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Cobert J, Mills H, Lee A, Gologorskaya O, Espejo E, Jeon SY, Boscardin WJ, Heintz TA, Kennedy CJ, Ashana DC, Chapman AC, Raghunathan K, Smith AK, Lee SJ. Measuring Implicit Bias in ICU Notes Using Word-Embedding Neural Network Models. Chest 2024; 165:1481-1490. [PMID: 38199323 PMCID: PMC11317817 DOI: 10.1016/j.chest.2023.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/12/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Language in nonmedical data sets is known to transmit human-like biases when used in natural language processing (NLP) algorithms that can reinforce disparities. It is unclear if NLP algorithms of medical notes could lead to similar transmissions of biases. RESEARCH QUESTION Can we identify implicit bias in clinical notes, and are biases stable across time and geography? STUDY DESIGN AND METHODS To determine whether different racial and ethnic descriptors are similar contextually to stigmatizing language in ICU notes and whether these relationships are stable across time and geography, we identified notes on critically ill adults admitted to the University of California, San Francisco (UCSF), from 2012 through 2022 and to Beth Israel Deaconess Hospital (BIDMC) from 2001 through 2012. Because word meaning is derived largely from context, we trained unsupervised word-embedding algorithms to measure the similarity (cosine similarity) quantitatively of the context between a racial or ethnic descriptor (eg, African-American) and a stigmatizing target word (eg, nonco-operative) or group of words (violence, passivity, noncompliance, nonadherence). RESULTS In UCSF notes, Black descriptors were less likely to be similar contextually to violent words compared with White descriptors. Contrastingly, in BIDMC notes, Black descriptors were more likely to be similar contextually to violent words compared with White descriptors. The UCSF data set also showed that Black descriptors were more similar contextually to passivity and noncompliance words compared with Latinx descriptors. INTERPRETATION Implicit bias is identifiable in ICU notes. Racial and ethnic group descriptors carry different contextual relationships to stigmatizing words, depending on when and where notes were written. Because NLP models seem able to transmit implicit bias from training data, use of NLP algorithms in clinical prediction could reinforce disparities. Active debiasing strategies may be necessary to achieve algorithmic fairness when using language models in clinical research.
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Affiliation(s)
- Julien Cobert
- Anesthesia Service, San Francisco VA Health Care System, University of California, San Francisco, San Francisco, CA; Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA.
| | - Hunter Mills
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA
| | - Albert Lee
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA
| | - Oksana Gologorskaya
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA
| | - Edie Espejo
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA
| | - Sun Young Jeon
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA
| | - W John Boscardin
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA
| | - Timothy A Heintz
- School of Medicine, University of California, San Diego, San Diego, CA
| | - Christopher J Kennedy
- Department of Psychiatry, Harvard Medical School, Boston, MA; Center for Precision Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Deepshikha C Ashana
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham, NC
| | - Allyson Cook Chapman
- Department of Medicine, the Division of Critical Care and Palliative Medicine, University of California, San Francisco, San Francisco, CA; Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Karthik Raghunathan
- Department of Anesthesia and Perioperative Care, Duke University, Durham, NC
| | - Alex K Smith
- Department of Geriatrics, Palliative, and Extended Care, Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA; Division of Geriatrics, University of California, San Francisco, San Francisco, CA
| | - Sei J Lee
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA
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Bergstein VE, O'Sullivan LR, Levy KH, Vulcano E, Aiyer AA. Racial Disparities in 30-day Readmission After Orthopaedic Surgery: A 5-year National Surgical Quality Improvement Program Database Analysis. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00004. [PMID: 38437055 PMCID: PMC10906581 DOI: 10.5435/jaaosglobal-d-24-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/17/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Readmission rate after surgery is an important outcome measure in revealing disparities. This study aimed to examine how 30-day readmission rates and causes of readmission differ by race and specific injury areas within orthopaedic surgery. METHODS The American College of Surgeon-National Surgical Quality Improvement Program database was queried for orthopaedic procedures from 2015 to 2019. Patients were stratified by self-reported race. Procedures were stratified using current procedural terminology codes corresponding to given injury areas. Multiple logistic regression was done to evaluate associations between race and all-cause readmission risk, and risk of readmission due to specific causes. RESULTS Of 780,043 orthopaedic patients, the overall 30-day readmission rate was 4.18%. Black and Asian patients were at greater (OR = 1.18, P < 0.01) and lesser (OR = 0.76, P < 0.01) risk for readmission than White patients, respectively. Black patients were more likely to be readmitted for deep surgical site infection (OR = 1.25, P = 0.03), PE (OR = 1.64, P < 0.01), or wound disruption (OR = 1.45, P < 0.01). For all races, all-cause readmission was highest after spine procedures and lowest after hand/wrist procedures. CONCLUSIONS Black patients were at greater risk for overall, spine, shoulder/elbow, hand/wrist, and hip/knee all-cause readmission. Asian patients were at lower risk for overall, spine, hand/wrist, and hip/knee surgery all-cause readmission. Our findings can identify complications that should be more carefully monitored in certain patient populations.
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Affiliation(s)
- Victoria E. Bergstein
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD (Ms. Bergstein, Ms. O’Sullivan, Dr. Aiyer); the Sophie Davis Biomedical Education Program, CUNY School of Medicine, New York, NY (Mr. Levy), and the Columbia University Orthopedics at Mount Sinai Medical Center, Miami Beach, FL (Dr. Vulcano)
| | - Lucy R. O'Sullivan
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD (Ms. Bergstein, Ms. O’Sullivan, Dr. Aiyer); the Sophie Davis Biomedical Education Program, CUNY School of Medicine, New York, NY (Mr. Levy), and the Columbia University Orthopedics at Mount Sinai Medical Center, Miami Beach, FL (Dr. Vulcano)
| | - Kenneth H. Levy
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD (Ms. Bergstein, Ms. O’Sullivan, Dr. Aiyer); the Sophie Davis Biomedical Education Program, CUNY School of Medicine, New York, NY (Mr. Levy), and the Columbia University Orthopedics at Mount Sinai Medical Center, Miami Beach, FL (Dr. Vulcano)
| | - Ettore Vulcano
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD (Ms. Bergstein, Ms. O’Sullivan, Dr. Aiyer); the Sophie Davis Biomedical Education Program, CUNY School of Medicine, New York, NY (Mr. Levy), and the Columbia University Orthopedics at Mount Sinai Medical Center, Miami Beach, FL (Dr. Vulcano)
| | - Amiethab A. Aiyer
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD (Ms. Bergstein, Ms. O’Sullivan, Dr. Aiyer); the Sophie Davis Biomedical Education Program, CUNY School of Medicine, New York, NY (Mr. Levy), and the Columbia University Orthopedics at Mount Sinai Medical Center, Miami Beach, FL (Dr. Vulcano)
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3
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Cornall G, Zhao E, Luckett T, Erciyas E, Monck D, Glare P, Wang A, Lee YC. Management of pain in cancer patients- lessons from practices during the COVID-19: a qualitative study of cancer care providers' perspectives. BMC Health Serv Res 2024; 24:232. [PMID: 38388905 PMCID: PMC10885360 DOI: 10.1186/s12913-024-10710-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/12/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The ongoing COVID-19 pandemic has impacted health systems globally and affected managing many chronic conditions, including cancer. This study aimed to explore the perceptions of multi-disciplinary cancer care providers on how cancer pain management was affected by the COVID-19 pandemic. METHODS Participants were eligible if they were cancer care providers of any specialty and discipline from two tertiary hospitals in Australia. Data were collected using semi-structured interviews to explore cancer care providers' perspectives on cancer pain management within COVID-19. Thematic analysis of interview transcripts used an integrated approach that started with inductive coding before coding deductively against a behaviour framework called the COM-B Model, which proposes that 'capability', 'motivation' and 'opportunity' are requisites for any behaviour. RESULTS Twenty-three providers participated. Five themes were developed and interpreted from the analysis of data, namely: "Telehealth enables remote access to cancer pain management but also created a digital divide", "Access to cancer pain management in the community is compromised due to the pandemic", "COVID-19 negatively impacts hospital resource allocation", "Patients were required to trade off cancer pain management against other health priorities" and "Hospital restrictions result in decreased social and psychological support for patients with cancer pain". CONCLUSIONS The landscape of cancer pain management in the Australian health system underwent substantial shifts during the COVID-19 pandemic, with lasting impacts. Cancer care providers perceived the pandemic to have significant adverse effects on pain management across multiple levels, with repercussions for patients experiencing cancer-related pain. A more adaptive health system model needs to be established in the future to accommodate vulnerable cancer patients.
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Affiliation(s)
- Georgina Cornall
- Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - Emma Zhao
- Sydney Nursing School, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia.
- Department of Anaesthetics and Pain Management Centre, Royal Prince Alfred Hospital, Sydney, Australia.
- Department of Anaesthesia and Pain Service, Chris O'Brien Lifehouse, Sydney, Australia.
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Sydney, Australia
| | - Ertugrul Erciyas
- Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - David Monck
- Department of Anaesthetics and Pain Management Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Paul Glare
- Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - Andy Wang
- Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
- Department of Anaesthetics and Pain Management Centre, Royal Prince Alfred Hospital, Sydney, Australia
- Department of Anaesthesia and Pain Service, Chris O'Brien Lifehouse, Sydney, Australia
| | - Yi-Ching Lee
- Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
- Department of Anaesthetics and Pain Management Centre, Royal Prince Alfred Hospital, Sydney, Australia
- Department of Anaesthesia and Pain Service, Chris O'Brien Lifehouse, Sydney, Australia
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Sydney, Australia
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Duveau C, Wets C, Delaruelle K, Demoulin S, Dauvrin M, Lepièce B, Ceuterick M, De Maesschalck S, Bracke P, Lorant V. Individual, interpersonal, and organisational factors associated with discrimination in medical decisions affecting people with a migration background with mental health problems: the case of general practice. ETHNICITY & HEALTH 2024; 29:126-145. [PMID: 37936401 DOI: 10.1080/13557858.2023.2279476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/31/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES Although people with a migration background (MB) have more unmet mental health needs than the general population, patients with a MB are still underrepresented in mental health care services. Provider bias towards these patients has been evidenced repeatedly but its driving factors remain elusive. We assessed the moderating effect of the individual (e.g. age and ethnicity), interpersonal (e.g. healthcare provider trust), and organisational (e.g. perceived workload) factors on general practitioners (GPs) differential decision-making regarding diagnosis, treatment, and referral for a depressed patient with or without a MB. DESIGN An experimental study was carried out in which GPs were shown one of two video vignettes featuring adult male depressed patients, one with a MB and the other without. Belgian GPs (n = 797, response rate was 13%) had to decide on their diagnosis, treatment, and referral. Analysis of variance and logistic regression were used to analyse the effect of a MB, adding interaction terms for the explanatory variables. RESULTS Overall, we found that there were ethnic differences in GPs' decisions regarding diagnosis and treatment recommendations. GPs perceived the symptoms of the patient with a MB as less severe (F = 7.68, p < 0.01) and demonstrated a reduced likelihood to prescribe a combination of medical and non-medical treatments (F = 11.55, p < 0.001). Those differences increased in accordance with the GP's age and perceived workload; at an interpersonal level, we found that differences increased when the GP thought the patient was exaggerating his distress. CONCLUSION This paper showed that lower levels of trust among GPs' towards their migrant patients and high GP workloads contribute to an increased ethnic bias in medical decision-making. This may perpetuate ethnic inequalities in mental health care. Future researchers should develop an intervention to decrease the ethnic inequities in mental health care by addressing GPs' trust in their migrant and ethnic minority patients.
