The Effect of Race/Ethnicity and Desirable Social Characteristics on Physicians' Decisions to Prescribe Opioid Analgesics

Tamayo-Sarver, Joshua H.; Dawson, Neal V.; Hinze, Susan W.; Cydulka, Rita K.; Wigton, Robert S.; Albert, Jeffrey M.; Ibrahim, Said A.; Baker, David W.

doi:10.1111/j.1553-2712.2003.tb00608.x

Cited by 94 publications

(96 citation statements)

References 44 publications

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“…The influence of physician-patient racial and ethnic concordance on patient care has been consistently documented for decades, [16][17][18][19][20] and may partially explain some of the disparities found. Previous studies have demonstrated that despite their best efforts, physicians sometimes struggle to perform as unbiased operators, often allowing their own cultural and social constructs to partially dictate their approach to patient care, including their medication prescribing.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Neighborhood Socioeconomic Status and Race on the Prescribing of Opioids in Emergency Departments Throughout the United States

et al. 2013

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BACKGROUND: Racial and ethnic disparities in opioid prescribing in the emergency department (ED) are well described, yet the influence of socioeconomic status (SES) remains unclear. OBJECTIVES: (1) To examine the effect of neighborhood SES on the prescribing of opioids for moderate to severe pain; and (2) to determine if racial disparities in opioid prescribing persist after accounting for SES. DESIGN: We used cross-sectional data from the National Hospital Ambulatory Medical Care Survey between 2006 and 2009 to examine the prescribing of opioids to patients presenting with moderate to severe pain (184 million visits). We used logistic regression to examine the association between the prescribing of opioids, SES, and race. Models were adjusted for age, sex, pain-level, injury-status, frequency of emergency visits, hospital type, and region. MAIN MEASURES: Our primary outcome measure was whether an opioid was prescribed during a visit for moderate to severe pain. SES was determined based on income, percent poverty, and educational level within a patient's zip code. RESULTS: Opioids were prescribed more frequently at visits from patients of the highest SES quartile compared to patients in the lowest quartile, including percent poverty (49.0 % vs. 39.4 %, P<0.001), household income (47.3 % vs. 40.7 %, P < 0.001), and educational level (46.3 % vs. 42.5 %, P=0.01). Black patients were prescribed opioids less frequently than white patients across all measures of SES. In adjusted models, black patients (AOR 0.73; 95 % CI 0.66-0.81) and patients from poorer areas (AOR 0.76; 95 % CI 0.68-0.86) were less likely to receive opioids after accounting for pain-level, age, injury-status, and other covariates. CONCLUSIONS: Patients presenting to emergency departments from lower SES regions were less likely to receive opioids for equivalent levels of pain than those from more affluent areas. Black and Hispanic patients were also less likely to receive opioids for equivalent levels of pain than whites, independent of SES.

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Section: Discussionmentioning

confidence: 99%

The Impact of Neighborhood Socioeconomic Status and Race on the Prescribing of Opioids in Emergency Departments Throughout the United States

et al. 2013

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“…Such studies have shown relatively poor adherence to evidencebased guidelines for the treatment of acute LBP among physicians, especially among general practitioners with more years of clinical experience. Other case vignette studies in medical research have focused on the professional judgments of social workers regarding the need for institutional care [26], the opioid prescribing practices of emergency room physicians [27], and the effect of racial bias in medical decision-making [28]. Case vignettes can test a number of hypothesized variables thought to influence decision-making, and predictive variables can include both experimental factors (randomized factors systematically altered in different versions of the vignette), and respondent factors (variables reflecting attitudes and characteristics of the decision-maker).…”

Section: Methodsmentioning

confidence: 99%

Supervisor and Organizational Factors Associated with Supervisor Support of Job Accommodations for Low Back Injured Workers

et al. 2016

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PURPOSE-Temporary job accommodations contribute to the prevention of chronic work disability due to low back pain (LBP) through the facilitation of early return to work; yet, workplace dimensions of job accommodation are poorly understood. The objective of this study was to determine supervisor and organizational factors associated with supervisors' support for temporary job accommodations for LBP injured workers. METHODS-Supervisorswere recruited from 19 workplaces in the USA and Canada and completed an online survey regarding job accommodation practices and potential associated factors with respect to a case vignette of a worker with LBP. Multivariable linear regression was used to identify the most parsimonious set of factors associated with supervisors' support for accommodations. RESULTS-

