Race in Physician Decision to Prescribe Opioid Analgesia

Metrohealth System, Cleveland OH

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Abstract

DESCRIPTION: (provided by applicant) Several studies have shown that racial and ethnic minorities are less likely to receive analgesics. This study presents a theoretical framework for understanding these differences. The aim of this study is to begin to test this framework by conducting a series of mail surveys with case scenarios to determine: 1) the effect of race on physicians? use of analgesics for 3 acute, painful conditions (back pain with sciatica, ankle fracture, and migraine headache); 2) whether providing information on patients? socioeconomic status, role impairment, and likelihood that narcotics might be misused mitigates the effect of race on physicians? decisions to prescribe analgesics; and 3) whether physician characteristics are related to differential treatment of racial and ethnic minorities. Phase 1 of this study will determine clinical factors that influence physicians? decisions to prescribe opioid analgesics for the 3 conditions (regardless of patients? race/ethnicity) using individual physician interviews and a mail survey of 650 emergency department physicians. In phase 2, information from phase 1 will be used to construct scenarios that include information on the most important clinical factors affecting prescribing opioid analgesics. Two versions of each of the 3 scenarios will be constructed: 1) clinical factors plus race (race only); and 2) clinical factors, race, and information on patients? socioeconomic status, role impairment, and likelihood that narcotics might be misused (race plus). These scenarios will be mailed in random order to 6075 emergency department physicians. Responses will be analyzed to determine whether racial and ethnic minorities are less likely to receive opioids with the race only scenarios (Aim 1), whether any difference in treatment persists for the race plus scenarios (Aim 2), and whether physician characteristics obtained from the phase 2 mailing explain lower use of opioid analgesics (Aim 3). This study moves investigation beyond documentation of racial disparities in treatment and toward theory based hypothesis testing. Understanding the causes of racial disparities will permit careful development of targeted interventions to address possible racial disparities in physician treatment decisions.