-American and 30% Caucasian (n=2136). There was no statistically significant racial difference in the administration of any analgesia (back pain: 86% vs. 86%, p=0.81; migraine: 83% vs. 73%, p=0.09; LBF: 94% vs. 90%, p=0.17), or in opiate administration for migraine or LBF. African-Americans who presented with back pain were less likely to receive an opiate than Caucasians (50% vs. 72%, p<0.001). Secondary outcomes showed that higher acuity, older age, physician training in emergency medicine, and male physicians were positively associated with opiate administration. Neither race nor gender patient-physician congruency correlated with opiate administration.
Conclusion: No race-based disparity in overall analgesia administration was noted for all three conditions: LBF, migraine, and back pain at this institution. A race-based disparity in the likelihood of receiving opiate analgesia for back pain was observed in this ED. The etiology of this is likely multifactorial, but understanding physician and patient characteristics of institutions may help to decrease the disparity by raising awareness of practice patterns and can provide the basis for quality improvement projects. [West J Emerg Med. 2015;16(3):372–380.] |
| first_indexed | 2024-04-13T20:13:21Z |
| format | Article |
| id | doaj.art-0ddbef9ae693477994d9b9cba81b17f1 |
| institution | Directory Open Access Journal |
| issn | 1936-900X 1936-9018 |
| language | English |
| last_indexed | 2024-04-13T20:13:21Z |
| publishDate | 2015-05-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-0ddbef9ae693477994d9b9cba81b17f12022-12-22T02:31:46ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182015-05-0116337238010.5811/westjem.2015.3.23893Racial Differences in Opiate Administration for Pain Relief at an Academic Emergency DepartmentDickason, R. Myles 0Chauhan, Vijai 1Mor, Astha2Ibler, Erin3Kuehnle, Sarah 4Mahoney, Daren 5Armbrecht, Eric 6Dalawari, Preeti 7New York Hospital Queens, Department of Emergency Medicine, Flushing, New YorkSaint Louis University School of Medicine, Division of Emergency Medicine, St. Louis, MissouriSaint Louis University School of Medicine, Division of Emergency Medicine, St. Louis, MissouriSt. Luke’s Roosevelt Hospital Center, Department of Surgery, New York, New YorkMaricopa Medical Center, Department of Emergency Medicine, Phoenix, ArizonaUniversity of Nevada School of Medicine, Department of Emergency Medicine, Las Vegas, NevadaUniversity of Nevada School of Medicine, Department of Emergency Medicine, Las Vegas, NevadaSaint Louis University School of Medicine, Division of Emergency Medicine, St. Louis, MissouriIntroduction: The decision to treat pain in the emergency department (ED) is a complex, idiosyncratic process. Prior studies have shown that EDs undertreat pain. Several studies demonstrate an association between analgesia administration and race. This is the first Midwest single institution study to address the question of race and analgesia, in addition to examining the effects of both patient and physician characteristics on race-based disparities in analgesia administration. Methods: This was a retrospective chart review of patients presenting to an urban academic ED with an isolated diagnosis of back pain, migraine, or long bone fracture (LBF) from January 1, 2007 to December 31, 2011. Demographic and medication administration information was collected from patient charts by trained data collectors blinded to the hypothesis of the study. The primary outcome was the proportion of African-Americans who received analgesia and opiates, as compared to Caucasians, using Pearson’s chi-squared test. We developed a multiple logistic regression model to identify which physician and patient characteristics correlated with increased opiate administration. Results: Of the 2,461 patients meeting inclusion criteria, 57% were African-American and 30% Caucasian (n=2136). There was no statistically significant racial difference in the administration of any analgesia (back pain: 86% vs. 86%, p=0.81; migraine: 83% vs. 73%, p=0.09; LBF: 94% vs. 90%, p=0.17), or in opiate administration for migraine or LBF. African-Americans who presented with back pain were less likely to receive an opiate than Caucasians (50% vs. 72%, p<0.001). Secondary outcomes showed that higher acuity, older age, physician training in emergency medicine, and male physicians were positively associated with opiate administration. Neither race nor gender patient-physician congruency correlated with opiate administration. Conclusion: No race-based disparity in overall analgesia administration was noted for all three conditions: LBF, migraine, and back pain at this institution. A race-based disparity in the likelihood of receiving opiate analgesia for back pain was observed in this ED. The etiology of this is likely multifactorial, but understanding physician and patient characteristics of institutions may help to decrease the disparity by raising awareness of practice patterns and can provide the basis for quality improvement projects. [West J Emerg Med. 2015;16(3):372–380.]http://escholarship.org/uc/item/9nq4v967 |
| spellingShingle | Dickason, R. Myles Chauhan, Vijai Mor, Astha Ibler, Erin Kuehnle, Sarah Mahoney, Daren Armbrecht, Eric Dalawari, Preeti Racial Differences in Opiate Administration for Pain Relief at an Academic Emergency Department Western Journal of Emergency Medicine |
| title | Racial Differences in Opiate Administration for Pain Relief at an Academic Emergency Department |
| title_full | Racial Differences in Opiate Administration for Pain Relief at an Academic Emergency Department |
| title_fullStr | Racial Differences in Opiate Administration for Pain Relief at an Academic Emergency Department |
| title_full_unstemmed | Racial Differences in Opiate Administration for Pain Relief at an Academic Emergency Department |
| title_short | Racial Differences in Opiate Administration for Pain Relief at an Academic Emergency Department |
| title_sort | racial differences in opiate administration for pain relief at an academic emergency department |
| url | http://escholarship.org/uc/item/9nq4v967 |
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