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Affiliation(s)
- Camille Duveau
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Camille Wets
- Health and Demographic Research, Ghent University, Ghent, Belgium
| | | | - Stéphanie Demoulin
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Marie Dauvrin
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
- Belgian Health Care Knowledge Centre, KCE, Brussels, Belgium
| | - Brice Lepièce
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | | | | | - Piet Bracke
- Health and Demographic Research, Ghent University, Ghent, Belgium
| | - Vincent Lorant
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
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Choudhry HS, Patel AM, Zhu A, Guttikonda S, Shaikh A, Sadek HS, Seery CW, Dastjerdi MH. Interspecialty Opioid Prescribing Patterns in Ophthalmology Following Declaration of a Public Health Emergency. J Ocul Pharmacol Ther 2024; 40:34-47. [PMID: 37878373 DOI: 10.1089/jop.2023.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
Purpose: Previous literature has investigated opioid prescription trends in ophthalmology at large, however, little has been done looking at differences between subspecialties. We evaluate if significant trends exist among subspecialties in opioid prescribing patterns. This study aims to illuminate potential over-usage of opioids in ophthalmology that could compromise patient quality of life. Methods: Medicare data and "National Plan and Provider Enumeration System (NPPES) Downloadable File" were queried for cases of ophthalmologists with nonsuppressed opioid prescription data from 2014 to 2019. Ophthalmologists with no subspecialty code or missing regional, gender, degree, or graduation information were excluded. Chi-squared analysis, analysis of variance, t-tests, and multivariate logistic regression were utilized. Results: Five thousand one hundred forty-three physician records were included in analysis, 450 of which were by cornea subspecialists. Most cornea cases were male, graduated before 2005, and practiced in the South. All subspecialties had a significantly increased likelihood of making opioid claims and higher prescription rates compared with cornea (P < 0.050) besides glaucoma (P = 0.357). Only oculoplastics had significantly increased likelihood of greater total supply of opioids compared with cornea (odds ratio [OR] = 22.195, 95% confidence interval [CI] = 12.209-40.350, P < 0.001), while pediatrics (OR = 4.036, 95% CI = 1.377-11.831, P = 0.011) and neuro-ophthalmology (OR = 4.158, 95% CI = 1.237-13.975, P = 0.021) in addition to oculoplastics (OR = 64.380, 95% CI = 26.306-157.560, P < 0.001) were predicted to have significantly greater opioid beneficiaries. Males, the South/Midwest, and graduating before 2005, all were generally associated with increased likelihood of greater total opioid claims, supply, beneficiaries, and prescription rate (P < 0.050). Conclusion: Subspecialty, demographic, chronological, and regional trends exist for opioid prescribing patterns in ophthalmology.
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Affiliation(s)
- Hassaam S Choudhry
- Department of Ophthalmology and Visual Science at Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Aman M Patel
- Department of Ophthalmology and Visual Science at Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Aretha Zhu
- Department of Ophthalmology and Visual Science at Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Sri Guttikonda
- Rutgers The State University of New Jersey, Piscataway, New Jersey, USA
| | - Anam Shaikh
- Department of Ophthalmology and Visual Science at Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Hadeel S Sadek
- Department of Ophthalmology and Visual Science at Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Christopher W Seery
- Department of Ophthalmology and Visual Science at Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Bascom Palmer Eye Institute at the University of Miami, Coral Gables, Florida, USA
| | - Mohammad H Dastjerdi
- Department of Ophthalmology and Visual Science at Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Bergan DE, Rojas A, Briggs I, Andersen E. Framing and Policymaker Evaluations of the Opioid Crisis. HEALTH COMMUNICATION 2023; 38:2604-2616. [PMID: 35816366 DOI: 10.1080/10410236.2022.2093555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Several extremely influential theories, including the multiple streams approach and punctuated equilibrium theory, predict that dramatic policy change occurs when problems are reframed. However, there is little direct evidence of how framing messages influence policymaker attitudes, perceptions, and behaviors. In an online survey of local policymakers in Illinois, we find that different media frames of the opiate epidemic influence policymaker attitudes and attributions of responsibility. We conclude with some implications for framing theory and its role in theories of policymaking.
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Affiliation(s)
- Daniel E Bergan
- Department of Communication & James Madison College, Michigan State University
| | - Alan Rojas
- Department of Political Science, Roosevelt University
| | - Ian Briggs
- James Madison College, Michigan State University
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Pham TV, Doorley J, Kenney M, Joo JH, Shallcross AJ, Kincade M, Jackson J, Vranceanu AM. Addressing chronic pain disparities between Black and White people: a narrative review of socio-ecological determinants. Pain Manag 2023; 13:473-496. [PMID: 37650756 PMCID: PMC10621777 DOI: 10.2217/pmt-2023-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/10/2023] [Indexed: 09/01/2023] Open
Abstract
A 2019 review article modified the socio-ecological model to contextualize pain disparities among different ethnoracial groups; however, the broad scope of this 2019 review necessitates deeper socio-ecological inspection of pain within each ethnoracial group. In this narrative review, we expanded upon this 2019 article by adopting inclusion criteria that would capture a more nuanced spectrum of socio-ecological findings on chronic pain within the Black community. Our search yielded a large, rich body of literature composed of 174 articles that shed further socio-ecological light on how chronic pain within the Black community is influenced by implicit bias among providers, psychological and physical comorbidities, experiences of societal and institutional racism and biomedical distrust, and the interplay among these factors. Moving forward, research and public-policy development must carefully take into account these socio-ecological factors before scaling up pre-existing solutions with questionable benefit for the chronic pain needs of Black individuals.
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Affiliation(s)
- Tony V Pham
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - James Doorley
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Martha Kenney
- Department of Anesthesiology, Duke University Medical Centre, Durham, NC 27710, USA
| | - Jin Hui Joo
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Amanda J Shallcross
- Wellness & Preventative Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Michael Kincade
- Center for Alzheimer's Research & Treatment, Massachusetts Alzheimer's Disease Research Centre, Boston, MA 02129, USA
| | - Jonathan Jackson
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
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Nguemeni Tiako MJ, Shofer F, Dolan A, Goldberg EB, Rhodes KV, Hess EP, Bellamkonda VR, Perrone J, Cannuscio CC, Becker L, Rodgers MA, Zyla MM, Bell JJ, McCollum S, Engel-Rebitzer E, Schapira MM, Meisel ZF. Personalized risk communication and opioid prescribing in association with nonprescribed opioid use: A secondary analysis of a randomized controlled trial. Acad Emerg Med 2023; 30:851-858. [PMID: 36869633 DOI: 10.1111/acem.14710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/15/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND To determine the impact of personalized risk communication and opioid prescribing on nonprescribed opioid use, we conducted a secondary analysis of randomized controlled trial participants followed prospectively for 90 days after an emergency department (ED) visit for acute back or kidney stone pain. METHODS A total of 1301 individuals were randomized during an encounter at four academic EDs into a probabilistic risk tool (PRT) arm, a narrative-enhanced PRT arm, or a general risk information arm (control). In this secondary analysis, both risk tool arms were combined and compared with the control arm. We used logistic regressions to determine associations between receiving personalized risk information, receiving an opioid prescription in the ED, and nonprescribed opioid use in general and by race. RESULTS Complete follow-up data were available for 851 participants; 23.3% (n = 198) were prescribed opioids (34.2% of White vs. 11.6% of Black participants, p < 0.001). Fifty-six (6.6%) participants used nonprescribed opioids. Participants in the personalized risk communication arms had lower nonprescribed opioid use odds (adjusted odds ratio [aOR] 0.58, 95% confidence interval [CI] 0.4-0.83). Black versus White participants had greater nonprescribed opioid use odds (aOR 3.47, 95% CI 2.05-5.87, p < 0.001). Black participants who were prescribed opioids had a lower marginal probability of using nonprescribed opioids versus those who were not (0.06, 95% CI 0.04-0.08, p < 0.001 vs. 0.10, 95% CI 0.08-0.11, p < 0.001). The absolute risk difference in nonprescribed opioid use for Black and White participants, respectively, in the risk communication versus the control arm, was 9.7% and 0.1% (relative risk ratio 0.43 vs. 0.95). CONCLUSIONS Among Black but not White participants, personalized opioid risk communication and opioid prescribing were associated with lower odds of nonprescribed opioid use. Our findings suggest that racial disparities in opioid prescribing-which have been previously described within the context of this trial-may paradoxically increase nonprescribed opioid use. Personalized risk communication may effectively reduce nonprescribed opioid use, and future research should be designed specifically to explore this possibility in a larger cohort.
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Affiliation(s)
- Max Jordan Nguemeni Tiako
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frances Shofer
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Abby Dolan
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erica B Goldberg
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karin V Rhodes
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Erik P Hess
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Venkatesh R Bellamkonda
- Department of Emergency Medicine, Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeanmarie Perrone
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carolyn C Cannuscio
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lance Becker
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Melissa A Rodgers
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael M Zyla
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey J Bell
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sharon McCollum
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eden Engel-Rebitzer
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marilyn M Schapira
- Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Hospital, Philadelphia, Pennsylvania, USA
| | - Zachary F Meisel
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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9
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Derricks V, Gainsburg I, Shields C, Fiscella K, Epstein R, Yu V, Griggs JJ. Examining the effects of physician burnout on pain management for patients with advanced lung cancer. Support Care Cancer 2023; 31:469. [PMID: 37458824 DOI: 10.1007/s00520-023-07899-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/21/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Physician burnout is generally associated with worse clinical outcomes. The purpose of this study is to examine the effects of physician burnout on the quality of physicians' pain assessment and opioid prescribing for patients with advanced lung cancer. Moreover, we test whether these relationships are moderated by patient-level factors, such as patient race and activation level, that have a demonstrated impact on clinical encounters. METHODS We conducted a secondary analysis of data from a multisite randomized field experiment. From 2012 to 2016, 96 primary care physicians and oncologists who treated solid tumors were recruited from hospitals and medical sites in three small metropolitan and rural areas in the USA. Physicians saw two unannounced standardized patients who presented with advanced lung cancer. Standardized patients varied across race (Black or White) and activation level (activated, typical). Visits were audio recorded and transcribed. Pain management was evaluated by the quality of pain assessment and opioid prescribing during these visits. RESULTS Mixed-effects linear regression and generalized mixed-effects modeling showed that higher levels of burnout were associated with a greater likelihood of prescribing an opioid and prescribing stronger opioid doses for patients. These effects were not moderated by patient race or activation level. CONCLUSION Findings from this work inform our understanding of physician-level factors that impact clinical decision-making in the context of cancer pain management. Specifically, this study identifies the role of physician burnout on the quality of prescribing for patients with advanced lung cancer.
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Affiliation(s)
- Veronica Derricks
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N Blackford St., Indianapolis, IN, 46202, USA.
