|
 After reviewing the medical histories of more than 250,000 patients,
researchers found that black patients who had been diagnosed with
kidney stones were more likely to get lower doses of opioid
medications and less likely to be given an intravenous
anti-inflammatory drug compared to whites. Black patients were also
more likely to get no pain medication at all.
Latino patients tended to get even lower doses of opioid
medications, but did receive the nonsteroidal anti-inflammatory drug
(NSAID) ketorolac in similar proportions to white patients,
researchers report in the American Journal of Emergency Medicine.
White patients were more likely than either black or Hispanic
patients to get the highest opioid dosage.
"Despite efforts to diminish narcotic use in healthcare and despite
the availability of effective non-narcotic pain medications, we
still see more narcotics are prescribed than non-narcotics," said
study coauthor Dr. George Haleblian, an assistant professor of
surgery at Harvard Medical School and director of the urology
residency program at Brigham and Women's Hospital in Boston.
Moreover, Haleblian said in an email, "we see that there is a racial
disparity in how pain medications are given."
The study can't explain why black and Hispanic patients would be
getting different treatment in the ER, Haleblian said. "While we
can't completely tell from the database that this difference is from
racial bias, the fact that black patients were most likely to
receive no pain medications is telling," he said. "We hypothesize
that it's likely some overt or subconscious bias may be at play."
To take a closer look at the possibility of racial bias in the care
of those with kidney stones, Haleblian and his colleagues turned to
a hospital discharge database that includes patient information such
as age, gender, race, insurance status and substance abuse history.
The researchers focused on patients aged 18 and older who were
diagnosed in the ER with pain due to kidney stones.
Just over half, 55.4%, of white patients received ketorolac, the
non-narcotic medication, as compared with 49.2% of the black
patients and 59.3% of Hispanic patients.
"We were surprised that more ketorolac was not used across the
board," Haleblian said.
[to top of second column] |
More black (18%) than white (16.2%) or Hispanic (15%) patients
received no injections at all to relieve pain. Hispanic patients
were most likely to receive ketorolac only.
Haleblian and his colleagues note that the database does not offer
information on the drugs that were prescribed to the patients to
take after they were discharged.
The new findings are "disturbing," said Dr. Michael Lynch, an
assistant professor in the department of emergency medicine at the
University of Pittsburgh School of Medicine, who wasn't involved in
the study.
"But unfortunately, they are replicating other work that has been
done," Lynch said. "And unfortunately, as in all facets of our
society, when we look for instances of bias, it is often found."
Lynch suspects that the doctors who treated patients in the study
wouldn't see themselves as biased. "It's easy to think it can't be
you," Lynch said. "The more it's identified and studied and
objectively defined, the more likely we are to recognize it in
ourselves and take a step back and reflect. That's the first step,
honest self-reflection."
Previous studies have found this kind of bias even in the pediatric
population, said Dr. Nathan Irvin, an assistant professor in the
department of emergency medicine at Johns Hopkins Medicine in
Baltimore, who also wasn't involved in the study.
Irvin suspects that implicit biases are more likely to be on display
in fast-paced situations like emergency rooms, where healthcare
providers don't have time to reflect on possible biases.
"A workaround that might be effective is if an order list pops up
(on the computer screen) with everything pertinent to someone with
kidney stones," Irvin said. "It's one way to standardize care. And
biases don't have a chance to flare up."
SOURCE: https://bit.ly/2tZw7IE American Journal of Emergency
Medicine, online January 8, 2020.
[© 2020 Thomson Reuters. All rights
reserved.] Copyright 2020 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
Thompson Reuters is solely responsible for this content.
 |
