Open AccessRacial Disparities Across Provider Specialties in Opioid Prescriptions Dispensed to M edicaid Beneficiaries with Chronic Noncancer Pain
Author(s) -
Ringwalt Chris,
Roberts Andrew W.,
Gugelmann Hallam,
Skinner Asheley Cockrell
Publication year - 2015
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/pme.12555
Subject(s) - medicine , medicaid , specialty , medical prescription , family medicine , chronic pain , population , odds ratio , retrospective cohort study , medicare part d , prescription drug , psychiatry , health care , nursing , environmental health , economics , economic growth
Objective Chronic pain affects both psychological and physical functioning, and is responsible for more than $60 billion in lost productivity annually in the U nited S tates. Although previous studies have demonstrated racial disparities in opioid treatment, there is little evidence regarding disparities in treatment of chronic noncancer pain ( CNCP ) and the role played by physician specialty in these disparities.Design A retrospective cohort study. Setting We analyzed N orth C arolina M edicaid claims data, from J uly 1, 2009 to M ay 31, 2010, to examine disparities by different provider specialties in beneficiaries' dispensed prescriptions for opioids. Subjects The population included white and black N orth C arolina M edicaid beneficiaries with CNCP (N = 75,458). Methods We used bivariate statistics and logistic regression analysis to examine race‐based discrepancies in opioid prescribing by physician specialty. Results Compared with white beneficiaries with CNCP (N = 49,197), black beneficiaries (N = 26,261) were less likely (odds ratio [ OR ] 0.91 [confidence interval { CI }: 0.88–0.94]) to fill an opioid prescription. Our hypothesis was partially supported: we found that race‐based differences in beneficiaries' dispensed opioid prescriptions were more prominent in certain specialties. In particular, these differences were most salient among patients of specialists in obstetrics and gynecology ( OR 0.78 [ CI : 0.67–0.89]) and internal medicine ( OR 0.86 [ CI : 0.79–0.92]), as well as general practitioners/family medicine physicians ( OR 0.91 [ CI : 0.85–0.97]). Conclusions Our findings suggest that, in our study population, black beneficiaries with CNCP are less likely than whites to fill prescriptions for opioid analgesics as a function of their provider's specialty. Although race‐based differences in patients filling opioid prescriptions have been noted in previous studies, this is the first study that clearly demonstrates these disparities by provider specialty.