Disparities in Opioid Pain Management for Long Bone Fractures

Benzing, Adam; Bell, Courtney D.; Derazin, Megan; Mack, Rene; MacIntosh, Tracy

doi:10.1007/s40615-020-00701-1

Cited by 26 publications

(34 citation statements)

References 29 publications

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“…Other surveys found negative attitudes or concerns regarding prescription opioid use disorder but beliefs in potential effectiveness of opioids for treating pain and support for policies and guidelines aimed at mitigating risks, with increased confidence when following “best practices” ( 41 – 43 ). Regarding patient preferences and values, a new systematic review found that among various opioid-related outcomes (effects), patients ranked pain relief, nausea, and vomiting as most important, followed by constipation ( 44 ). “Addiction” was only evaluated in two studies and rated as less important than pain relief.…”

Section: Primary Clinical Questionsmentioning

confidence: 99%

CDC Clinical Practice Guideline for Prescribing Opioids for Pain—United States, 2022

Dowell¹,

Ragan²,

Jones³

et al. 2022

MMWR Recomm. Rep.

650

465

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Summary This guideline provides recommendations for clinicians providing pain care, including those prescribing opioids, for outpatients aged ≥18 years. It updates the CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016 (MMWR Recomm Rep 2016;65[No. RR-1]:1–49) and includes recommendations for managing acute (duration of <1 month), subacute (duration of 1–3 months), and chronic (duration of >3 months) pain. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care. The guideline addresses the following four areas: 1) determining whether or not to initiate opioids for pain, 2) selecting opioids and determining opioid dosages, 3) deciding duration of initial opioid prescription and conducting follow-up, and 4) assessing risk and addressing potential harms of opioid use. CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Recommendations are based on systematic reviews of the scientific evidence and reflect considerations of benefits and harms, patient and clinician values and preferences, and resource allocation. CDC obtained input from the Board of Scientific Counselors of the National Center for Injury Prevention and Control (a federally chartered advisory committee), the public, and peer reviewers. CDC recommends that persons with pain receive appropriate pain treatment, with careful consideration of the benefits and risks of all treatment options in the context of the patient’s circumstances. Recommendations should not be applied as inflexible standards of care across patient populations. This clinical practice guideline is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death.

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Section: Primary Clinical Questionsmentioning

confidence: 99%

CDC Clinical Practice Guideline for Prescribing Opioids for Pain—United States, 2022

Dowell¹,

Ragan²,

Jones³

et al. 2022

MMWR Recomm. Rep.

650

465

View full text Add to dashboard Cite

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“…International evidence illustrates how racial and ethnic groups experience disparities in triage scores, 14 radiographic assessment, 15 coronary angiography, 16 surgical waiting times 17 and analgesia recommendations. 18 Studies have shown that Indigenous Australians have a higher admission rate, 19 greater severity of illness 19 and higher burden of cardiometabolic comorbidities. 20 Additionally, Indigenous Australians have a reduced life expectancy and Australian Indigenous children have twice the mortality rate of non-Indigenous children.…”

Section: Introductionmentioning

confidence: 99%

Review article: Implicit bias towards Aboriginal and Torres Strait Islander patients within Australian emergency departments

Quigley

Hutton

Phillips

et al. 2020

Emerg Medicine Australasia

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Aboriginal and Torres Strait Islander peoples continue to suffer adverse experiences in healthcare, with inequitable care prevalent in emergency settings. Individual, institutional and systemic factors play a significant part in these persisting healthcare disparities, with biases remaining entrenched in healthcare institutions. This includes implicit racial bias which can result in stereotyping of racial minorities and premature diagnostic closure. Furthermore, it may contribute to distrust of medical professionals resulting in higher rates of leave events and hinder racial minorities from seeking care or following treatment recommendations. The aim of this review is to analyse the effect of implicit bias on patient outcomes in the ED in international literature and explore how these studies correlate to an Australian context.

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“…Inequity undoes the fiction of objective science and illuminates how EC is profoundly impacted by the social, commercial and political constructs surrounding ourselves, our workplaces and our patients. All clinical care provision is open to influence: analgesia is racially administered, 7 coronary syndromes altered by gender 8 and sepsis complicated by living conditions 9 . The ICEM22 statement calls for diversity and inclusion among the global EC community, as a foundation for better knowledge, advocacy and equity for our patients.…”

Section: Competing Interestsmentioning

confidence: 99%