title: Variation Between Physicians and Mid-level Providers in Opioid Treatment for Musculoskeletal Pain in the Emergency Department.
abstract: BACKGROUND
  Effective, appropriate, and safe opioid analgesia administration in the Emergency Department (ED) is a complex issue, with risks of both over- and underutilization of medications.
  
  
  OBJECTIVE
  To assess for possible association between practitioner status (physician [MD] vs. mid-level provider [MLP]) and use of opioids for in-ED treatment of musculoskeletal pain (MSP).
  
  
  METHODS
  This was a secondary, hypothesis-generating analysis of a subset of subjects who had ED analgesia noted as part of entry into a prospective registry trial of outpatient analgesia. The study was conducted at 12 U.S. academic EDs, 10 of which utilized MLPs. Patients were enrolled as a convenience sample from September 2012 through February 2014. Study patients were adults (>17 years of age) with acute MSP and eligibility for both nonsteroidal antiinflammatory drugs and opioids at ED discharge. The intervention of interest was whether patients received opioid therapy in the ED prior to discharge.
  
  
  RESULTS
  MDs were significantly more likely to order opioids than MLPs for ED patients with MSP. The association between MD/MLP status and likelihood of treatment with opioids was similar in both classical logistic regression (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.1-4.5, p = 0.019) and in propensity-adjusted modeling (OR 2.1, 95% CI 1.0-4.5, p = 0.049).
  
  
  CONCLUSIONS
  In preliminary analysis, MD/MLP status was significantly associated with likelihood of provider treatment of MSP with opioids. A follow-up study is warranted to confirm the results of this hypothesis-testing analysis and to inform efforts toward consistency in opioid therapy in the ED.
authors.affiliation: Department of Emergency Medicine, University of Oklahoma College of Medicine, Tulsa, Oklahoma.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Thomas
authors.affiliation: Department of Emergency Medicine, University of Oklahoma College of Medicine, Tulsa, Oklahoma.
authors.forename: Shannon
authors.initials: S
authors.lastname: Mumma
authors.affiliation: Department of Emergency Medicine, University of Oklahoma College of Medicine, Tulsa, Oklahoma.
authors.forename: Amanda
authors.initials: A
authors.lastname: Satterwhite
authors.affiliation: Department of Emergency Medicine, University of Oklahoma College of Medicine, Tulsa, Oklahoma.
authors.forename: Tyler
authors.initials: T
authors.lastname: Haas
authors.affiliation: Department of Emergency Medicine, University of Oklahoma College of Medicine, Tulsa, Oklahoma.
authors.forename: Annette O
authors.initials: AO
authors.lastname: Arthur
authors.affiliation: Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Knox H
authors.initials: KH
authors.lastname: Todd
authors.affiliation: Department of Emergency Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Sharon
authors.initials: S
authors.lastname: Mace
authors.affiliation: Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, California.
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Diercks
authors.affiliation: Department of Emergency Medicine, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Charles V
authors.initials: CV
authors.lastname: Pollack
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000188:drug therapy*; D059408:Pain Management / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D014481:United States
chemical_list: D000701:Analgesics, Opioid
keywords: analgesia; mid-level providers; musculoskeletal pain; opioids; physicians