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA.
| | - Izzy Gainsburg
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
- Ross School of Business, University of Michigan, Ann Arbor, MI, USA
- John F. Kennedy School of Government, Harvard University, Cambridge, MA, USA
| | - Cleveland Shields
- Human Development & Family Studies, Purdue University, West Lafayette, IN, USA
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester School of Medicine, Rochester, NY, USA
| | - Ronald Epstein
- Department of Family Medicine, University of Rochester School of Medicine, Rochester, NY, USA
| | - Veronica Yu
- Department of Family Medicine, University of Rochester School of Medicine, Rochester, NY, USA
| | - Jennifer J Griggs
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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10
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Romanelli RJ, Shenoy R, Martinez MC, Mudiganti S, Mariano LT, Zanocco KA, Wagner Z, Kirkegaard A, Watkins KE. Disparities in postoperative opioid prescribing by race and ethnicity: an electronic health records-based observational study from Northern California, 2015-2020. Arch Public Health 2023; 81:83. [PMID: 37149630 PMCID: PMC10163682 DOI: 10.1186/s13690-023-01095-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 04/21/2023] [Indexed: 05/08/2023] Open
Abstract
OBJECTIVES To examine racial and ethnic disparities in postoperative opioid prescribing. DATA SOURCES Electronic health records (EHR) data across 24 hospitals from a healthcare delivery system in Northern California from January 1, 2015 to February 2, 2020 (study period). STUDY DESIGN Cross-sectional, secondary data analyses were conducted to examine differences by race and ethnicity in opioid prescribing, measured as morphine milligram equivalents (MME), among patients who underwent select, but commonly performed, surgical procedures. Linear regression models included adjustment for factors that would likely influence prescribing decisions and race and ethnicity-specific propensity weights. Opioid prescribing, overall and by race and ethnicity, was also compared to postoperative opioid guidelines. DATA EXTRACTION Data were extracted from the EHR on adult patients undergoing a procedure during the study period, discharged to home with an opioid prescription. PRINCIPAL FINDINGS Among 61,564 patients, on adjusted regression analysis, non-Hispanic Black (NHB) patients received prescriptions with higher mean MME than non-Hispanic white (NHW) patients (+ 6.4% [95% confidence interval: 4.4%, 8.3%]), whereas Hispanic and non-Hispanic Asian patients received lower mean MME (-4.2% [-5.1%, -3.2%] and - 3.6% [-4.8%, -2.3%], respectively). Nevertheless, 72.8% of all patients received prescriptions above guidelines, ranging from 71.0 to 80.3% by race and ethnicity. Disparities in prescribing were eliminated among Hispanic and NHB patients versus NHW patients when prescriptions were written within guideline recommendations. CONCLUSIONS Racial and ethnic disparities in opioid prescribing exist in the postoperative setting, yet all groups received prescriptions above guideline recommendations. Policies encouraging guideline-based prescribing may reduce disparities and overall excess prescribing.
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Affiliation(s)
| | | | - Meghan C Martinez
- Sutter Health, Center for Health Services Research-Palo Alto and Walnut Creek, Los Angeles, CA, USA
| | - Satish Mudiganti
- Sutter Health, Center for Health Services Research-Palo Alto and Walnut Creek, Los Angeles, CA, USA
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11
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Chen Q, Vella SP, Maher CG, Ferreira GE, Machado GC. Racial and ethnic differences in the use of lumbar imaging, opioid analgesics and spinal surgery for low back pain: A systematic review and meta-analysis. Eur J Pain 2023; 27:476-491. [PMID: 36585947 DOI: 10.1002/ejp.2075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/06/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVE There is a substantial gap between evidence and clinical care for low back pain (LBP) worldwide despite recommendations of best practice specified in clinical practice guidelines. The aim of this systematic review was to identify disparities associated with race or ethnicity in the use of lumbar imaging, opioid analgesics, and spinal surgery in people with LBP. DATABASES AND DATA TREATMENT We included observational studies which compared the use of lumbar imaging, opioid analgesics, and spinal surgery for the management of non-serious LBP between people from different racial/ethnic populations. We searched in MEDLINE, EMBASE and CINAHL from January 2000 to June 2021. Risk of bias of included studies was appraised in six domains. For each type of care, we pooled data stratified by race and ethnicity using random effects models. RESULTS We identified 13 eligible studies; all conducted in the United States. Hispanic/Latino (OR 0.69, 95%CI 0.49-0.96) and Black/African American (OR 0.59, 95%CI 0.46-0.75) people with LBP were less likely to be prescribed opioid analgesics than White people. Black/African Americans were less likely to undergo or be recommended spinal surgery for LBP (OR 0.47, 95%CI 0.33-0.67) than White people. There was a lack of high certainty evidence on racial/ethnic disparities in the use of lumbar imaging. CONCLUSION This review reveals lower rate of the use of guideline-discordant care, especially opioid prescription and spinal surgery, in racial/ethnic minority populations with LBP in the United States. Future studies in other countries evaluating care equity for LBP are warranted. PROSPERO Registration ID: CRD42021260668. SIGNIFICANCE This systematic review and meta-analysis revealed that people with low back pain from the minority racial/ethnic backgrounds were less likely to be prescribed opioid analgesics and undergo spinal surgery than the majority counterparts. Strategic interventions to improve the access to, and the value of, clinical care for minority populations with low back pain are warranted.
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Affiliation(s)
- Qiuzhe Chen
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Simon P Vella
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Chris G Maher
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Giovanni E Ferreira
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Gustavo C Machado
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
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12
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Hernandez R. "It's Always among Us. I Can't Act Like It's Not.": Women College Students' Perceptions of Physicians' Implicit Bias. HEALTH COMMUNICATION 2023; 38:50-60. [PMID: 34036850 DOI: 10.1080/10410236.2021.1932107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Physicians have an opportunity to provide accurate and timely information about sexual behavior to individuals in their care. However, many young people, and in particular college women, are reticent to talk to their physicians about sexual behavior. One explanation for this reticence may be the fact that physicians' implicit bias has the potential to denigrate communication between physicians and patients. However, little is known about how patients perceive physicians' implicit bias, or to what extent it shapes a patient's beliefs about communicating with their physician. Qualitative analysis of in-depth, semi-structured interviews was used to describe and explain the way women college students perceive issues concerning physicians' implicit bias. Results were interpreted through the lens of Communication Privacy Management theory and revealed that participants either avoided or limited communication with a physician as a result of anticipating implicit bias. Major themes included "untangling identity and the effects of physicians' implicit bias" and "seeking to understand physicians' cognition and emotion." These findings have the potential to improve communication interventions both for women college students and healthcare professionals by introducing evidence of patients' perceptions of implicit biases along the intersection of race, young age, sexuality, and female gender in physician-patient communication about sexual behavior.
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13
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Atkins N, Mukhida K. The relationship between patients’ income and education and their access to pharmacological chronic pain management: A scoping review. Can J Pain 2022; 6:142-170. [PMID: 36092247 PMCID: PMC9450907 DOI: 10.1080/24740527.2022.2104699] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Nicole Atkins
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Karim Mukhida
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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14
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Madeira F, Do Bú EA, Freitas G, Pereira CR. Distributive justice criteria and social categorization processes predict healthcare allocation bias. Br J Health Psychol 2022; 28:552-566. [PMID: 36504178 DOI: 10.1111/bjhp.12640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/16/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Drawing on theories of distributive justice and intergroup discrimination, we examined how much distributive justice criterion and racial group membership contribute to bias in healthcare allocation decisions, by testing a theoretical model that specifies perceived stereotypicality and individual responsibility as a serial mediation process in the relationship between disease's contraction controllability (controllable vs. non-controllable) and bias in medical decision-making. METHOD White Portuguese medical students (N = 213) participated in an online experimental study conducted in two phases. In phase 1, we manipulated the cause of disease contagion and the salience of patient's racial categorization, and measured the stereotypicality of behaviour. In phase 2, we assessed perceived responsibility and likelihood of recommending medical treatment. RESULTS Controllable (vs. non-controllable) contraction behaviours in phase 1 were perceived as more stereotypic. As a spillover effect, more stereotypical behaviours in phase 1 predicted more patient's responsibility for their disease in phase 2. Importantly, controllable behaviours of disease contraction in phase 1 negatively affected recommendations for medical treatment in phase 2; and this negative effect was serially mediated by the stereotypicality of behaviour and patient responsibility. Furthermore, patients' skin colour moderated this process, meaning that perceptions of controllable behaviour as more stereotypic were stronger for Black than for White patients. CONCLUSIONS This research shows how stereotyping and social categorization bias allocation decisions through the patient's level of responsibility in decision-making processes. The findings are discussed in light of principles of distributive justice and the literature on intergroup relations with respect to racial disparities in health care.
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Affiliation(s)
- Filipa Madeira
- Institute of Social Sciences University of Lisbon Lisbon Portugal
| | - Emerson Araújo Do Bú
- Institute of Social Sciences University of Lisbon Lisbon Portugal
- Faculty of Psychology University of Lisbon Lisbon Portugal
| | - Gonçalo Freitas
- Institute of Social Sciences University of Lisbon Lisbon Portugal
- Faculty of Psychology University of Lisbon Lisbon Portugal
| | - Cicero Roberto Pereira
- Institute of Social Sciences University of Lisbon Lisbon Portugal
- Department of Psychology Federal University of Paraíba João Pessoa Brazil
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15
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Exploring subconscious bias. The Journal of Laryngology & Otology 2022; 136:961-963. [DOI: 10.1017/s0022215121004199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackgroundImplicit biases may lead to subconscious evaluations of a person based on irrelevant characteristics such as race or gender. This audit investigates the presence of implicit bias in the management of patients who missed appointments in our department.MethodsThis study retrospectively analysed discharge rates in 285 patients who missed an out-patient appointment between 1 May 2020 and 1 April 2021 at Guy's and St Thomas’ Hospital. After reading the patients' names, 285 patients were categorised into genders, and ethnic categories of: White British; Black, Asian and minority (non-White) ethnic (‘BAME’); and other White.ResultsThere were no differences in discharge rates in terms of self-reported ethnic and gender groups. However, patients perceived as White British were less likely to be discharged when compared to patients perceived as Black, Asian and minority ethnic (35 per cent vs 58 per cent). Discharge rates for perceived gender did not differ.ConclusionImplicit bias may influence decision-making regarding whether to rebook a patient after missing an appointment.
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16
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Krakow AR, Talwar D, Mehta NN, Gandhi JS, Flynn JM. Getting the Message: The Declining Trend in Opioid Prescribing for Minor Orthopaedic Injuries in Children and Adolescents. J Bone Joint Surg Am 2022; 104:1166-1171. [PMID: 35793795 DOI: 10.2106/jbjs.21.01078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Opioids constitute the fastest-growing drug problem among children and adolescents in the United States. Recent heavy media coverage on the opioid prescription epidemic has garnered increased attention from prescribers and policymakers. The purpose of this study was to analyze trends in opioid prescribing for nonoperatively managed pediatric fractures and dislocations in order to examine changes in opioid-prescribing patterns across various U.S. regions. METHODS A retrospective review of the national Pediatric Health Information System (PHIS) database comprising 42 pediatric hospitals was performed to identify pediatric fractures and dislocations presenting to the emergency department (ED) or outpatient clinics from 2004 to 2017. We included patients with the 10 most frequently encountered diagnoses who were nonoperatively managed and were discharged home the same day. To account for hospital variation, we utilized a mixed-effects logistic regression model. RESULTS The final cohort included 134,931 patients, with a mean age (and standard deviation) of 12.57 ± 2.00 years (range, 10 to 18 years); 69.23% of patients were male. Overall, 51.69% of patients were prescribed at least 1 opioid dose during their ED or clinic visits. Of the patients receiving opioids, 72.04% were male and 54.10% were insured through a private insurance plan. When prescription trends were compared according to regions, children were more likely to be prescribed opioids in the South (71.37% more likely) and the Midwest (26.17% more likely) than in the Northeast. CONCLUSIONS Although the opioid prescription rates in all 4 regions have decreased dramatically over the years, some regions were quicker than others in responding to the opioid epidemic. A significant interregional variability in opioid-prescribing practices still exists, but an overall downward trend in opioid prescription rates for acute pain management in conservatively treated pediatric fractures and dislocations is evidence of progress in tackling the opioid crisis. CLINICAL RELEVANCE Opioid-related misuse is a national epidemic and reducing the use of opioids in pediatric orthopaedic procedures is critical. Although regional variability in opioid-prescribing practices still exists, an overall downward trend in opioid prescription rates for acute pain management in conservatively treated pediatric fractures and dislocations is evidence of progress in tackling the opioid crisis.
