the cost of my insurance just went up, to pay for those who don't have any...
Posted on 01/06/2008 6:56:42 PM PST by neverdem
In a 13-year study examining 150,000 emergency room visits, doctors were found more likely to prescribe strong narcotics to patients complaining of pain than in the past, yet less likely to prescribe them to minorities than to white patients. The study, appearing in the Journal of the American Medical Association (JAMA), said that this was the case even when patients complained of severe pain such as with kidney stones.
From 1993 to 2005, prescriptions of narcotics for pain relief in emergency rooms rose from 23 percent to 37 percent overall. This increase appears to be the result of changing attitudes among doctors who now view pain management as a key part of the healing process. However, the study found that opioid narcotics were prescribed in 31 percent of pain-related ER visits involving whites, 28 percent involving Asians, 24 percent involving Hispanics, and 23 percent involving blacks. In more than 2,000 visits for kidney stones, whites were given narcotics 72 percent of the time, Hispanics 68 percent, Asians 67 percent, and blacks 56 percent.
The Institute of Medicine report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care said that racial and ethnic minorities tend to receive lower-quality health care than whites do, even when insurance status, income, age, and severity of conditions are comparable. It recommends first and foremost to increase awareness about racial and ethnic disparities in health care among the general public, health care providers, insurance companies, and policymakers. Consistency and equity of care also should be promoted through the use of "evidence-based" guidelines to help providers and health plans make decisions about which procedures to order or pay for based on the best available science.
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
Other Resources:
JAMA Acute Pain Treatment Webpage
link to abstract
Explanation: Hospital ERs in black areas are endlessly abused by narcotics addicts. These ERs are less likely to immediately give narcotics.
More liberal crap. Minority victimization. And it is the fault of those that work hard and earn a living and pay taxes. When will Americans get tired of this crap?
If you go to the emergency room for both screaming agony and kind-of-hurts, you're less likely to get narcotics than if you only show up for screaming agony.
the cost of my insurance just went up, to pay for those who don't have any...
I'd like to agree, but according to the abstract: "Differential prescribing by race/ethnicity was evident for all types of pain visits, was more pronounced with increasing pain severity, and was detectable for long-bone fracture and nephrolithiasis as well as among children."
Exactly. If they re-did the study, but classified the patients according to history of arrests, convictions and treatment for drug abuse, rather than by race, the discrepancy would disappear (and maybe even reverse).
Cheap drugs against aggression don't work
Experts change advice on kids' allergies
FReepmail me if you want on or off my health and science ping list.
Exactly! I defer to an obviously more eloquent poster.
Inner city ER, 2 AM Saturday night: "Gimme drugs! Gimme them NOW! I got kidney stones!"
The abstract simply doesn't address other possible categorizations of the patients besides race/ethnicity, probably because the full article doesn't either. It's also muddling the difference between "receive an opioid" and "receive a prescription for an opioid". In an ER situation, opioids are often not prescribed immediately, since masking the pain can sometimes hamper efforts to identify the cause (not the case with a clearly broken/injured limb, but definitely true for many cases of abdominal and thoracic pain). So at least a certain percentage of these cases are a question of whether or not a prescription was given to a patient being discharged, for home use. And how did they count patients who were given a dose of an opioid at the hospital, but not given a take-home opioid prescription?
It's not wrong for a doctor's knowledge or reasonable perception of a patient's, or child patient's parent's, history of drug abuse to influence this decision. This is a separate issue from race/ethnicity, but is likely to correlate statistically with race/ethnicity and could well account for the results this study is reporting. A meaningful study would need to address whether drug abuse history, rather than race/ethnicity was the real differentiating factor, or whether doctors might be erroneously assuming a drug abuse history more often with non-whites. There's no point writing a take-home prescription for opioids for a child with a bone break or kidney stones, if the drugs are simply going to be consumed or sold by the parent, with the child not getting any. And there's often no benefit to writing a narcotics prescription for someone who has had a past narcotics abuse habit and is in danger of relapse -- the potential harm of triggering a relapse may be greater than the benefit of greater short-term pain relief from opioids vs some milder type of pain killer.
Women and children hardest hit.
Conservatives hate minorities.
Rich people suck.
etc.
etc.
The abstract simply doesn't address other possible categorizations of the patients besides race/ethnicity, probably because the full article doesn't either. It's also muddling the difference between "receive an opioid" and "receive a prescription for an opioid". In an ER situation, opioids are often not prescribed immediately, since masking the pain can sometimes hamper efforts to identify the cause (not the case with a clearly broken/injured limb, but definitely true for many cases of abdominal and thoracic pain). So at least a certain percentage of these cases are a question of whether or not a prescription was given to a patient being discharged, for home use. And how did they count patients who were given a dose of an opioid at the hospital, but not given a take-home opioid prescription?
It's not wrong for a doctor's knowledge or reasonable perception of a patient's, or child patient's parent's, history of drug abuse to influence this decision. This is a separate issue from race/ethnicity, but is likely to correlate statistically with race/ethnicity and could well account for the results this study is reporting. A meaningful study would need to address whether drug abuse history, rather than race/ethnicity was the real differentiating factor, or whether doctors might be erroneously assuming a drug abuse history more often with non-whites. There's no point writing a take-home prescription for opioids for a child with a bone break or kidney stones, if the drugs are simply going to be consumed or sold by the parent, with the child not getting any. And there's often no benefit to writing a narcotics prescription for someone who has had a past narcotics abuse habit and is in danger of relapse -- the potential harm of triggering a relapse may be greater than the benefit of greater short-term pain relief from opioids vs some milder type of pain killer.
ping to #12 (I’d originally copied you on this, but the server hiccuped and made me re-send it and deleted you from the “To” list in the process)
Whatever, they’ll pressure the ER’s into giving more drugs to minorities and in 5 years they’ll do a study saying that doctors are giving minorities too many drugs.
“Gee, if only health care professionals were chosen based on the color bar... hey, wait, I think I’ve solved this!” /sarc Thanks neverdem.
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