{"title":"有药物使用障碍的黑人和白人患者在骨科创伤后的急诊就诊情况和阿片类药物处方。","authors":"","doi":"10.1016/j.josat.2024.209455","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>Patients living with substance use disorder (SUD) have complex pain management needs, which may be mismanaged during hospital admission. Ineffectively managed pain following orthopaedic trauma, influenced by clinician biases related to race or SUD diagnosis, may subject patients to worse pain outcomes and subsequent emergency department (ED) encounters. This study examined ED encounters and opioid prescribing for pain-related complaints following orthopaedic trauma, among patients with SUD who identify as Black or African American relative to White patients.</p></div><div><h3>Methods</h3><p>This retrospective analysis included 1089 patients with a SUD diagnosis discharged from a Level I trauma center, following hospitalization for orthopaedic injuries, between 2016 and 2021. Multivariable regressions assessed the associations among race, opioid prescribing, and ED encounters within 90 days for pain-related care.</p></div><div><h3>Results</h3><p>Among the 1089 patients included in the sample, the proportion of individuals with an ED encounter within 90 days for pain-related care was 12.4 % and 4.5 % for Black and White patients, respectively (odds ratio [OR] = 3.0, <em>p</em> < .001). When adjusting for injury severity and demographics, the difference in ED encounters between Black and White patients remained significant (OR = 2.8, <em>p</em> = .002). Opioid prescription doses did not statistically differ by race.</p></div><div><h3>Conclusions</h3><p>The difference in ED encounters between Black and White patients with SUDs following orthopaedic trauma may indicate a need to optimize pain management prior to initial discharge and improve post-injury care.</p></div>","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Emergency department encounters and opioid prescribing following orthopaedic trauma among Black and White patients with substance use disorders\",\"authors\":\"\",\"doi\":\"10.1016/j.josat.2024.209455\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>Patients living with substance use disorder (SUD) have complex pain management needs, which may be mismanaged during hospital admission. Ineffectively managed pain following orthopaedic trauma, influenced by clinician biases related to race or SUD diagnosis, may subject patients to worse pain outcomes and subsequent emergency department (ED) encounters. This study examined ED encounters and opioid prescribing for pain-related complaints following orthopaedic trauma, among patients with SUD who identify as Black or African American relative to White patients.</p></div><div><h3>Methods</h3><p>This retrospective analysis included 1089 patients with a SUD diagnosis discharged from a Level I trauma center, following hospitalization for orthopaedic injuries, between 2016 and 2021. Multivariable regressions assessed the associations among race, opioid prescribing, and ED encounters within 90 days for pain-related care.</p></div><div><h3>Results</h3><p>Among the 1089 patients included in the sample, the proportion of individuals with an ED encounter within 90 days for pain-related care was 12.4 % and 4.5 % for Black and White patients, respectively (odds ratio [OR] = 3.0, <em>p</em> < .001). When adjusting for injury severity and demographics, the difference in ED encounters between Black and White patients remained significant (OR = 2.8, <em>p</em> = .002). Opioid prescription doses did not statistically differ by race.</p></div><div><h3>Conclusions</h3><p>The difference in ED encounters between Black and White patients with SUDs following orthopaedic trauma may indicate a need to optimize pain management prior to initial discharge and improve post-injury care.</p></div>\",\"PeriodicalId\":73960,\"journal\":{\"name\":\"Journal of substance use and addiction treatment\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-07-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of substance use and addiction treatment\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S294987592400167X\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"0\",\"JCRName\":\"PSYCHOLOGY, CLINICAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of substance use and addiction treatment","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S294987592400167X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"0","JCRName":"PSYCHOLOGY, CLINICAL","Score":null,"Total":0}
引用次数: 0
摘要
导言:药物使用障碍(SUD)患者有复杂的疼痛管理需求,在入院期间可能会出现管理不善的情况。骨科创伤后疼痛处理不当,会受到临床医生对种族或 SUD 诊断偏见的影响,可能导致患者的疼痛结果和随后的急诊(ED)就诊情况恶化。本研究调查了与白人患者相比,自称为黑人或非裔美国人的 SUD 患者在骨科创伤后出现的急诊就诊情况以及因疼痛相关主诉而开具的阿片类药物处方:这项回顾性分析纳入了 2016 年至 2021 年间因骨科创伤住院后从一级创伤中心出院的 1089 名诊断为 SUD 的患者。多变量回归评估了种族、阿片类药物处方和90天内接受疼痛相关治疗的急诊就诊次数之间的关联:在纳入样本的 1089 名患者中,黑人和白人患者在 90 天内因疼痛相关治疗而就诊于急诊室的比例分别为 12.4% 和 4.5%(赔率 [OR] = 3.0,P 结论:黑人和白人患者在 90 天内因疼痛相关治疗而就诊于急诊室的比例差异为 3.0%,P 结论:黑人和白人患者在 90 天内因疼痛相关治疗而就诊于急诊室的比例差异为 3.0%:矫形创伤后出现 SUD 的黑人和白人患者在急诊室就诊次数上的差异可能表明,有必要在首次出院前优化疼痛管理并改善伤后护理。
Emergency department encounters and opioid prescribing following orthopaedic trauma among Black and White patients with substance use disorders
Introduction
Patients living with substance use disorder (SUD) have complex pain management needs, which may be mismanaged during hospital admission. Ineffectively managed pain following orthopaedic trauma, influenced by clinician biases related to race or SUD diagnosis, may subject patients to worse pain outcomes and subsequent emergency department (ED) encounters. This study examined ED encounters and opioid prescribing for pain-related complaints following orthopaedic trauma, among patients with SUD who identify as Black or African American relative to White patients.
Methods
This retrospective analysis included 1089 patients with a SUD diagnosis discharged from a Level I trauma center, following hospitalization for orthopaedic injuries, between 2016 and 2021. Multivariable regressions assessed the associations among race, opioid prescribing, and ED encounters within 90 days for pain-related care.
Results
Among the 1089 patients included in the sample, the proportion of individuals with an ED encounter within 90 days for pain-related care was 12.4 % and 4.5 % for Black and White patients, respectively (odds ratio [OR] = 3.0, p < .001). When adjusting for injury severity and demographics, the difference in ED encounters between Black and White patients remained significant (OR = 2.8, p = .002). Opioid prescription doses did not statistically differ by race.
Conclusions
The difference in ED encounters between Black and White patients with SUDs following orthopaedic trauma may indicate a need to optimize pain management prior to initial discharge and improve post-injury care.