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Affiliation(s)
- Arielle R Krakow
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Divya Talwar
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nishank N Mehta
- Department of Orthopaedics, Stony Brook University, Stony Brook, New York
| | | | - John M Flynn
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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17
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Mind the Gate: General Practitioner's Attitudes Towards Depressed Patients with Diverse Migration Backgrounds. Community Ment Health J 2022; 58:499-511. [PMID: 34085187 DOI: 10.1007/s10597-021-00844-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
This study aims to examine (a) whether there are differences in general practitioners' (GPs) attitudes towards native Belgian patients, patients of foreign descent and asylum seeking patients who all express symptoms of major depression, and (b) whether these differences depend on GPs' experience with cultural competency training and interethnic contact. Using a video vignette study among 404 Flemish (Belgium) GPs, we find evidence of a provider bias. While GPs regard a patient of foreign descent as less trustworthy and less able to adhere to medical recommendations than a native Belgian patient, they also hold more pessimistic views on a potential recovery of an asylum seeking patient. In addition, we find that cultural competency training might alter GPs' attitudes of asylum seeking patients in a positive way. Summarized, our research highlights the need to target stereotypes among GPs for interventions designed to reduce migration-based disparities in healthcare use and health status.
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18
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Lam J, Vuolo M. Later-life transitions and changes in prescription medication use for pain and depression. BMC Geriatr 2022; 22:222. [PMID: 35300602 PMCID: PMC8931979 DOI: 10.1186/s12877-022-02921-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/09/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Over the past two decades, prescription medication use for pain and depression increased dramatically. Most studies consider the early life course, despite a similar increase among those in later life. In this paper, we examine whether and how later life transitions may relate to changes in medication use. METHODS We draw on data from the Health and Retirement Study and fixed-effects models to examine whether work, family, and civic transitions in later life are related to changes in the usage of prescription pain and depression medication. RESULTS Results show that individuals had higher odds of regularly using prescription pain and depression medications in periods when out of the labor market. Higher odds of depression medication use were also associated with periods of widowhood, and lower odds of use when frequently volunteering. Such relations persist adjusting for reported levels of pain and depression. CONCLUSION Our findings call attention to the importance of social ties and the presence of actors that may regulate health behaviors, as well as a change in social context, that may shape medication use in later life.
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Affiliation(s)
- Jack Lam
- Institute for Social Science Research, Life Course Centre - University of Queensland, Level 2, Cycad Building (1018), 80 Meiers Road, Indooroopilly, QLD, 4068, Australia.
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19
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Eneanya ND, Tiako MJN, Novick TK, Norton JM, Cervantes L. Disparities in Mental Health and Well-Being Among Black and Latinx Patients With Kidney Disease. Semin Nephrol 2022; 41:563-573. [PMID: 34973700 DOI: 10.1016/j.semnephrol.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Black and Latinx individuals in the United States are afflicted disproportionately with kidney disease. Because of structural racism, social risk factors drive disparities in disease prevalence and result in worse outcomes among these patient groups. The impact of social and economic oppression is pervasive in physical and emotional aspects of health. In this review, we describe the history of race and ethnicity among black and Latinx individuals in the United States and discuss how these politicosocial constructs impact disparities in well-being and mental health. Lastly, we outline future research, clinical considerations, and policy considerations to eliminate racial and ethnic disparities in well-being among black and Latinx individuals with kidney disease.
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Affiliation(s)
- Nwamaka D Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | | | - Tessa K Novick
- Division of Nephrology, Department of Internal Medicine, University of Texas, Austin Dell Medical School, Austin, TX
| | - Jenna M Norton
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Lilia Cervantes
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO
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20
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Emerson AJ, Chandler LE, Oxendine RH, Huff CM, Harris GM, Baxter GD, Wonsetler Jones EC. Systematic review of clinical decision-makers’ attitudes, beliefs, and biases that contribute to a marginalized process of care in persistent musculoskeletal pain. Part II: case vignettes. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.2000289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Alicia J. Emerson
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
- Centre for Health, Activity, and Rehabilitation Research, University of Otago, Dunedin, New Zealand
| | - Lauren E. Chandler
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - Riley H. Oxendine
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - Corey M. Huff
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - Gabrielle M. Harris
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - G. David Baxter
- Centre for Health, Activity, and Rehabilitation Research, University of Otago, Dunedin, New Zealand
| | - Elizabeth C. Wonsetler Jones
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
- Department of Public Health and Community Medicine, Tufts University, Boston, MA, USA
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21
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McCarty D, Shanahan M. Theory-Informed Clinical Practice: How Physical Therapists Can Use Fundamental Interventions to Address Social Determinants of Health. Phys Ther 2021; 101:6308777. [PMID: 34174078 DOI: 10.1093/ptj/pzab158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/14/2021] [Accepted: 04/25/2021] [Indexed: 11/14/2022]
Abstract
UNLABELLED The American Physical Therapy Association's Vision Statement for the profession is guided by principles of innovation, access, equity, and advocacy, and calls on physical therapists to stretch their influence beyond the walls of the clinic and the individuals they treat. Access and equity are problems that span multiple health care professions and entities; yet, addressing social determinants of health is a paradigm shift that clinicians need continued support to achieve. This article has 2 objectives: (1) to define the Fundamental Cause Theory and the Socioecological Model within the context of physical therapy in order to promote best clinical practice, and (2) to apply the concept of "fundamental interventions" in clinical practice to mitigate the negative impact of downstream effects of social determinants of health across levels of the Socioecological Model-individual, interpersonal, institutional, community, and societal. This theoretical lens provides the conceptual framework necessary for physical therapists to think creatively about ways to change their practice in their own contexts to impact the life of individual patients and transform the movement health of society. IMPACT As health care providers, physical therapists have a responsibility to make every effort to meet the needs of their patients and optimize movement health in society; yet significant structural and systemic barriers often prevent patients from reaching their fullest potential. Clinicians can no longer subscribe to a narrow scope of practice focused on individual attainment of therapy goals. This Perspective discusses Fundamental Cause Theory and the Socioecological Model theoretical frameworks that can help physical therapists develop, test, and implement functional interventions to address the needs of society as a whole.
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Affiliation(s)
- Dana McCarty
- Division of Physical Therapy, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Meghan Shanahan
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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22
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Patel M, Johnson AJ, Booker SQ, Bartley EJ, Palit S, Powell-Roach K, Terry EL, Fullwood D, DeMonte L, Mickle AM, Sibille KT. Applying the NIA Health Disparities Research Framework to Identify Needs and Opportunities in Chronic Musculoskeletal Pain Research. THE JOURNAL OF PAIN 2021; 23:25-44. [PMID: 34280570 DOI: 10.1016/j.jpain.2021.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 11/19/2022]
Abstract
Disparities in the experience of chronic musculoskeletal pain in the United States stem from a confluence of a broad array of factors. Organized within the National Institute on Aging Health Disparity Research Framework, a literature review was completed to evaluate what is known and what is needed to move chronic musculoskeletal pain research forward specific to disproportionately affected populations. Peer-reviewed studies published in English, on human adults, from 2000 to 2019, and conducted in the United States were extracted from PubMed and Web of Science. Articles were reviewed for key words that focused on underrepresented ethnic/race groups with chronic musculoskeletal pain applying health factor terms identified in the NIAHealth Disparity Research Framework four levels of analysis: 1) environmental, 2) sociocultural, 3) behavioral, and 4) biological. A total of 52 articles met inclusion criteria. There were limited publications specific to underrepresented ethnic/race groups with chronic musculoskeletal pain across all levels with particular research gaps under sociocultural and biological categories. Current limitations in evidence may be supplemented by a foundation of findings specific to the broader topic of "chronic pain" which provides guidance for future investigations. Study designs including a focus on protective factors and multiple levels of analyses would be particularly meritorious. PERSPECTIVE: Chronic musculoskeletal pain unequally burdens underrepresented ethnic/race groups. In order to move research forward and to systematically investigate the complex array of factors contributing toward health disparities, an organized approach is necessary. Applying the NIA Health Disparities Research Framework, an overview of the current state of evidence specific to chronic musculoskeletal pain and underrepresented ethnic/race groups is provided with future directions identified.
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Affiliation(s)
- Monika Patel
- Department of Anesthesiology, Division of Pain Medicine, University of Florida Health at Jacksonville, Jacksonville, Florida
| | - Alisa J Johnson
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Staja Q Booker
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; College of Nursing, University of Florida, Gainesville, Florida
| | - Emily J Bartley
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Shreela Palit
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Keesha Powell-Roach
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; College of Nursing, University of Florida, Gainesville, Florida
| | - Ellen L Terry
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; College of Nursing, University of Florida, Gainesville, Florida
| | - Dottington Fullwood
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; Department of Aging and Geriatric Research, Institute on Aging, College of Medicine, University of Florida, Gainesville, Florida
| | - Lucas DeMonte
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Angela M Mickle
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Kimberly T Sibille
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; Department of Aging and Geriatric Research, Institute on Aging, College of Medicine, University of Florida, Gainesville, Florida; Department of Anesthesiology, Division of Pain Medicine, College of Medicine, University of Florida, Gainesville, Florida.