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“…The mostly null findings in this study could also be interpreted as promising evidence that physicians' decisionmaking is not significantly influenced by race/ethnicity when other clinical and family context variables are held constant (such as socioeconomic status, parental employment, family composition, treatment motivation, etc.). For example, in another study examining the role of adult patient race/ ethnicity on decisions to prescribe medication, investigators found that patient characteristics such as occupation and perceived reliability with follow-up were more significantly associated with physician decision-making than the patient's race/ethnicity [27].…”

Section: Discussionmentioning

confidence: 99%

“…Yet independent of race, physicians' perceptions of patients' education and physical activity preferences were significant predictors of treatment recommendations [26]. Tamayo-Sarver and colleagues found that "socially desirable patient characteristics" associated with occupation, relationship with primary care doctor, and reliability of follow-up were significantly associated with opioid prescription rates, but race/ethnicity was not [27].…”

Section: Racial/ethnic Disparities In Children's Mental Health Carementioning

confidence: 99%

“…Burk and Sher also used videotapes of adolescents to examine the impact of family history of alcoholism on mental health workers' assessment of diagnosis and predicted psychopathology [29]. In a study most closely reflecting the general aims of this study, Tamayo-Sarver and colleagues used text vignettes (varying only the name of the patient) with color face photos depicting patients of different races, to test for differences in emergency room physicians' prescription patterns as noted above [27].…”

Section: Racial/ethnic Disparities In Children's Mental Health Carementioning

confidence: 99%

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Does Patient Race/Ethnicity Influence Physician Decision-Making for Diagnosis and Treatment of Childhood Disruptive Behavior Problems?

Garland

Taylor

Brookman‐Frazee

et al. 2014

J. Racial and Ethnic Health Disparities

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Race/ethnic disparities in utilization of children's mental health care have been well documented and are particularly concerning given the long-term risks of untreated mental health problems (Institute of Medicine, 2003; Kessler et al. Am J Psychiatry 152:10026-1032. Research investigating the higher rates of unmet need among race/ethnic minority youths has focused primarily on policy, fiscal, and individual child or family factors that can influence service access and use. Alternatively, this study examines provider behavior as a potential influence on race/ethnic disparities in mental health care. The goal of the study was to examine whether patient (family) race/ethnicity influences physician diagnostic and treatment decision-making for childhood disruptive behavior problems. The study utilized an internet-based video vignette with corresponding survey of 371 randomly selected physicians from across the USA representing specialties likely to treat these patients (pediatricians, family physicians, general and child psychiatrists). Participants viewed a video vignette in which only race/ethnicity of the mother randomly varied (nonHispanic White, Hispanic, and African American) and then responded to questions about diagnosis and recommended treatments. Physicians assigned diagnoses such as oppositional defiant disorder (48 %) and attention deficit disorder (63 %) to the child, but there were no differences in diagnosis based on race/ethnicity. The majority of respondents recommended psychosocial treatment (98 %) and/or psychoactive medication treatment (60 %), but there were no significant differences based on race/ethnicity. Thus, in this study using mock patient stimuli and controlling for other factors, such as insurance coverage, we did not find major differences in physician diagnostic or treatment decision-making based on patient race/ethnicity.

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The Effect of Race/Ethnicity and Desirable Social Characteristics on Physicians' Decisions to Prescribe Opioid Analgesics

Cited by 94 publications

References 44 publications

The Impact of Neighborhood Socioeconomic Status and Race on the Prescribing of Opioids in Emergency Departments Throughout the United States

The Impact of Neighborhood Socioeconomic Status and Race on the Prescribing of Opioids in Emergency Departments Throughout the United States

Supervisor and Organizational Factors Associated with Supervisor Support of Job Accommodations for Low Back Injured Workers

Does Patient Race/Ethnicity Influence Physician Decision-Making for Diagnosis and Treatment of Childhood Disruptive Behavior Problems?

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