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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1067 — Racial Disparities in the Monitoring of Patients on Chronic Opioid Therapy

Hausmann LR, VA Pittsburgh Healthcare System; University of Pittsburgh, School of Medicine; Gao S, and Lee ES, VA Pittsburgh Healthcare System; Kwoh CK, VA Pittsburgh Healthcare System; University of Pittsburgh, School of Medicine;

Objectives:
Although racial disparities in prescribing opioid medications for pain are well-documented, disparities in the monitoring of patients who are prescribed opioids are under-studied. This study examined whether recommended opioid monitoring practices are applied differently to African American and white patients.

Methods:
This retrospective cohort study utilized data from the data warehouse at the Veterans Affairs (VA) Pittsburgh Healthcare System. The sample included 1,646 white and 253 African American patients who filled opioid prescriptions for non-cancer pain for >=90 consecutive days at the VA pharmacy in fiscal years 2007 and 2008. Outcomes included the following opioid monitoring practices: use of opioid treatment agreement; documentation of pain during follow-up visits; urine drug testing; and patient referrals to pain and substance abuse specialists. Racial differences were tested using logistic and linear regression models adjusting for patient clinical and demographic characteristics.

Results:
Opioid agreements were on file for 26.3% of patients; pain was documented in 71.7% of primary care follow-up visits; 49.3% of patients underwent urine drug tests; and 21.2% and 4.2% of patients were referred to pain and substance abuse specialists, respectively. In adjusted comparisons, pain was documented less for African Americans than for whites (adjusted beta coefficient = -0.11, 95% confidence interval [CI] = -0.15, -0.07). Compared to whites, African Americans were also less likely to be referred to pain specialists (adjusted odds ratio [adjOR] = 0.50, 95% CI = 0.34, 0.73) and more likely to be referred for substance abuse assessment (adjOR = 1.79, 95% CI = 1.04, 3.09). Having an opioid agreement on file or at least one urine drug test did not differ by race. However, among patients with at least one drug test, African Americans underwent more tests than whites (unadjusted beta coefficient = 2.27, 95% CI = 0.66, 3.89). Adjusted analyses suggested this difference was explained by African Americans having more primary care visits.

Implications:
Adherence to recommended monitoring practices for patients on chronic opioid therapy was low overall and some racial differences were observed.

Impacts:
Addressing disparities in opioid monitoring practices may be a previously neglected route to reducing racial disparities in pain management. Efforts to increase the use of recommended opioid monitoring practices overall should also be considered.


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