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Bazargan M, Loeza M, Ekwegh T, Adinkrah EK, Kibe LW, Cobb S, Assari S, Bazargan-Hejazi S. Multi-Dimensional Impact of Chronic Low Back Pain among Underserved African American and Latino Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7246. [PMID: 34299695 PMCID: PMC8306928 DOI: 10.3390/ijerph18147246] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/23/2021] [Accepted: 07/02/2021] [Indexed: 12/25/2022]
Abstract
Chronic low back pain is one of the most common, poorly understood, and potentially disabling chronic pain conditions from which older adults suffer. The existing low back pain research has relied almost exclusively on White/Caucasian participant samples. This study examines the correlates of chronic low back pain among a sample of underserved urban African American and Latino older adults. Controlling for age, gender, race/ethnicity, education, living arrangement, and number of major chronic conditions, associations between low back pain and the following outcome variables are examined: (1) healthcare utilization, (2) health-related quality of life (HR-QoL) and self-rated quality of health; and (3) physical and mental health outcomes. METHODS We recruited nine hundred and five (905) African American and Latino older adults from the South Los Angeles community using convenience and snowball sampling. In addition to standard items that measure demographic variables, our survey included validated instruments to document HR-QoL health status, the Short-Form McGill Pain Questionnaire-2, Geriatric Depression Scale, sleep disorder, and healthcare access. Data analysis includes bivariate and 17 independent multivariate models. RESULTS Almost 55% and 48% of the Latino and African American older adults who participated in our study reported chronic low back pain. Our data revealed that having low back pain was associated with three categories of outcomes including: (1) a higher level of healthcare utilization measured by (i) physician visits, (ii) emergency department visits, (iii) number of Rx used, (iv) a higher level of medication complexity, (v) a lower level of adherence to medication regimens, and (vi) a lower level of satisfaction with medical care; (2) a lower level of HR-QoL and self-assessment of health measured by (i) physical health QoL, (ii) mental health QoL, and (iii) a lower level of self-rated health; and (3) worse physical and mental health outcomes measured by (i) a higher number of depressive symptoms, (ii) a higher level of pain, (iii) falls, (iv) sleep disorders, (v) and being overweight/obese. DISCUSSION Low back pain remains a public health concern and significantly impacts the quality of life, health care utilization, and health outcomes of underserved minority older adults. Multi-faceted and culturally sensitive interventional studies are needed to ensure the timely diagnosis and treatment of low back pain among underserved minority older adults. Many barriers and challenges that affect underserved African American and Latino older adults with low back pain simply cannot be addressed in over-crowded EDs. Our study contributes to and raises the awareness of healthcare providers and health policymakers on the necessity for prevention, early diagnosis, proper medical management, and rehabilitation policies to minimize the burdens associated with chronic low back pain among underserved older African American and Latino patients in an under-resourced community such as South Los Angeles.
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Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA; (M.B.); (M.L.); (S.A.)
- Department of Public Health, CDU, Los Angeles, CA 90059, USA;
- Physician Assistant Program, CDU, Los Angeles, CA 90059, USA;
- Department of Family Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Margarita Loeza
- Department of Family Medicine, Charles R Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA; (M.B.); (M.L.); (S.A.)
- Department of Family Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Tavonia Ekwegh
- School of Nursing, CDU, Los Angeles, CA 90059, USA; (T.E.); (S.C.)
| | | | - Lucy W. Kibe
- Physician Assistant Program, CDU, Los Angeles, CA 90059, USA;
| | - Sharon Cobb
- School of Nursing, CDU, Los Angeles, CA 90059, USA; (T.E.); (S.C.)
| | - Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA; (M.B.); (M.L.); (S.A.)
- Department of Public Health, CDU, Los Angeles, CA 90059, USA;
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry, UCLA, Los Angeles, CA 90095, USA
- Department of Psychiatry, CDU, Los Angeles, CA 90059, USA
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24
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Engel-Rebitzer E, Dolan AR, Aronowitz SV, Shofer FS, Nguemeni Tiako MJ, Schapira MM, Perrone J, Hess EP, Rhodes KV, Bellamkonda VR, Cannuscio CC, Goldberg E, Bell J, Rodgers MA, Zyla M, Becker LB, McCollum S, Meisel ZF. Patient Preference and Risk Assessment in Opioid Prescribing Disparities: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2118801. [PMID: 34323984 PMCID: PMC8322998 DOI: 10.1001/jamanetworkopen.2021.18801] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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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Affiliation(s)
- Eden Engel-Rebitzer
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
| | - Abby R. Dolan
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Frances S. Shofer
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Max Jordan Nguemeni Tiako
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Yale School of Medicine, New Haven, Connecticut
| | - Marilyn M. Schapira
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of General and Internal Medicine, University of Pennsylvania, Philadelphia
| | - Jeanmarie Perrone
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Penn Center for Addiction Medicine and Policy, Philadelphia, Pennsylvania
| | - Erik P. Hess
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Karin V. Rhodes
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Venkatesh R. Bellamkonda
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Carolyn C. Cannuscio
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
| | - Erica Goldberg
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
| | - Jeffrey Bell
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
| | - Melissa A. Rodgers
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- College of Education, University of Texas at Austin, Austin
| | - Michael Zyla
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
| | - Lance B. Becker
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Sharon McCollum
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
| | - Zachary F. Meisel
- Center for Emergency Care Policy and Research, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Penn Injury Science Center, University of Pennsylvania, Philadelphia
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25
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Ganguly AP, Lira MC, Lodi S, Forman LS, Colasanti JA, Williams EC, Liebschutz JM, del Rio C, Samet JH, Tsui JI. Race and satisfaction with pain management among patients with HIV receiving long-term opioid therapy. Drug Alcohol Depend 2021; 222:108662. [PMID: 33775447 PMCID: PMC9215531 DOI: 10.1016/j.drugalcdep.2021.108662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/08/2021] [Accepted: 01/21/2021] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Management of chronic pain is an essential aspect of HIV primary care. Previous literature in the general population has elucidated racial disparities in the evaluation and treatment of pain. This study examined racial/ethnic differences in patient satisfaction and barriers to pain management among a cohort of PWH receiving LTOT. MATERIALS AND METHODS Patient-reported survey and EMR data were compared between non-white (n = 135; 81.3 %) and white (n = 31; 18.7 %) patients in a cohort of 166 PWH receiving LTOT in two clinics in Atlanta and Boston. Quantile and linear regression were used to evaluate the association between race and pain management outcomes: 1) satisfaction with pain management (0-10) and 2) patient-related barriers to pain management, including patient perceptions of pain medications, fatalism, and communication about pain. Models were adjusted for sex, age, clinical site, and baseline general health. RESULTS Non-white participants were noted to receive chronic opioids for a shorter mean duration of time than white participants (6.0 versus 11.0 years, p < 0.001) and lower mean morphine equivalent daily dose (MEDD) than white participants (28.1 versus 66.9 mg, p < 0.001). In adjusted analyses, there was no significant difference in satisfaction with pain management among non-white and white participants (p = 0.101). There was no significant difference in barriers to pain management in unadjusted (p = 0.335) nor adjusted models (p = 0.397). CONCLUSION While non-white PWH were noted to have received lower doses of chronic opioids and for shorter duration than white PWH, satisfaction with pain management was similar. Patient-related barriers to pain management were similar among non-white and white PWH.
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Affiliation(s)
- Anisha P. Ganguly
- Internal Medicine Residency, University of Washington, Seattle, Washington
| | - Marlene C. Lira
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Sara Lodi
- Boston University School of Public Health, Boston, Massachusetts
| | - Leah S. Forman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Jonathan A. Colasanti
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Emily C. Williams
- University of Washington School of Public Health, Department of Health Services, Seattle, Washington,VA Puget Sound Health Care System, Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington
| | - Jane M. Liebschutz
- Division of General Internal Medicine, Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carlos del Rio
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jeffrey H. Samet
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts,Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts,Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Judith I. Tsui
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington
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26
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Barengo JH, Redmann AJ, Kennedy P, Rutter MJ, Smith MM. Demographic Characteristics of Children Diagnosed with Bacterial Tracheitis. Ann Otol Rhinol Laryngol 2021; 130:1378-1382. [PMID: 33834902 DOI: 10.1177/00034894211007250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Examine the presentation and clinical course of patients with bacterial tracheitis (BT). Identify if socioeconomic differences exist among children who present with BT. METHODS This was a retrospective case series from a tertiary care pediatric medical center. The study group included patients less than 18 years old who were diagnosed with BT from January 2011 to March 2019. Patients with a tracheostomy and those who developed BT after prolonged hospitalization were excluded. Patient demographics were compared with the demographics of the counties surrounding the hospital. RESULTS 33 patients with BT met inclusion criteria. The most common presenting symptoms were difficulty breathing, stridor, and sore throat (81.8% each), followed by cough (78.8%). Median length of stay was 3 days [interquartile range (IQR):2-4]. 19 patients (57.5%) were admitted to the intensive care unit. Intubation was required for 13 patients (39.4%), for a median length of 2 days [IQR:2-2]. Methicillin sensitive staphylococcus aureus was the most common bacterial etiology (33%). Mean presenting age was 8.58 years [95% confidence interval:7.3-9.9] and 14 patients were female (42.4%). 31 patients were white (93.9%), 1 was black (3%), and 1 was Hispanic (3%). BT patients were more likely to have private insurance compared to comparison (81.8% vs 63.4%, P < .001). CONCLUSION Children who presented with BT were more likely to be privately insured than a comparison population.
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Affiliation(s)
- Jenna H Barengo
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew J Redmann
- Department of Otolaryngology-Head & Neck Surgery, University of Minnesota, Minneapolis, MN, USA.,Department of Pediatric Otolaryngology, Children's Minnesota, Minneapolis, MN, USA
| | - Patrick Kennedy
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Michael J Rutter
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA.,Division of Otolaryngology, Cincinnati Children's Hospital Medical, Center, Cincinnati, OH, USA
| | - Matthew M Smith
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA.,Division of Otolaryngology, Cincinnati Children's Hospital Medical, Center, Cincinnati, OH, USA
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Nicholson HL, Wheeler PB. Prescription Drug Misuse among African Americans and Afro Caribbeans: Results from the National Survey of American Life. Subst Use Misuse 2021; 56:962-970. [PMID: 33769198 DOI: 10.1080/10826084.2021.1901928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The misuse of prescription medications is an understudied topic among the non-Hispanic Black population in the U.S. Even less is known about the prevalence and correlates of misuse among African Americans and Afro-Caribbeans, despite documented differences in their substance use behaviors. OBJECTIVES We aimed to examine the prevalence and correlates of lifetime prescription drug misuse among African Americans and Afro Caribbeans using data from the National Survey of American Life. METHODS A national household probability sample of non-institutionalized African Americans and Afro Caribbeans from the Collaborative Psychiatric Epidemiology Surveys was used. Pooled and ethnicity-stratified logistic regressions were estimated. RESULTS Findings showed no significant differences between African Americans (6.36%) and Afro-Caribbeans (5.71%) in lifetime prescription drug misuse. Several correlates were found to be associated with misuse among only African American or Afro-Caribbean respondents. CONCLUSIONS While research has shown prescription drug misuse is an issue among Blacks overall, our results show that the role of ethnicity must not be overlooked, especially when tailoring prevention and intervention programs. Limitations of this study are discussed.
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Affiliation(s)
- Harvey L Nicholson
- Department of Sociology and Criminology & Law, University of Florida, Florida, USA
| | - Paris B Wheeler
- Department of Educational, School, and Counseling Psychology, University of Kentucky, Lexington, Kentucky, USA
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28
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McDowell MJ, Goldhammer H, Potter JE, Keuroghlian AS. Strategies to Mitigate Clinician Implicit Bias Against Sexual and Gender Minority Patients. PSYCHOSOMATICS 2020; 61:655-661. [DOI: 10.1016/j.psym.2020.04.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/24/2022]
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Assessing Provider Bias in General Practitioners' Assessment and Referral of Depressive Patients with Different Migration Backgrounds: Methodological Insights on the Use of a Video-Vignette Study. Community Ment Health J 2020; 56:1457-1472. [PMID: 32133547 DOI: 10.1007/s10597-020-00590-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
Although the prevalence of common mental health conditions such as depression and anxiety, is higher among people with a migration background, these groups are generally underrepresented in all forms of institutionalized mental health care. At the root of this striking discrepancy might be unequal referral by health care practitioners. In this article we describe the development of a quasi-experimental video vignette methodology to assess potential forms of unequal diagnosing, treatment and referral patterns, based on clients' migration background and asylum status. The presented methodology also allows to explore whether potential differences are related to provider bias, i.e. underlying attitudes and expectations held by general practitioners. Potential assets and drawbacks of this methodology are discussed in detail.
