Hassan Zakaria, MD

Advisor: R. Leonard Vance, PhD, CIH

Preceptor: Elizabeth Eustis Turf, PhD

Objective:
 This study aims to examine the relationship between emergency department patient encounter characteristics and narcotic analgesic prescribing practices in order to determine what patient characteristics, if any, influence the decision to prescribe narcotics.

Methods:
Cross sectional data on patients presenting to U.S. emergency departments from the 2003 and 2004 National Hospital Ambulatory Medical Care Survey were analyzed.  Patients reporting moderate to severe pain were included in the sample and analysis. Chi square tests of significance were used to assess the association between individual demographic and encounter characteristics to narcotic prescription or administration. Separate multiple logistic regressions were then performed on patients presenting with one of the three most common diagnosis categories or reasons for visit, since this was thought to also influence the decision to prescribe narcotics or not. Multivariate analysis produced adjusted odds ratios and 95% confidence intervals in order to determine the independent associations between each predictor variable and narcotic medication prescription or administration.

Results:
Our sample included 26, 248 individuals presenting to U.S. emergency departments with moderate to severe pain as recorded by the NHMCS survey. Average age of patient was 37.8 years old. Various patient and encounter characteristics appeared to influence narcotic administration in the univaariate analysis including age, race, ethnicity, alcohol use, method of payment, and whether or not visit was related to a work injury or illness. No gender differences were found.  Using multivariate analysis and combining the top 3 reasons for visit, we found that race, patient alcohol use, method of payment, age and ethnicity all had significant bearing on the prescription of narcotics. After further subdividing by  reason for visit, only Black race was found to be associated with significantly lower rates of narcotic administration in all three reasons for visit.  The same was true when looking at top three diagnoses. While age, patient alcohol use, method of payment and ethnicity were associated with significantly different rates of narcotic administration , only Black race was significantly associated with lower rates of narcotic administration all three diagnosis individually.

Conclusion:
While initiatives like Healthy People 2010 are aimed at improving health and eliminating health care disparities, it appears that disparities still do exist on many levels. As it has been concluded through various other studies, it appears that race does influence health care providers’ decisions to prescribe or administer narcotics. In January of 2001 JAHCO revised their standards to better address pain management of patients in the United States. While pain may be better-evaluated and recorded and overall rates or pain medication administration or prescription may have improved, it appears that the common disparities have not.