Racial Disparities Across Provider Specialties in Opioid Prescriptions Dispensed to Medicaid Beneficiaries with Chronic Noncancer Pain

Chris Ringwalt, Andrew W. Roberts, Hallam Gugelmann, Asheley Cockrell Skinner

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective: Chronic pain affects both psychological and physical functioning, and is responsible for more than $60 billion in lost productivity annually in the United States. 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 North Carolina Medicaid claims data, from July 1, 2009 to May 31, 2010, to examine disparities by different provider specialties in beneficiaries' dispensed prescriptions for opioids. Subjects: The population included white and black North Carolina Medicaid 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.

Original languageEnglish
Pages (from-to)633-640
Number of pages8
JournalPain Medicine
Volume16
Issue number4
DOIs
StatePublished - Apr 1 2015
Externally publishedYes

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Medicaid
Chronic Pain
Opioid Analgesics
Prescriptions
Odds Ratio
Confidence Intervals
Physician's Role
Family Physicians
Internal Medicine
Gynecology
General Practitioners
Population
Obstetrics
Cohort Studies
Retrospective Studies
Logistic Models
Regression Analysis
Medicine
Psychology
Physicians

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Racial Disparities Across Provider Specialties in Opioid Prescriptions Dispensed to Medicaid Beneficiaries with Chronic Noncancer Pain. / Ringwalt, Chris; Roberts, Andrew W.; Gugelmann, Hallam; Skinner, Asheley Cockrell.

In: Pain Medicine, Vol. 16, No. 4, 01.04.2015, p. 633-640.

Research output: Contribution to journalArticle

Ringwalt, Chris ; Roberts, Andrew W. ; Gugelmann, Hallam ; Skinner, Asheley Cockrell. / Racial Disparities Across Provider Specialties in Opioid Prescriptions Dispensed to Medicaid Beneficiaries with Chronic Noncancer Pain. In: Pain Medicine. 2015 ; Vol. 16, No. 4. pp. 633-640.
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abstract = "Objective: Chronic pain affects both psychological and physical functioning, and is responsible for more than $60 billion in lost productivity annually in the United States. 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 North Carolina Medicaid claims data, from July 1, 2009 to May 31, 2010, to examine disparities by different provider specialties in beneficiaries' dispensed prescriptions for opioids. Subjects: The population included white and black North Carolina Medicaid 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.",
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