Racial and Ethnic Disparities in Opioid Prescribing for Long Bone Fractures at Discharge From the Emergency Department: A Cross-sectional Analysis of 22 Centers From a Health Care Delivery System in Northern California

Romanelli, Robert J.; Shen, Zijun; Szwerinski, Nina; Scott, Alexandra; Lockhart, Stephen H.; Pressman, Alice

doi:10.1016/j.annemergmed.2019.05.018

Cited by 23 publications

(32 citation statements)

References 33 publications

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“…The opioid epidemic has been characterized by its disproportionate impact on low-income Caucasian communities. 12,14,15 Our data are consistent with these previously elucidated national trends. Existing literature reports that providers perceived Black patients to have less pain than Caucasian patients, which affected prescriber behavior and may explain lower opioid prescription rates among those patients.…”

Section: Discussionsupporting

confidence: 92%

National Trends in Opioid Prescriptions Following Outpatient Otologic Surgery, 2005‐2017

Cooperman¹,

Jin²,

Qian³

et al. 2021

Otolaryngol.--head neck surg.

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Objective To describe opioid stewardship in ambulatory otologic surgery from 2005 to 2017. Study Design Descriptive study of US private insurance claims. Setting Nationwide deidentified private insurance claims database (Clinformatics DataMart; Optum). Methods A total of 17,431 adult opioid-naïve outpatients were included in the study. Patients were identified from CPT-4 codes ( Current Procedural Terminology, Fourth Edition) as having undergone middle ear or mastoid surgery. Multiple regression was used to determine sociodemographic and geographic predictors of postoperative morphine milligram equivalents (MMEs) prescribed, including procedure type, year of procedure, age, sex, education, income level, and geographic region of the United States. Results The mean prescribed perioperative dose over the examined period was 203.03 MMEs (95% CI, 200.27-205.79; 5-mg hydrocodone pill equivalents, 40.61). In multivariate analysis, patients undergoing mastoid surgery were prescribed more opioids than those undergoing middle ear surgery (mean difference, 39.89 MME [95% CI, 34.37-45.41], P < .01; 5-mg hydrocodone pill equivalents, 8.0). Men were prescribed higher doses than women (mean difference, 15.39 [95% CI, 9.87-20.90], P < .01; 5-mg hydrocodone pill equivalents, 3.1). Overall MMEs prescribed by year demonstrates a sharp drop in MMEs from 2015 to 2017. Conclusion While the amount of opioids prescribed perioperatively has declined in recent years, otologists should continue to be cognizant of potential overprescribing in light of previous studies of patients’ relatively low opioid intake.

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Section: Discussionsupporting

confidence: 92%

National Trends in Opioid Prescriptions Following Outpatient Otologic Surgery, 2005‐2017

Cooperman¹,

Jin²,

Qian³

et al. 2021

Otolaryngol.--head neck surg.

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“…A total of six articles remained from which data was extracted and summarized into findings. [17][18][19][20][21][22]…”

Section: Search Results and Study Inclusionmentioning

confidence: 99%

“…This review included one meta-analysis, 18 two studies presenting with cross-sectional designs, 21,22 17 investigated the outcome of dose reduction of opioid pain relievers within a two-year follow-up period.…”

Section: General Characteristics Of Included Studiesmentioning

confidence: 99%

Racial and Ethnic Disparities in Pain Management

Harris¹,

Long

2021

Clin Prac Athl Train

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Pain is subjective, which makes its management a complicated task. The challenge of medical decisionmaking associated with pain often requires health care providers to rely heavily on their individual discretion and experience. This often creates an avenue for biases to play a role in the selection of the best available and most appropriate pain management interventions. Therefore, the overall purpose of this review is to summarize the current literature related to racial and ethnic disparities in pain management. Electronic searches of four databases revealed 2,112 articles; however, only six studies met criteria for inclusion in this review. Even when the source of pain is the same, research indicates management may differ between racial or ethnic groups. While the treatment of objectively painful conditions remains relatively constant among races and ethnicities, inequities in pain management become more apparent in the treatment of conditions characterized by only subjective pain indicators. Further disparities were identified in the dosage, dosage reduction, and oversight of opioid analgesics between groups. Inequities in prescribing patterns widen existing healthcare disparities by contributing to undertreatment of pain in ethnic minorities and overtreatment of pain and subsequent risk of opioid abuse in Whites. Health care providers must use a patient-centered and evidence-based approach to combat the ambiguity of clinical decisionmaking regarding pain. When knowledgeable of appropriate standard of care for pain management, athletic trainers can identify when a patient's pain needs are unmet or when substance abuse interventions may be necessary.

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“…Minority patients were prescribed less potent opioids on average than non-Hispanic White patients, potentially reflecting bias. 6 Third, systemic racism resulting from deeply entrenched historically situated patterns of thinking and acting is often least apparent. Bias in computer algorithms, for example, can influence clinical or research decision making in ways that can disproportionately negatively affect people of color.…”

Section: Measuring Inequitymentioning

confidence: 99%

Piloting and Scaling a Good Health Equity Evidence Base From Big Data

Lockhart

2021

AMA Journal of Ethics

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Eliminating racial inequity in health outcomes has historically been complicated by a lack of clear methods to quantify the problems and study interventions' effects. Health care organizations' investment in electronic health record systems for millions of patients, however, presents opportunities to use data to research health inequity and respond to it. One health system's development and validation of a measure to identify and quantify outcomes inequity across patient groups demonstrates an approach that could be nationally scalable.To claim one AMA PRA Category 1 Credit TM for the CME activity associated with this article, you must do the following: (1) read this article in its entirety, (2) answer at least 80 percent of the quiz questions correctly, and (3) complete an evaluation. The quiz, evaluation, and form for claiming AMA PRA Category 1 Credit TM are available through the AMA Ed Hub TM .

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Racial and Ethnic Disparities in Opioid Prescribing for Long Bone Fractures at Discharge From the Emergency Department: A Cross-sectional Analysis of 22 Centers From a Health Care Delivery System in Northern California

Cited by 23 publications

References 33 publications

National Trends in Opioid Prescriptions Following Outpatient Otologic Surgery, 2005‐2017

National Trends in Opioid Prescriptions Following Outpatient Otologic Surgery, 2005‐2017

Racial and Ethnic Disparities in Pain Management

Piloting and Scaling a Good Health Equity Evidence Base From Big Data

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