Disparities in analgesia and opioid prescribing practices for patients with musculoskeletal pain in the emergency department

Janet Kaye Heins, Alan Heins, Marianthe Grammas, Melissa Costello, Kun Huang, Satya Mishra
Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association 2006, 32 (3): 219-24

INTRODUCTION: Healthy People 2010 seeks to eliminate racial and ethnic disparities in health care; however, disparities due to age and race have been described in emergency department pain treatment. Although pain is a common patient complaint in emergency departments, many people receive no analgesia. This study examined the influence of patient and provider characteristics on ED and discharge analgesia and opioid prescribing practices.

METHODS: This descriptive study used chart review of selected variables from ED patients 18 years and older who presented with musculoskeletal pain and were treated by core ED faculty. Logistic regression analyses were performed to determine whether analgesia- and opioid-prescribing disparities existed and were influenced by patient and provider characteristics.

RESULTS: A total of 868 patient records were examined. Physician characteristics and wide variation in practice were the only sources of disparities in the prescription of analgesics in the emergency department, but patient characteristics including race, age, chronic pain, and trauma influenced prescription of ED opioids and discharge analgesics. No gender or financial status disparities were found. Fewer opioids and discharge analgesics were prescribed for black patients than for white patients. Younger patients, those with trauma, and those with chronic pain received more opioids and discharge analgesics compared with older patients and those without trauma or chronic pain. Providers who completed emergency medicine residencies and had fewer than 3 years' experience prescribed more analgesics in the emergency department.

DISCUSSION: Pain management in our emergency department is widely variable, with some disparities based on patient and physician characteristics. Multicenter prospective studies are needed to validate these findings and examine knowledge and attitude development about pain and its management. Protocols for nurse-initiated analgesia may help improve and standardize ED pain care.

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