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30
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Reboussin BA, Rabinowitz JA, Thrul J, Maher B, Green KM, Ialongo NS. Trajectories of cannabis use and risk for opioid misuse in a young adult urban cohort. Drug Alcohol Depend 2020; 215:108182. [PMID: 32745836 PMCID: PMC8420929 DOI: 10.1016/j.drugalcdep.2020.108182] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although much of the attention surrounding the opioid epidemic has focused on rural and suburban Whites and prescription opioids, heroin overdoses among urban Blacks are on the rise. While some argue that legalization of cannabis will combat the epidemic, there are concerns it ignores the shift in the epidemic and could increase vulnerability to opioid misuse. The goal of this study is to examine the association between cannabis use from adolescence to young adulthood with opioid misuse in a primarily urban Black cohort. METHODS Data are from a study of 580 youth (87 % Black and 71 % low SES) residing in Baltimore City followed from ages 6-26. Cannabis trajectories were identified between ages 14-26 using group-based trajectory modeling. Logistic regressions were conducted to examine the impact of trajectories on opioid misuse in young adulthood adjusting for individual, neighborhood and peer factors. Opioid misuse was defined as using heroin or narcotics or painkillers without a prescription between ages 19-26. RESULTS Four cannabis trajectories were identified: Low/Non-Users (59.7 %), Adolescent Onset Limited (19.5 %), Young Adult Onset (10.8 %), and Adolescent Onset Chronic (10.0 %). Adolescent Onset Chronic cannabis users had the highest rate of opioid misuse (44.8 %) followed by Adolescent Onset Limited (18.8 %), Young Adult Onset (14.8 %) and Low/Non-Users (8.3 %). Prevalences were significantly higher for Adolescent Onset groups relative to Low/Non-Users even after adjustment for individual, neighborhood and peer factors. CONCLUSIONS Adolescent onset cannabis use is associated with opioid misuse in young adulthood among urban Blacks even after adjustment for socioecological factors associated with opioid misuse.
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Affiliation(s)
- Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Jill A Rabinowitz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Brion Maher
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Kerry M Green
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Nicholas S Ialongo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
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Abstract
Given the profound influence of social media and emerging evidence of its effects on human behavior and health, bioethicists have an important role to play in the development of professional standards of conduct for health professionals using social media and in the design of online systems themselves. In short, social media is a bioethics issue that has serious implications for medical practice, research, and public health. Here, we inventory several ethical issues across four areas at the intersection of social media and health: the impact of social networking sites on the doctor-patient relationship, the development of e-health platforms to deliver care, the use of online data and algorithms to inform health research, and the broader public health consequences of widespread social media use. In doing so, we review discussions of these topics and emphasize the need for bioethics to focus more deeply on the ways online technology platforms are designed and implemented. We argue that bioethicists should turn their attention to the ways in which consumer engagement, bias, and profit maximization shape online content and, consequently, human behavior and health. We also offer a set of recommendations and suggest future directions for addressing ethical challenges in these domains.
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Matthias MS, Talib TL, Huffman MA. Managing Chronic Pain in an Opioid Crisis: What Is the Role of Shared Decision-Making? HEALTH COMMUNICATION 2020; 35:1239-1247. [PMID: 31179769 PMCID: PMC6901808 DOI: 10.1080/10410236.2019.1625000] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Shared decision-making (SDM) is a widely-advocated practice that has been linked to improved patient adherence, satisfaction, and clinical outcomes. SDM is a process in which patients and providers share information, express opinions, and build consensus toward a treatment decision. Chronic pain and its treatment present unique challenges for SDM, especially in the current environment in which opioids are viewed as harmful and a national opioid crisis has been declared. The purpose of this qualitative study is to understand treatment decision-making with patients taking opioids for chronic pain. Ninety-five clinic visits and 31 interviews with patients and primary care providers (PCPs) were analyzed using the constant comparison method. Results revealed that 1) PCPs desire patient participation in treatment decisions, but with caveats where opioids are concerned; 2) Disagreements about opioids, including perceptions of lack of listening, presented challenges to SDM; and 3) PCPs described engaging in persuasion or negotiation to convince patients to try alternatives to opioids, or appeasing patients requesting opioids with very small amounts in an effort to maintain the patient-provider relationship. Results are discussed through the lens of Charles, Gafni, and Whelan's SDM model, and implications of the role of the patient-provider relationship in SDM and chronic pain treatment are discussed.
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Affiliation(s)
- Marianne S Matthias
- Department of Veterans Affairs, Center for Health Information and Communication
- Department of Communication Studies, Indiana University-Purdue University
- Regenstrief Institute
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine
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Cooley E, Brown-Iannuzzi JL, Lei RF, Philbrook LE, Cipolli W, McKee SE. Investigating the Health Consequences for White Americans Who Believe White Americans Are Wealthy. SOCIAL PSYCHOLOGICAL AND PERSONALITY SCIENCE 2020. [DOI: 10.1177/1948550620905219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Poor White Americans report feeling “worse off” than poor Black Americans despite the persistent negative effects of racism on Black Americans. Additionally, some health issues are rising among White but not Black Americans. Across two representative samples, we test whether White = wealthy stereotypes lead White Americans to feel relatively worse off than their racial group and whether these perceptions have health consequences. Across both samples, White Americans perceived their own status to be significantly lower than the status of the majority of White Americans. In contrast, Black Americans perceived their own status to be significantly higher than the majority of Black Americans. Critically, status comparisons between the self and one’s racial group predicted the experience of fewer positive emotions among White, but not Black, Americans, which mediated reduced mental and physical health. We conclude that race/class stereotypes may shape how poverty subjectively feels.
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Torres PJ, Henry SG, Ramanathan V. Let's talk about pain and opioids: Low pitch and creak in medical consultations. DISCOURSE STUDIES 2020; 22:174-204. [PMID: 32256188 PMCID: PMC7111341 DOI: 10.1177/1461445619893796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In recent years, the opioid crisis in the United States has sparked significant discussion on doctor-patient interactions concerning chronic pain treatments, but little to no attention has been given to investigating the vocal aspects of patient talk. This exploratory sociolinguistic study intends to fill this knowledge gap by employing prosodic discourse analysis to examine context-specific linguistic features used by the interlocutors of two distinct medical interactions. We found that patients employed both low pitch and creak as linguistic resources when describing chronic pain, narrating symptoms, and requesting opioids. The situational use of both features informs us about the linguistic ways in which patients frame fraught issues like chronic pain in light of the current opioid crisis. This study expands the breadth of phonetic analysis within the domain of discourse analysis, serving to illuminate discussions surrounding the illocutionary role of the lower vocal tract in expressing emotions.
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Affiliation(s)
| | - Stephen Gresham Henry
- Division of General Medicine, Geriatrics, and Bioethics, University of California Davis, Sacramento, CA, USA
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Saha S, Beach MC. Impact of Physician Race on Patient Decision-Making and Ratings of Physicians: a Randomized Experiment Using Video Vignettes. J Gen Intern Med 2020; 35:1084-1091. [PMID: 31965527 PMCID: PMC7174451 DOI: 10.1007/s11606-020-05646-z] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/26/2019] [Accepted: 01/03/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Studies suggest that black patients have better interactions, on average, with physicians of their own race. Whether this reflects greater "cultural competence" in race-concordant relationships, or other effects of race unrelated to physician behavior, is unclear. It is also unclear if physician race influences patient decision-making. OBJECTIVE To determine whether physician race affects patients' ratings of physicians and decision-making, independent of physician behavior. DESIGN Randomized study using standardized video vignettes. PARTICIPANTS Primary care patients with coronary risk factors or disease. INTERVENTIONS Each participant viewed one of 16 vignettes depicting a physician reviewing cardiac catheterization results and recommending coronary artery bypass graft (CABG) surgery. Vignettes varied only in terms of physicians' race, gender, age, and communication style (high vs. low patient-centeredness). MAIN MEASURES Participants rated the video physician's communication, interpersonal style, competence, trustworthiness, likability, and overall performance (0-4 Likert scales). They also rated the necessity of CABG (0-5 scale) and whether they would undergo CABG or obtain a second opinion if they were the video patient (0-3 scales). KEY RESULTS Participants included 107 black and 131 white patients (72% participation rate). Black participants viewing a black (vs. white) video physician gave higher ratings on all physician attributes (e.g., overall rating 3.22 vs. 2.34, p < 0.001) and were more likely to perceive CABG as necessary (4.05 vs. 3.72, p = 0.03) and say they would undergo CABG if they were the video patient (2.43 vs. 2.09, p = 0.004). Patient-centered communication style reduced, but did not eliminate, the impact of race concordance. Physician race was not associated with any outcomes among white patients. CONCLUSIONS Black patients viewed the doctor in a scripted vignette more positively, and were more receptive to the same recommendation, communicated in the same way, with a black vs. white physician. Patient-centered communication reduced but did not eliminate the effect of physician race.
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Affiliation(s)
- Somnath Saha
- Section of General Internal Medicine, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd. (P3HSRD), Portland, OR, USA.
- Division of General Internal Medicine & Geriatrics, Oregon Health and Science University, Portland, OR, USA.
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Jain P, Zaher Z, Mazid I. Opioids on Twitter: A Content Analysis of Conversations regarding Prescription Drugs on Social Media and Implications for Message Design. JOURNAL OF HEALTH COMMUNICATION 2020; 25:74-81. [PMID: 31900054 DOI: 10.1080/10810730.2019.1707911] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
As many as 130 lives are lost every day in the United States due to prescription drug misuse. The opioid crisis is gripping the country and disrupting the lives of millions. Not surprisingly, health organizations are desperately seeking solutions to educate and inform people regarding the issue, often seeking the help of various social media platforms. In this study, we do a content analysis of Twitter messages related to opioids in order to understand the factors that are most likely to influence content sharing. Our findings indicate that structure, source, and the actual content of the post all influence the likelihood of the content's being shared. Specifically, certain types of content enhanced the likelihood of content sharing whereas use of the term "addiction" discouraged retweeting. Theoretical and practical implications for message design are discussed.
