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Patient Preference and Risk Assessment in Opioid Prescribing Disparities: A Secondary Analysis of a Randomized Clinical Trial

IMPORTANCE: Although racial disparities in acute pain control are well established, the role of patient analgesic preference and the factors associated with these disparities remain unclear. OBJECTIVE: To characterize racial disparities in opioid prescribing for acute pain after accounting for patie...

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Autores principales: Engel-Rebitzer, Eden, Dolan, Abby R., Aronowitz, Shoshana V., Shofer, Frances S., Nguemeni Tiako, Max Jordan, Schapira, Marilyn M., Perrone, Jeanmarie, Hess, Erik P., Rhodes, Karin V., Bellamkonda, Venkatesh R., Cannuscio, Carolyn C., Goldberg, Erica, Bell, Jeffrey, Rodgers, Melissa A., Zyla, Michael, Becker, Lance B., McCollum, Sharon, Meisel, Zachary F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8322998/
https://www.ncbi.nlm.nih.gov/pubmed/34323984
http://dx.doi.org/10.1001/jamanetworkopen.2021.18801
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author Engel-Rebitzer, Eden
Dolan, Abby R.
Aronowitz, Shoshana V.
Shofer, Frances S.
Nguemeni Tiako, Max Jordan
Schapira, Marilyn M.
Perrone, Jeanmarie
Hess, Erik P.
Rhodes, Karin V.
Bellamkonda, Venkatesh R.
Cannuscio, Carolyn C.
Goldberg, Erica
Bell, Jeffrey
Rodgers, Melissa A.
Zyla, Michael
Becker, Lance B.
McCollum, Sharon
Meisel, Zachary F.
author_facet Engel-Rebitzer, Eden
Dolan, Abby R.
Aronowitz, Shoshana V.
Shofer, Frances S.
Nguemeni Tiako, Max Jordan
Schapira, Marilyn M.
Perrone, Jeanmarie
Hess, Erik P.
Rhodes, Karin V.
Bellamkonda, Venkatesh R.
Cannuscio, Carolyn C.
Goldberg, Erica
Bell, Jeffrey
Rodgers, Melissa A.
Zyla, Michael
Becker, Lance B.
McCollum, Sharon
Meisel, Zachary F.
author_sort Engel-Rebitzer, Eden
collection PubMed
description IMPORTANCE: Although racial disparities in acute pain control are well established, the role of patient analgesic preference and the factors associated with these disparities remain unclear. OBJECTIVE: To characterize racial disparities in opioid prescribing for acute pain after accounting for patient preference and to test the hypothesis that racial disparities may be mitigated by giving clinicians additional information about their patients’ treatment preferences and risk of opioid misuse. DESIGN, SETTING, AND PARTICIPANTS: This study is a secondary analysis of data collected from Life STORRIED (Life Stories for Opioid Risk Reduction in the ED), a multicenter randomized clinical trial conducted between June 2017 and August 2019 in the emergency departments (EDs) of 4 academic medical centers. Participants included 1302 patients aged 18 to 70 years who presented to the ED with ureter colic or musculoskeletal back and/or neck pain. INTERVENTIONS: The treatment arm was randomized to receive a patient-facing intervention (not examined in this secondary analysis) and a clinician-facing intervention that consisted of a form containing information about each patient’s analgesic treatment preference and risk of opioid misuse. MAIN OUTCOMES AND MEASURES: Concordance between patient preference for opioid-containing treatment (assessed before ED discharge) and receipt of an opioid prescription at ED discharge. RESULTS: Among 1302 participants in the Life STORRIED clinical trial, 1012 patients had complete demographic and treatment preference data available and were included in this secondary analysis. Of those, 563 patients (55.6%) self-identified as female, with a mean (SD) age of 40.8 (14.1) years. A total of 455 patients (45.0%) identified as White, 384 patients (37.9%) identified as Black, and 173 patients (17.1%) identified as other races. After controlling for demographic characteristics and clinical features, Black patients had lower odds than White patients of receiving a prescription for opioid medication at ED discharge (odds ratio [OR], 0.42; 95% CI, 0.27-0.65). When patients who did and did not prefer opioids were considered separately, Black patients continued to have lower odds of being discharged with a prescription for opioids compared with White patients (among those who preferred opioids: OR, 0.43 [95% CI, 0.24-0.77]; among those who did not prefer opioids: OR, 0.45 [95% CI, 0.23-0.89]). These disparities were not eliminated in the treatment arm, in which clinicians were given additional data about their patients’ treatment preferences and risk of opioid misuse. CONCLUSIONS AND RELEVANCE: In this secondary analysis of data from a randomized clinical trial, Black patients received different acute pain management than White patients after patient preference was accounted for. These disparities remained after clinicians were given additional patient-level data, suggesting that a lack of patient information may not be associated with opioid prescribing disparities. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03134092
