Impact of Physician and Patient Gender on Pain Management in the Emergency Department—A Multicenter Study

Safdar, Basmah; Heins, Alan; Homel, Peter; Miner, James R.; Neighbor, Martha L.; DeSandre, Paul; Todd, Knox H.

doi:10.1111/j.1526-4637.2008.00524.x

Cited by 121 publications

(105 citation statements)

References 41 publications

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“…Bell & Hudson, 2001;Criste, 2003;Turk & Okifuji, 1999;van Lennep et al, 1999), and still a few others have shown biases against men (e.g. Bergelson & Tommaso, 1995;Blum, Slade, Boden, Cabin, & Caulin-Glaser, 2004;Safdar et al, 2006). In a nutshell, the pattern of results seems inconclusive.…”

Section: Introductionmentioning

confidence: 62%

A contextual approach on sex-related biases in pain judgements: The moderator effects of evidence of pathology and patients’ distress cues on nurses’ judgements of chronic low-back pain

Bernardes

Lima

2011

Psychology & Health

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Section: Introductionmentioning

confidence: 62%

A contextual approach on sex-related biases in pain judgements: The moderator effects of evidence of pathology and patients’ distress cues on nurses’ judgements of chronic low-back pain

Bernardes

Lima

2011

Psychology & Health

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“…This pattern emerges both in vignettes studies depicting chronic low-back pain patients (CLBP) 53,54 and in a prospective observational study of physicians' PMP in the ER. 48 . Therefore, like for primary-care preventive practices 10,12,21,49 , patient sex seems to have a different impact on male and female physicians' PMP.…”

Section: Introductionmentioning

confidence: 99%

Engendering Pain Management Practices: The Role of Physician Sex on Chronic Low-Back Pain Assessment and Treatment Prescriptions

Bernardes

Costa

Carvalho

2013

The Journal of Pain

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The impact of physician sex on dimensions of medical care such as treatment prescriptions and referrals has been underexplored, especially in a pain context. Also, few studies have analyzed whether physicians sex moderates the influence of patients' or clinical situations' characteristics on pain management practices or its mediating processes. Therefore, our goal was to explore whether physician sex moderates the: a) effects of patient's (distressed) pain behaviors and diagnostic evidence of pathology (EP) on treatment prescriptions and referrals for chronic low-back pain (CLBP), and b) mediating role of pain credibility judgments and psychological attributions on these effects. 310 general practitioners (GPs; 72.6% women) participated in a betweensubjects design, 2 (patient's pain behaviors) x 2 (EP) x 2 (GP sex) x 2 (patient sex). GPs were presented with vignettes depicting a fe(male) CLBP patient, with(out) distress and with(out) EP (e.g., herniated disc). GPs judged the patient's pain and the probability of treatment prescriptions and referrals. Results showed that EP had a larger effect on male than on female physicians' referrals to psychology/psychiatry. Also, GP sex moderated the pain judgments that accounted for the effect of EP and pain behaviors on prescriptions. These findings suggest framing medical decision making as a process influenced by gender assumptions. This is a postprint version of a manuscript published in THE JOURNAL OF PAIN available at http://dx.doi. org/10.1016/j.jpain.2013.03.004 3 Perspective This paper shows that physician sex moderates the influence of clinical cues on pain management practices and the mediating role of pain judgments on these effects. It may potentially increase clinicians' awareness of the influence of gender assumptions on pain management practices and contribute to the development of more gender sensitive services.

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“…They were influenced by either the gender or race of their patients [29]. Safdar et al reported that the gender of ED physicians influenced the quantity of opioid analgesics they prescribed to those of their same gender [23].…”

Section: Discussionmentioning

confidence: 99%

“…Many studies look at the effect of patient characteristics on the decision of the medical provider to prescribe pain medications [4,[15][16][17][18][19][20][21][22], but few describe the variability of prescribing habits of ED providers [23][24][25]. The objective of our study was to describe the opioid prescribing practices of physicians and PAs, to include civilian and military providers, in an emergency department when treating patients with a discharge diagnosis of chronic pain.…”

Section: Introductionmentioning

confidence: 99%

Emergency Department Opioid Prescribing Practices for Chronic Pain: a 3-Year Analysis

et al. 2014

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Chronic pain is a common reason for emergency department (ED) visits. Our objective was to describe opioid prescribing practices of ED providers when treating patients with chronic pain. We retrospectively evaluated opioid prescriptions from EDs at two tertiary care military hospitals. We queried the outpatient record database to obtain a list of opioid medications prescribed and ICD-9 codes associated with visits for chronic pain. We collected provider type and gender, number of pills, opioid type, and refills. We compared the incidence with chi-square or Fisher's exact tests. Wilcoxon test was used for non-parametric continuous variables. Over 3 years, 28,103 visits generated an opioid prescription. One thousand three hundred twenty-two visits were associated with chronic pain, and 443 (33 %) visits were associated with an opioid prescription. Providers were 79 % physicians, 19 % physician assistants (PAs), 81 % male, and 69 % active duty military. Medications were 43 % oxycodone, 30 % hydrocodone, 9.5 % tramadol, 2.5 % codeine, and 15 % other. The number of pills was 20 [interquartile range (IQR) 15-30] (range 1-240), morphine equivalents (M.E.) per pill was 7.5 [7.5-7.5] (2.5-120) and total M.E. per prescription was 150 [112.5-270] (15-6000). Physicians were more likely to prescribe a non-opioid than PAs (77 vs 45 %, p< 0.0001). Civilian providers were more likely to prescribe an opioid than active duty providers (58 vs 42 %, p<0.0001). Providers prescribed a median of 20 pills per prescription and most commonly prescribed oxycodone. PAs were more likely to prescribe an opioid for chronic pain than physicians. Civilian providers were more likely to prescribe an opioid than active duty providers.

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Impact of Physician and Patient Gender on Pain Management in the Emergency Department—A Multicenter Study

Abstract: Provider gender as opposed to patient gender appears to influence pain management decisions in the ED.

Cited by 121 publications

References 41 publications

A contextual approach on sex-related biases in pain judgements: The moderator effects of evidence of pathology and patients’ distress cues on nurses’ judgements of chronic low-back pain

A contextual approach on sex-related biases in pain judgements: The moderator effects of evidence of pathology and patients’ distress cues on nurses’ judgements of chronic low-back pain

Engendering Pain Management Practices: The Role of Physician Sex on Chronic Low-Back Pain Assessment and Treatment Prescriptions

Emergency Department Opioid Prescribing Practices for Chronic Pain: a 3-Year Analysis

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