Racial Disparities in Analgesic Prescribing for Post-Surgical Pain Management among Older Americans following Hip and Knee Replacement Surgeries

美国老年人髋关节和膝关节置换手术后术后疼痛管理镇痛处方的种族差异

基本信息

批准号：
10508187
负责人：
Caroline Pinto Thirukumaran
金额：
$ 20.5万
依托单位：
UNIVERSITY OF ROCHESTER
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2024-06-30
项目状态：
已结题

项目摘要

ABSTRACT Black patients are less likely to be prescribed opioid or non-opioid analgesics for pain relief than White patients who present with similar pain intensities, especially in the emergency room. Many of these disparities are attributed to physician prescribing practices. However, whether similar disparities exist in opioid and non- opioid analgesic prescribing for post-operative pain for older Americans following one of the most common elective surgeries for their age – hip and knee replacements (“joint replacements”) – is unknown. Joint replacements are highly successful surgeries for older Medicare beneficiaries with advanced osteoarthritis. The ability of these surgeries to provide relief from pain, and improve functionality and health-related quality of life has placed them among the highest-volume surgeries for older Medicare beneficiaries. Opioid and non- opioid analgesics are the two groups of drugs commonly used to relieve surgical pain following joint replacements. Opioids were previously the first choice of drugs for short-term post-operative pain control. However, with the devastating implications of the opioid crisis, there is a growing recognition of the importance of minimizing the duration of post-operative opioid prescribing and increasing the use of non-opioid analgesics. Importantly, there is considerable variation in the prescribing amounts and duration of these drugs. This variability when coupled with prescriber biases, may create barriers for Black Medicare beneficiaries while accessing much-needed care for post-operative pain, and represents substantial unmet pain management needs for these patients. These unmet needs further exacerbate the disparities in post-operative recovery and contribute to the inequity in joint replacement care. Furthermore, state laws that restrict the prescribing of opioids for acute pain have the potential to exacerbate these disparities if the decline in opioid prescribing is not accompanied by a commensurate increase in non-opioid analgesic prescribing. The goal of our proposal is to generate rigorous empirical evidence to support equitable post-operative analgesic prescribing. We achieve this goal by examining whether a patient’s race influences opioid and non-opioid analgesic prescribing following joint replacement surgeries (Aim 1), and whether state opioid prescribing restrictions are likely to influence these disparities (Aim 2). We focus our analysis on Medicare beneficiaries in New York undergoing joint replacements from 2014-2019. We will use Medicare datasets and sophisticated empirical methods to address the proposed Aims. The findings from our proposal will generate evidence for improving equity in post- operative analgesic prescribing for joint replacement patients across the country and for the design of interventions that can attenuate racial disparities in surgical pain management.

抽象的与白人相比，黑人患者不太可能服用阿片类或非阿片类镇痛药来缓解疼痛疼痛强度相似的患者，尤其是在急诊室，其中许多差异。然而，阿片类药物和非阿片类药物是否存在类似的差异。阿片类镇痛药用于治疗美国老年人术后疼痛，最常见的原因之一是适合他们年龄的选择性手术——髋关节和膝关节置换术（“关节置换术”）——尚不清楚。对于患有晚期骨关节炎的老年医疗保险受益人来说，置换手术是非常成功的手术。这些手术能够缓解疼痛并改善患者的功能和健康相关质量生活使它们成为老年医疗保险受益人和非阿片类受益人接受手术量最大的手术之一。阿片类镇痛药是两类常用于缓解关节术后疼痛的药物阿片类药物以前是短期术后疼痛控制的首选药物。然而，随着阿片类药物危机的破坏性影响，人们越来越认识到阿片类药物的重要性尽量减少术后阿片类药物处方的持续时间并增加非阿片类镇痛药的使用。重要的是，这些药物的处方量和持续时间存在很大差异。变异性与处方者偏见相结合，可能会给黑人医疗保险受益人造成障碍，而获得急需的术后疼痛护理，并且代表着大量未得到满足的疼痛管理这些未得到满足的需求进一步加剧了术后康复和康复方面的差异。此外，州法律限制开药如果阿片类药物处方量减少，用于治疗急性疼痛的阿片类药物有可能加剧这些差异不伴随非阿片类镇痛药处方的相应增加我们建议的目标是。产生严格的经验证据来支持公平的术后镇痛处方我们实现了。通过检查患者的种族是否影响阿片类药物和非阿片类镇痛药处方来实现这一目标关节置换手术后（目标 1），以及阿片类药物国家处方限制是否可能我们的分析重点是纽约正在经历的医疗保险受益人。我们将使用 Medicare 数据集和复杂的经验方法来计算 2014 年至 2019 年的关节置换术。我们提案的结果将为改善后公平性提供证据。全国关节置换患者的手术镇痛处方和设计可以减少手术疼痛管理中种族差异的干预措施。