title: Racial differences in opiate administration for pain relief at an academic emergency department.
abstract: BACKGROUND
  The decision to treat pain in the emergency department (ED) is a complex, idiosyncratic process. Prior studies have shown that EDs undertreat pain. Several studies demonstrate an association between analgesia administration and race. This is the first Midwest single institution study to address the question of race and analgesia, in addition to examining the effects of both patient and physician characteristics on race-based disparities in analgesia administration.
  
  
  METHODS
  This was a retrospective chart review of patients presenting to an urban academic ED with an isolated diagnosis of back pain, migraine, or long bone fracture (LBF) from January 1, 2007 to December 31, 2011. Demographic and medication administration information was collected from patient charts by trained data collectors blinded to the hypothesis of the study. The primary outcome was the proportion of African-Americans who received analgesia and opiates, as compared to Caucasians, using Pearson's chi-squared test. We developed a multiple logistic regression model to identify which physician and patient characteristics correlated with increased opiate administration.
  
  
  RESULTS
  Of the 2,461 patients meeting inclusion criteria, 57% were African-American and 30% Caucasian (n=2136). There was no statistically significant racial difference in the administration of any analgesia (back pain: 86% vs. 86%, p=0.81; migraine: 83% vs. 73%, p=0.09; LBF: 94% vs. 90%, p=0.17), or in opiate administration for migraine or LBF. African-Americans who presented with back pain were less likely to receive an opiate than Caucasians (50% vs. 72%, p<0.001). Secondary outcomes showed that higher acuity, older age, physician training in emergency medicine, and male physicians were positively associated with opiate administration. Neither race nor gender patient-physician congruency correlated with opiate administration.
  
  
  CONCLUSIONS
  No race-based disparity in overall analgesia administration was noted for all three conditions: LBF, migraine, and back pain at this institution. A race-based disparity in the likelihood of receiving opiate analgesia for back pain was observed in this ED. The etiology of this is likely multifactorial, but understanding physician and patient characteristics of institutions may help to decrease the disparity by raising awareness of practice patterns and can provide the basis for quality improvement projects.
authors.affiliation: New York Hospital Queens, Department of Emergency Medicine, Flushing, New York.
authors.forename: R Myles
authors.initials: RM
authors.lastname: Dickason
authors.affiliation: Saint Louis University School of Medicine, Division of Emergency Medicine, St. Louis, Missouri.
authors.forename: Vijai
authors.initials: V
authors.lastname: Chauhan
authors.affiliation: Saint Louis University School of Medicine, Division of Emergency Medicine, St. Louis, Missouri.
authors.forename: Astha
authors.initials: A
authors.lastname: Mor
authors.affiliation: St. Luke's Roosevelt Hospital Center, Department of Surgery, New York, New York.
authors.forename: Erin
authors.initials: E
authors.lastname: Ibler
authors.affiliation: Maricopa Medical Center, Department of Emergency Medicine, Phoenix, Arizona.
authors.forename: Sarah
authors.initials: S
authors.lastname: Kuehnle
authors.affiliation: University of Nevada School of Medicine, Department of Emergency Medicine, Las Vegas, Nevada.
authors.forename: Daren
authors.initials: D
authors.lastname: Mahoney
authors.affiliation: Saint Louis University Center for Outcomes Research, St. Louis, Missouri.
authors.forename: Eric
authors.initials: E
authors.lastname: Armbrecht
authors.affiliation: Saint Louis University School of Medicine, Division of Emergency Medicine, St. Louis, Missouri.
authors.forename: Preeti
authors.initials: P
authors.lastname: Dalawari
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001416:Back Pain / Q000188:drug therapy; D004334:Drug Administration Schedule; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D050723:Fractures, Bone / Q000150:complications; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D015146:Midwestern United States; D008881:Migraine Disorders / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D000701:Analgesics, Opioid