Racial and Ethnic Disparities in Emergency Department Analgesic Prescription

275

215

Background Substantial pain prevalence is as high as 40% in community populations. There is consistent evidence that racial/ethnic minority individuals are overrepresented among those who experience such pain and whose pain management is inadequate. Questions/purposes The objectives of this paper are to (1) define parameters of and summarize evidence pertinent to racial/ethnic minority disparities in pain management, (2) identify factors contributing to observed disparities, and (3) identify strategies to minimize the disparities. Methods Scientific literature was selectively reviewed addressing pain epidemiology, differences in pain management of non-Hispanic whites versus racial/ethnic minority groups, and patient and physician factors contributing to such differences.

Section: Acute Nonmalignant Painmentioning

confidence: 99%

Defining Racial and Ethnic Disparities in Pain Management

Mossey

2011

275

215

“…Several studies suggest differences in function between races after joint arthroplasty [8,11,19,33]. Others have reported differences in the experience of pain by patients and in the management of that pain [8,33].…”

Section: Introductionmentioning

confidence: 99%

“…Others have reported differences in the experience of pain by patients and in the management of that pain [8,33]. Green et al [11] found chronic pain affects the quality of life and health status of the African-American population to a greater extent than in Caucasians in the United States.…”

Section: Introductionmentioning

confidence: 99%

Ethnic and Gender Differences in the Functional Disparities after Primary Total Knee Arthroplasty

Kamath

Horneff

Gaffney

et al. 2010

Background The benefits of TKA have been well documented. Whether these benefits apply equally across gender and ethnic groups is unclear. Given the underuse of TKA among certain demographic groups, it is important to understand whether gender or ethnicity influence pain and function after TKA. Questions/purposes We determined (1) the influence of race, gender, and body mass index (BMI) on primary TKA functional scores and ROM before gender-specific implants; and (2) months).Results African-Americans had longer delays to presentation, higher BMI, and worse 2-year KSS. Women (all races) had higher BMI and worse preoperative flexion/arc ROM. African-American women had worse final ROM and had similar final gains in ROM (postoperative minus preoperative ROM) after controlling for confounders. Conclusions Gender and race affected functional KSS and ROM variables. The worse results experienced by AfricanAmerican women may be attributable to a longer delay to presentation. However, the scores and motion were high for all subgroups, and underuse of TKA in women and AfricanAmericans cannot be justified based on a perception of lesser functional gains. Level of Evidence Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

“…Minorities may underreport pain when dealing with opposite-sex providers or with physicians perceived to be of ''higher status.'' System/provider bias is evidenced by differential pharmacy opioid stocking rates by socioeconomic region [8] or emergency room analgesia discrepancies [29]. Differences in prescribing practices for white versus nonwhite patients have also been documented in postoperative patients, patients with cancer, and patients with chronic pain in the Veterans Affairs system.…”

Section: Introductionmentioning

confidence: 99%

Breakout Session: Gender and Ethnic Disparities in Pain Management

Kamath

O’Connor

2011

Background Pain management is a complex and evolving topic. Treatment of pain must account for biochemical as well as social and economic factors. Sex, gender, and ethnic differences exist in the pathophysiology, diagnosis, and provision of care for patients with pain. Questions/purposes We sought to identify the sex, gender, and ethnic disparities leading to care inequalities with respect to pain management. Our purposes were to (1) clarify the state of where we are now, (2) outline ways to approach where we need to go, and (3) generate solutions for how we get there. Where are we now? Studies are beginning to uncover the biologic mechanisms underlying the pain response in sex, gender, and ethnic subgroups. Patient characteristics that increase the risk of postoperative pain are being identified. Where do we need to go? Much work needs to be done in medical education with respect to sex, gender, and ethnic disparities in pain management. Research efforts must better describe differences in physiology of pain, incidence of pain, coping strategies, patient-doctor relationships, and gender/ethnic-specific modes of care for the patient with pain. How do we get there? Future work will involve combined efforts with pain/anesthesia specialty societies, developing a disparities and pain management curriculum for medical providers, endorsing health literacy, performing highquality Level I/II research, and exploring systems processes in pain management in the acute hospital setting.