NEW YORK (Reuters Health) - Since national quality improvement initiatives were introduced in the United States in the late 1990s, use of opioid painkillers in the emergency room (ER) setting for pain-related visits has increased, new research shows. However, white patients continue to be treated more often with these pain-relievers than patients of other racial groups.
NEW YORK (Reuters Health) - Since national quality improvement initiatives were introduced in the United States in the late 1990s, use of opioid painkillers in the emergency room (ER) setting for pain-related visits has increased, new research shows. However, white patients continue to be treated more often with these pain-relievers than patients of other racial groups.
As reported in the Journal of the American Medical Association for January 2, Dr. Mark J. Pletcher, from the University of California in San Francisco, and colleagues analyzed data from the National Hospital Ambulatory Medical Care Survey (1993-2005) to assess opioid-prescribing patterns for pain-related visits to ERs in the US.
Forty-two percent of the 374,891 ER visits examined were pain-related, the report indicates. During the study period, opioid use for such visits rose from 23 percent in 1993 to 37 percent in 2005.
Over all years, 31 percent of white patients with pain received an opioid compared with 23 percent of black, 24 percent of Hispanic, and 28 percent of Asian/other patients. In 2005, a racial gap was still apparent: 40 percent of whites with pain received these agents compared with only 32 percent of all other patients.
!ADVERTISEMENT!The racial gap identified was present for all types of pain studied and increased with pain severity. Even for the most severe types of pain, such as long-bone fractures, whites continued to receive opioids more often than patients of other racial groups.
The racial differences were also apparent in pediatric patients.
The investigators acknowledge that it is conceivable that the disparity represents overprescribing to white patients, but they think it a more plausible explanation is true undertreatment of pain in minority patients. This may not be a result of physician bias but could reflect expectations and assertiveness of the patients.
"Our results suggest that new strategies are needed to understand and improve the quality and equity of management of acute pain in the US," Pletcher and colleagues conclude.
While much of this will involve efforts aimed at physicians, it is also likely to "require nonphysician interventions such as patient-targeted self-efficacy education, nurse-initiated pain-treatment protocols, and other system-level changes to facilitate equitable, systematic, and consistent alleviation of pain in emergency department patients," they write.
SOURCE: Journal of the American Medical Association, January 2, 2008.