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spelling pubmed-83229982021-08-19 Patient Preference and Risk Assessment in Opioid Prescribing Disparities: A Secondary Analysis of a Randomized Clinical Trial Engel-Rebitzer, Eden Dolan, Abby R. Aronowitz, Shoshana V. Shofer, Frances S. Nguemeni Tiako, Max Jordan Schapira, Marilyn M. Perrone, Jeanmarie Hess, Erik P. Rhodes, Karin V. Bellamkonda, Venkatesh R. Cannuscio, Carolyn C. Goldberg, Erica Bell, Jeffrey Rodgers, Melissa A. Zyla, Michael Becker, Lance B. McCollum, Sharon Meisel, Zachary F. JAMA Netw Open Original Investigation IMPORTANCE: Although racial disparities in acute pain control are well established, the role of patient analgesic preference and the factors associated with these disparities remain unclear. OBJECTIVE: To characterize racial disparities in opioid prescribing for acute pain after accounting for patient preference and to test the hypothesis that racial disparities may be mitigated by giving clinicians additional information about their patients’ treatment preferences and risk of opioid misuse. DESIGN, SETTING, AND PARTICIPANTS: This study is a secondary analysis of data collected from Life STORRIED (Life Stories for Opioid Risk Reduction in the ED), a multicenter randomized clinical trial conducted between June 2017 and August 2019 in the emergency departments (EDs) of 4 academic medical centers. Participants included 1302 patients aged 18 to 70 years who presented to the ED with ureter colic or musculoskeletal back and/or neck pain. INTERVENTIONS: The treatment arm was randomized to receive a patient-facing intervention (not examined in this secondary analysis) and a clinician-facing intervention that consisted of a form containing information about each patient’s analgesic treatment preference and risk of opioid misuse. MAIN OUTCOMES AND MEASURES: Concordance between patient preference for opioid-containing treatment (assessed before ED discharge) and receipt of an opioid prescription at ED discharge. RESULTS: Among 1302 participants in the Life STORRIED clinical trial, 1012 patients had complete demographic and treatment preference data available and were included in this secondary analysis. Of those, 563 patients (55.6%) self-identified as female, with a mean (SD) age of 40.8 (14.1) years. A total of 455 patients (45.0%) identified as White, 384 patients (37.9%) identified as Black, and 173 patients (17.1%) identified as other races. After controlling for demographic characteristics and clinical features, Black patients had lower odds than White patients of receiving a prescription for opioid medication at ED discharge (odds ratio [OR], 0.42; 95% CI, 0.27-0.65). When patients who did and did not prefer opioids were considered separately, Black patients continued to have lower odds of being discharged with a prescription for opioids compared with White patients (among those who preferred opioids: OR, 0.43 [95% CI, 0.24-0.77]; among those who did not prefer opioids: OR, 0.45 [95% CI, 0.23-0.89]). These disparities were not eliminated in the treatment arm, in which clinicians were given additional data about their patients’ treatment preferences and risk of opioid misuse. CONCLUSIONS AND RELEVANCE: In this secondary analysis of data from a randomized clinical trial, Black patients received different acute pain management than White patients after patient preference was accounted for. These disparities remained after clinicians were given additional patient-level data, suggesting that a lack of patient information may not be associated with opioid prescribing disparities. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03134092 American Medical Association 2021-07-29 /pmc/articles/PMC8322998/ /pubmed/34323984 http://dx.doi.org/10.1001/jamanetworkopen.2021.18801 Text en Copyright 2021 Engel-Rebitzer E et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Engel-Rebitzer, Eden
Dolan, Abby R.
Aronowitz, Shoshana V.
Shofer, Frances S.
Nguemeni Tiako, Max Jordan
Schapira, Marilyn M.
Perrone, Jeanmarie
Hess, Erik P.
Rhodes, Karin V.
Bellamkonda, Venkatesh R.
Cannuscio, Carolyn C.
Goldberg, Erica
Bell, Jeffrey
Rodgers, Melissa A.
Zyla, Michael
Becker, Lance B.
McCollum, Sharon
Meisel, Zachary F.
Patient Preference and Risk Assessment in Opioid Prescribing Disparities: A Secondary Analysis of a Randomized Clinical Trial
title Patient Preference and Risk Assessment in Opioid Prescribing Disparities: A Secondary Analysis of a Randomized Clinical Trial
title_full Patient Preference and Risk Assessment in Opioid Prescribing Disparities: A Secondary Analysis of a Randomized Clinical Trial
title_fullStr Patient Preference and Risk Assessment in Opioid Prescribing Disparities: A Secondary Analysis of a Randomized Clinical Trial
title_full_unstemmed Patient Preference and Risk Assessment in Opioid Prescribing Disparities: A Secondary Analysis of a Randomized Clinical Trial
title_short Patient Preference and Risk Assessment in Opioid Prescribing Disparities: A Secondary Analysis of a Randomized Clinical Trial
title_sort patient preference and risk assessment in opioid prescribing disparities: a secondary analysis of a randomized clinical trial
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8322998/
https://www.ncbi.nlm.nih.gov/pubmed/34323984
http://dx.doi.org/10.1001/jamanetworkopen.2021.18801
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