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Affiliation(s)
- Parul Jain
- Scripps College of Communication, Ohio University, Athens, OH, USA
| | - Zulfia Zaher
- Department of Journalism, Central Michigan University, Mount Pleasant, MI, USA
| | - Imran Mazid
- School of Communications, Grand Valley State University, Allendale, MI, USA
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Diniz E, Castro P, Bousfield A, Figueira Bernardes S. Classism and dehumanization in chronic pain: A qualitative study of nurses' inferences about women of different socio-economic status. Br J Health Psychol 2019; 25:152-170. [PMID: 31811704 DOI: 10.1111/bjhp.12399] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 11/08/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Class-based dehumanization in health is poorly investigated. Beliefs about social class are often shared across cultures, with people of lower socio-economic status (SES) being typically dehumanized. This study specifically examined how nurses' perceptions of pain patients' SES were associated with (more or less) dehumanizing inferences about their pain and different treatment recommendations. DESIGN Sequential mixed methods including Similitude Analysis (statistical analysis of qualitative data) and a Thematic Analysis. Fifty female nurses watched short videos of two white women of different SES (low vs. middle) and similar levels of pain behaviours. Afterwards, nurses were asked to complete (1) a Free Association Task (associating characteristics and a profession to the women) and (2) a Story-Completion Task (writing a story describing women's lives, pain, and recommending treatments). Data were analysed with Similitude and Thematic Analysis. RESULTS The women's SES was recognized, linked to distinct professions, and associated with distinct inferences. The middle-SES woman was depicted with both Uniquely Human (e.g., autonomous) and Human Nature (e.g., communicative) traits, positive future prospects, and competence to self-manage pain. The low-SES woman was associated with Human Nature traits (hard-working) but denied Uniquely Human traits associated with competence; she was imagined as passive towards pain, with poor future prospects and referred to psychoeducation. CONCLUSION Findings reveal the role of class-based cultural belief systems in pain care, showing how nurses' recognition of low SES is associated with dehumanizing inferences and recommendations, which may contribute to reproducing pain care disparities. Theoretical implications of these findings for social and health psychology are drawn. Statement of contribution What is already known on the subject? • Psychosocial research on health and pain care disparities has paid more attention to the role of race/racism and gender/sexism than the role of social class/classism; Belief systems about social class are shared across cultures; people from lower SES are often dehumanized by being denied competence, civility, and self-determination; Class-based dehumanization may influence the relational and technical aspects of clinical encounters but little is still known about these processes. What does this study add? Drawing upon a mixed-methods approach, this study provides novel findings on class-based dehumanization inferences made by female nurses on female chronic pain patients; Nurses perceived the lower SES patient with fewer Uniquely Human traits, that is, less competent, with more pain-related disability, and recommended her more psychoeducation. Class-based dehumanization processes may contribute to reproducing pain care disparities and may prove to be important targets for intervention development.
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Affiliation(s)
- Eva Diniz
- Instituto Universitário de Lisboa (ISCTE-IUL) & Centro de Investigação e Intervenção Social (CIS-IUL), Lisbon, Portugal
| | - Paula Castro
- Instituto Universitário de Lisboa (ISCTE-IUL) & Centro de Investigação e Intervenção Social (CIS-IUL), Lisbon, Portugal
| | - Andréa Bousfield
- Laboratório de Psicologia Social da Comunicação e Cognição (LACCOS), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - Sónia Figueira Bernardes
- Instituto Universitário de Lisboa (ISCTE-IUL) & Centro de Investigação e Intervenção Social (CIS-IUL), Lisbon, Portugal
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Ransome Y, Haeny AM, McDowell YE, Jordan A. Religious involvement and racial disparities in opioid use disorder between 2004-2005 and 2012-2013: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug Alcohol Depend 2019; 205:107615. [PMID: 31704384 PMCID: PMC6927538 DOI: 10.1016/j.drugalcdep.2019.107615] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Psychosocial factors have rarely been studied to understand racial differences in opioid use disorders (OUD). We investigate religious involvement and Black-White differences in OUD risk between 2004-05 and 2012-13. METHODS We use Non-Hispanic Black and White adults from the National Epidemiologic Survey on Alcohol and Related Conditions (wave 2, N = 26,661 and NESARC-III, N = 26,960) (NESARC). We conducted survey-weighted logistic regression to examine whether race moderates the association between religious involvement and lifetime DSM-IV and -5 OUD and whether those differences change (i.e., are modified) by time, adjusted for covariates such as age, education, and urbanicity. Religious involvement measures were service attendance, social interaction, and subjective religiosity/spirituality. RESULTS The prevalence of lifetime DSM-IV (3.82 vs 1.66) and DSM-5 (2.49 vs 1.32) OUD in NESARC-III was higher among White compared to Black respondents. Never attending services declined for both races over time. Race moderated the association between service attendance (F(4,65) = 14.9, p = 0.000), social interaction (F(4,65) = 34.4, p = 0.000) and subjective religiosity/spirituality (F(2,65) = 7.03, p = 0.000) on DSM-IV OUD in wave 2 and using DSM-5 OUD in NESARC-III (F(1,113) = 2.79, p = 0.066). Race differences in religion and DSM-IV OUD risk was modified by time (i.e., survey year) (all p < 0.000). For instance, higher service attendance was associated with lower DSM-IV risk for Black respondents in wave 2 but higher risk in NESARC-III. There were no changes in regression slopes among White respondents. CONCLUSIONS Religious involvement may be important for prevention and treatment practices that respond to racial differences in risk of OUD. Replicate studies should examine other religious factors and specific types of opioids.
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Affiliation(s)
- Yusuf Ransome
- Yale School of Public Health, Department of Social and Behavioral Sciences, Studies of Religion Ethnicity Technology and Contextual Influences on Health (STRETCH)-Lab, 60 College Street, New Haven, CT 06510.
| | - Angela M Haeny
- Yale School of Medicine, Department of Psychiatry, Division of Prevention and Community Research, and The Consultation Center 389 Whitney Avenue, New Haven, CT 06511
| | - Yoanna E McDowell
- University of Missouri, Alcohol, Health, and Behavior Lab, Department of Psychological Sciences, 146 Psychology Building, Columbia, MO 65211
| | - Ayana Jordan
- Yale School of Medicine, Department of Psychiatry, and Connecticut Mental Health Center 40 Temple Street, New Haven, CT 06510
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Aronowitz SV, Mcdonald CC, Stevens RC, Richmond TS. Mixed studies review of factors influencing receipt of pain treatment by injured black patients. J Adv Nurs 2019; 76:34-46. [DOI: 10.1111/jan.14215] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 07/12/2019] [Accepted: 08/28/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Robin C. Stevens
- School of Nursing University of Pennsylvania Philadelphia PA USA
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40
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Henry SG, Matthias MS. Patient-Clinician Communication About Pain: A Conceptual Model and Narrative Review. PAIN MEDICINE 2019; 19:2154-2165. [PMID: 29401356 DOI: 10.1093/pm/pny003] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective Productive patient-clinician communication is an important component of effective pain management, but we know little about how patients and clinicians actually talk about pain in clinical settings and how it might be improved to produce better patient outcomes. The objective of this review was to create a conceptual model of patient-clinician communication about noncancer pain, review and synthesize empirical research in this area, and identify priorities for future research. Methods A conceptual model was developed that drew on existing pain and health communication research. CINAHL, EMBASE, and PubMed were searched to find studies reporting empirical data on patient-clinician communication about noncancer pain; results were supplemented with manual searches. Studies were categorized and analyzed to identify crosscutting themes and inform model development. Results The conceptual model comprised the following components: contextual factors, clinical interaction, attitudes and beliefs, and outcomes. Thirty-nine studies met inclusion criteria and were analyzed based on model components. Studies varied widely in quality, methodology, and sample size. Two provisional conclusions were identified: contrary to what is often reported in the literature, discussions about analgesics are most frequently characterized by patient-clinician agreement, and self-presentation during patient-clinician interactions plays an important role in communication about pain and opioids. Conclusions Published studies on patient-clinician communication about noncancer pain are few and diverse. The conceptual model presented here can help to identify knowledge gaps and guide future research on communication about pain. Investigating the links between communication and pain-related outcomes is an important priority for future research.
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Affiliation(s)
- Stephen G Henry
- Department of Internal Medicine, University of California Davis, Sacramento, California
| | - Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana.,Regenstrief Institute, Indianapolis, Indiana.,Department of Communication Studies, Indiana University-Purdue University, Indianapolis, Indiana.,Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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41
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Witry MJ, St Marie BJ, Viyyuri BR, Windschitl PD. Factors Influencing Judgments to Consult Prescription Monitoring Programs: A Factorial Survey Experiment. Pain Manag Nurs 2019; 21:48-56. [PMID: 31133408 DOI: 10.1016/j.pmn.2019.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/05/2019] [Accepted: 04/01/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Prescription monitoring programs (PMPs) can provide health care professionals with valuable information. However, few studies have explored providers' decision making for accessing PMPs. AIMS This study aimed to identify provider characteristics and situational factors most influencing perceived importance of consulting the PMP for patients in a simulated context. DESIGN The study used a cross-sectional factorial survey. SETTINGS The survey was administered electronically. PARTICIPANTS/SUBJECTS Community pharmacists, advanced practice registered nurses (APRNs), and physicians in Iowa. METHODS Participants were recruited by mail which included a link to the online survey. The survey consisted of demographic questions, eight randomly generated vignettes, and one ranked item. The vignettes described a hypothetical prescription using eight experimental variables whose levels were randomly varied. Respondents evaluated each vignette for importance to access the PMP. Analyses used linear mixed-effects models in R (Version 3.5.0). RESULTS A total of 138 responses were available for multilevel analysis. Women, physicians, and APRNs rated it more important to consult the PMP for a given prescription compared with men and pharmacists. Accessing a PMP was perceived as more important with cash payments, quantity dispensed, suspicion for misuse, hydromorphone and oxycodone prescriptions, and headache. Advancing age, postoperative pain, and anxiety or sleep indications were associated with less importance. CONCLUSIONS Age, indication for prescribing, misuse, and payment mode each independently had greater importance to providers in accessing the PMP. This was the first study to isolate the influence of different controlled substances on how important it was to consult the PMP.
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Affiliation(s)
- Matthew J Witry
- Department of Pharmacy Practice and Science, University of Iowa, Iowa City, Iowa.
| | | | | | - Paul D Windschitl
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa
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42
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Shields CG, Fuzzell LN, Christ SL, Matthias MS. Patient and provider characteristics associated with communication about opioids: An observational study. PATIENT EDUCATION AND COUNSELING 2019; 102:888-894. [PMID: 30552013 PMCID: PMC6491239 DOI: 10.1016/j.pec.2018.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/16/2018] [Indexed: 05/07/2023]
Abstract
OBJECTIVE Our objective is to examine the relationship of patient and provider characteristics and communication with chronic non-cancer pain and opioid management in primary care. METHOD We conducted an observational study using audio-recorded primary care appointments (up to 3/patient) and self-reported assessments of primary care providers (PCPs) and patients. We coded visit transcripts for 1) opioid and pain management talk and 2) mental health and opioid safety talk. RESULTS Eight PCPs and 30 patients had complete data for 78 clinic visits. PCPs and patients engaged in more opioid and pain management talk when patients reported greater pain catastrophizing and PCPs reported higher psychosocial orientation. PCPs and patients engaged in talk about mental health and opioid safety when patients reported greater anxiety, higher working alliance with their PCP, and when PCPs reported higher burnout. PCPs' negative attitudes about opioids were associated with fewer discussions about mental health and opioid safety. CONCLUSIONS Our results should facilitate design of interventions that improve communication and, ultimately, pain outcomes for patients. PRACTICE IMPLICATIONS Clinicians can use our results to increase patient engagement in discussions about opioid use and pain management or mental health and safety discussions.
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Affiliation(s)
- Cleveland G Shields
- Purdue University, Department of Human Development & Family Studies, Regenstrief Center for Healthcare Engineering, Purdue University, Purdue Center for Cancer Research, West Lafayette, IN, USA.
| | - Lindsay N Fuzzell
- Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO USA
| | - Sharon L Christ
- Purdue University, Department of Human Development & Family Studies, Regenstrief Center for Healthcare Engineering, Purdue University, Purdue Center for Cancer Research, West Lafayette, IN, USA; Purdue University, Department of Statistics, West Lafayette, IN, 47906, USA
| | - Marianne S Matthias
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA; Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA; Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA
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43
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Maly A, Vallerand AH. Neighborhood, Socioeconomic, and Racial Influence on Chronic Pain. Pain Manag Nurs 2018; 19:14-22. [PMID: 29422123 DOI: 10.1016/j.pmn.2017.11.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 10/06/2017] [Accepted: 11/04/2017] [Indexed: 11/24/2022]
Abstract
The purpose of this review is to highlight the neighborhood, socioeconomic, and racial influences on chronic pain. Negative influences on the experience of chronic pain are explored and defined as any adverse stressor common in low socioeconomic, urban neighborhoods that potentially contributes to health disparity in African Americans experiencing chronic pain. The multifactorial influences on chronic pain disparity in African Americans are explored and expounded upon in this review of existing evidence. Databases used for the search included CINAHL, PubMed, and PsycArticles. The experience of chronic pain is multifaceted, existing with multiple comorbidities and lasting consequences. To improve the burden of chronic pain requires a multifactorial assessment that considers neighborhood risk factors, emphasis on environmental stressors, limitations to support networks, barriers to physical activity, and access to primary care providers with whom communication is open and without bias. A comprehensive assessment of barriers will aid in the development of interventions that reach beyond the physical factors of chronic pain, also considering the psychosocial barriers to improving the burden of chronic pain in African Americans living in impoverished urban neighborhoods.
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Affiliation(s)
- Angelika Maly
- Wayne State University College of Nursing, Detroit, Michigan.
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Ranapurwala SI, Naumann RB, Austin AE, Dasgupta N, Marshall SW. Methodologic limitations of prescription opioid safety research and recommendations for improving the evidence base. Pharmacoepidemiol Drug Saf 2018; 28:4-12. [PMID: 29862602 DOI: 10.1002/pds.4564] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/29/2018] [Accepted: 05/03/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE The ongoing opioid epidemic has claimed more than a quarter million Americans' lives over the past 15 years. The epidemic began with an escalation of prescription opioid deaths and has now evolved to include secondary waves of illicit heroin and fentanyl deaths, while the deaths due to prescription opioid overdoses are still increasing. In response, the Centers for Disease Control and Prevention (CDC) moved to limit opioid prescribing with the release of opioid prescribing guidelines for chronic noncancer pain in March 2016. The guidelines represent a logical and timely federal response to this growing crisis. However, CDC acknowledged that the evidence base linking opioid prescribing to opioid use disorders and overdose was grades 3 and 4. METHODS Motivated by the need to strengthen the evidence base, this review details limitations of the opioid safety studies cited in the CDC guidelines with a focus on methodological limitations related to internal and external validity. RESULTS Internal validity concerns were related to poor confounding control, variable misclassification, selection bias, competing risks, and potential competing interventions. External validity concerns arose from the use of limited source populations, historical data (in a fast-changing epidemic), and issues with handling of cancer and acute pain patients' data. We provide a nonexhaustive list of 7 recommendations to address these limitations in future opioid safety studies. CONCLUSION Strengthening the opioid safety evidence base will aid any future revisions of the CDC guidelines and enhance their prevention impact.
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Affiliation(s)
- Shabbar I Ranapurwala
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca B Naumann
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anna E Austin
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nabarun Dasgupta
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephen W Marshall
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Thomas EV. "Why Even Bother; They Are Not Going to Do It?" The Structural Roots of Racism and Discrimination in Lactation Care. QUALITATIVE HEALTH RESEARCH 2018; 28:1050-1064. [PMID: 29557297 DOI: 10.1177/1049732318759491] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Through semi-structured interviews with 36 International Board Certified Lactation Consultants (IBCLCs) who assist mothers with breastfeeding, this study takes a systematic look at breastfeeding disparities. Specifically, this study documents race-based discrimination against patients in the course of lactation care and links the implicit bias literature to breastfeeding disparities. IBCLCs report instances of race-based discrimination against patients such as unequal care provided to patients of color and overt racist remarks said in front of or behind patient's backs. This study connects patient discrimination in lactation to institutional inequality and offers suggestions to address these inequities.
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Affiliation(s)
- Erin V Thomas
- 1 Graduate of Georgia State University, Atlanta, Georgia, USA ORISE Research Fellow, Oak Ridge Tennesee, USA
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Cohen LJ, Donnenberg VS, Wiernik PH, Newman WC, Amankulor N. Core Entrustable Professional Activities in Clinical Pharmacology for Entering Residency: Value of Interprofessional Health-Care Teams in Medication Prescribing and Medication Error Prevention. J Clin Pharmacol 2018; 58:843-848. [DOI: 10.1002/jcph.1117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 02/15/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Lawrence J. Cohen
- University of North Texas System College of Pharmacy; University of North Texas Health Science Center; Fort Worth TX USA
| | - Vera S. Donnenberg
- The University of Pittsburgh School of Medicine; The UPMC Hillman Cancer Centers; Pittsburgh PA USA
| | - Peter H. Wiernik
- Our Lady of Mercy Cancer Center; New York Medical College; Bronx NY USA
| | - William C. Newman
- The University of Pittsburgh School of Medicine; The UPMC Hillman Cancer Centers; Pittsburgh PA USA
| | - Nduka Amankulor
- The University of Pittsburgh School of Medicine; The UPMC Hillman Cancer Centers; Pittsburgh PA USA
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Leichtling GJ, Irvine JM, Hildebran C, Cohen DJ, Hallvik SE, Deyo RA. Clinicians' Use of Prescription Drug Monitoring Programs in Clinical Practice and Decision-Making. PAIN MEDICINE 2018; 18:1063-1069. [PMID: 27794549 DOI: 10.1093/pm/pnw251] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives Little is known about clinicians' use of prescription drug monitoring program (PDMP) profiles in decision-making. The objective of this qualitative study was to understand how clinicians use, interpret, and integrate PDMP profiles with other information in making clinical decisions. Design Qualitative interviews of clinician PDMP users. Setting Oregon registrants in the state's PDMP. Subjects Thirty-three clinicians practicing in primary care, emergency medicine, pain management, psychiatry, dentistry, and surgery. Methods We conducted semistructured telephone interviews with PDMP users. A multidisciplinary team used a grounded theory approach to identify patterns of PDMP use and how PDMP profiles influence clinical decisions. Results PDMP use varied from consistent monitoring to checking the PDMP only on suspicion of misuse, with inconsistent use reported particularly among short-term prescribers. Primary care clinicians reported less routine use with existing pain patients than with new patients. In response to worrisome PDMP profiles with new patients, participants reported declining to prescribe, except in the case of acute, verifiable conditions. Long-term prescribers reported sometimes continuing prescriptions for existing patients depending on perceived patient intent, honesty, and opioid misuse risk. Some long-term prescribers reported discharging patients from their practices due to worrisome PDMP profiles; others expressed strong ethical grounds for retaining patients but discontinuing controlled substances. Conclusion Greater consistency is needed in use of PDMP in monitoring existing patients and in conformity to guidelines against discharging patients from practice. Research is needed to determine optimal approaches to interpreting PDMP profiles in relation to clinical judgment, patient screeners, and other information.
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Affiliation(s)
| | | | | | | | | | - Richard A Deyo
- Departments of Family Medicine.,Medicine.,Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon.,Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, Oregon, USA
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Healthcare Providers' Recommendations for Physical Activity among US Arthritis Population: A Cross-Sectional Analysis by Race/Ethnicity. ARTHRITIS 2018. [PMID: 29535871 PMCID: PMC5817278 DOI: 10.1155/2018/2807035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction We examined racial/ethnic disparities in healthcare providers' recommendations for physical activity among individuals with arthritis and evaluated this association among groups of individuals who adhered to physical activity guidelines and those who did not. Methods With a cross-sectional design based on Behavioral Risk Factor Surveillance System, we analyzed individuals with self-reported physician-diagnosed arthritis, ≥18 years of age (n = 83,376). Outcome variable was healthcare providers' recommendations for physical activity. Race/ethnicity was categorized as African American, Hispanic, and White. Associations were examined using multivariate logistic regression. Results African Americans (Adjusted OR: 0.66; 95% CI: 0.55–0.79) and Hispanics (Adjusted OR: 0.68; 95% CI: 0.56–0.83) were less likely to receive providers' recommendations. Conclusions Although the importance of physical activity to improve health outcomes for adults with arthritis, as well as providers' influence on individuals' behavior change, is well established, providers are less likely to recommend physical activity to minorities. Further studies are required to identify the causes for this quality-of-care issue.
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Dasgupta N, Beletsky L, Ciccarone D. Opioid Crisis: No Easy Fix to Its Social and Economic Determinants. Am J Public Health 2018; 108:182-186. [PMID: 29267060 PMCID: PMC5846593 DOI: 10.2105/ajph.2017.304187] [Citation(s) in RCA: 532] [Impact Index Per Article: 88.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2017] [Indexed: 12/12/2022]
Abstract
The accepted wisdom about the US overdose crisis singles out prescribing as the causative vector. Although drug supply is a key factor, we posit that the crisis is fundamentally fueled by economic and social upheaval, its etiology closely linked to the role of opioids as a refuge from physical and psychological trauma, concentrated disadvantage, isolation, and hopelessness. Overreliance on opioid medications is emblematic of a health care system that incentivizes quick, simplistic answers to complex physical and mental health needs. In an analogous way, simplistic measures to cut access to opioids offer illusory solutions to this multidimensional societal challenge. We trace the crisis' trajectory through the intertwined use of opioid analgesics, heroin, and fentanyl analogs, and we urge engaging the structural determinants lens to address this formidable public health emergency. A broad focus on suffering should guide both patient- and community-level interventions.
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Affiliation(s)
- Nabarun Dasgupta
- Nabarun Dasgupta is with the Injury Prevention Research Center and the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Leo Beletsky is with the School of Law and the Bouvé College of Health Sciences, Northeastern University, Boston, MA and is also with the University of California, San Diego School of Medicine, La Jolla. Daniel Ciccarone is with the Department of Family and Community Medicine, University of California, San Francisco
| | - Leo Beletsky
- Nabarun Dasgupta is with the Injury Prevention Research Center and the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Leo Beletsky is with the School of Law and the Bouvé College of Health Sciences, Northeastern University, Boston, MA and is also with the University of California, San Diego School of Medicine, La Jolla. Daniel Ciccarone is with the Department of Family and Community Medicine, University of California, San Francisco
| | - Daniel Ciccarone
- Nabarun Dasgupta is with the Injury Prevention Research Center and the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Leo Beletsky is with the School of Law and the Bouvé College of Health Sciences, Northeastern University, Boston, MA and is also with the University of California, San Diego School of Medicine, La Jolla. Daniel Ciccarone is with the Department of Family and Community Medicine, University of California, San Francisco
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Ruben MA, Blanch-Hartigan D, Shipherd JC. To Know Another’s Pain: A Meta-analysis of Caregivers’ and Healthcare Providers’ Pain Assessment Accuracy. Ann Behav Med 2018; 52:662-685. [DOI: 10.1093/abm/kax036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Mollie A Ruben
- School of Arts and Sciences, Massachusetts College of Pharmacy and Health Sciences University, Boston, MA
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, US Department of Veterans Affairs, Boston, MA
| | | | - Jillian C Shipherd
- National Center for PTSD, Women’s Health Sciences, VA Boston Healthcare System, Boston, MA
- Boston University School of Medicine, Boston, MA
- Lesbian, Gay, Bisexual, and Transgender (LGBT) Program, Veterans Health Administration, Washington, DC
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