Racial equity in linkage to inpatient opioid use disorder treatment in patients that received emergency care.

Autor: Faiz J; Department of Emergency Medicine, Boston University School of Medicine, Boston Medical Center, BCD Building, 800 Harrison Ave., Boston, MA 02118, United States of America. Electronic address: faiz.jessica@gmail.com., Bernstein E; Department of Emergency Medicine, Boston University School of Medicine, Boston Medical Center, BCD Building, 800 Harrison Ave., Boston, MA 02118, United States of America. Electronic address: ebernste@bu.edu., Dugas JN; Department of Emergency Medicine, Boston University School of Medicine, Boston Medical Center, BCD Building, 800 Harrison Ave., Boston, MA 02118, United States of America. Electronic address: julianne.dugas@bmc.org., Schechter-Perkins EM; Department of Emergency Medicine, Boston University School of Medicine, Boston Medical Center, BCD Building, 800 Harrison Ave., Boston, MA 02118, United States of America. Electronic address: elissa.perkins@bmc.org., Nentwich L; Department of Emergency Medicine, Boston University School of Medicine, Boston Medical Center, BCD Building, 800 Harrison Ave., Boston, MA 02118, United States of America. Electronic address: lauren.nentwich@bmc.org., Nelson KP; Department of Emergency Medicine, Boston University School of Medicine, Boston Medical Center, BCD Building, 800 Harrison Ave., Boston, MA 02118, United States of America. Electronic address: kerrie@bu.edu., Cleveland Manchanda EC; Department of Emergency Medicine, Boston University School of Medicine, Boston Medical Center, BCD Building, 800 Harrison Ave., Boston, MA 02118, United States of America. Electronic address: Emily.cleveland@bmc.org., Young L; Department of Emergency Medicine, Boston University School of Medicine, Boston Medical Center, BCD Building, 800 Harrison Ave., Boston, MA 02118, United States of America. Electronic address: ludy.young@bmc.org., Pare JR; Department of Emergency Medicine, Boston University School of Medicine, Boston Medical Center, BCD Building, 800 Harrison Ave., Boston, MA 02118, United States of America. Electronic address: joseph.pare@bmc.org.
Jazyk: angličtina
Zdroj: The American journal of emergency medicine [Am J Emerg Med] 2022 Apr; Vol. 54, pp. 221-227. Date of Electronic Publication: 2022 Jan 24.
DOI: 10.1016/j.ajem.2022.01.037
Abstrakt: Objectives: Opioid use disorder (OUD) is a national epidemic, and Black and Hispanic patients are less likely to receive treatment when compared to white patients. In this study, race was used as a proxy to assess potential effects of racism on the referral process for OUD treatment. Our primary aim was to examine whether Black or Hispanic patients experienced increased barriers to inpatient OUD detoxification (detox) placement at a community-integrated, substance use disorder support program based in an emergency department (ED). Our secondary aim was to determine if Black and Hispanic patients were more likely to have >3 referrals.
Methods: This retrospective cohort study was conducted at a large urban safety-net hospital and included patients seen in the ED from July 2018 to September 2019 with ICD-10 codes for an opioid-related visit and who sought placement to inpatient detox. A generalized linear mixed model controlling for multiple visits, age, sex, insurance, time, day of week, and time of year was used to assess the association between race/ethnicity and hypothesized barriers to placement. The proportion of patients with >3 visits for referral to inpatient detox was compared between Black and Hispanic patients and white patients using a chi-squared test.
Results: We identified 1733 encounters from 782 unique patients seeking connection to inpatient detox for OUD. Of the 1733 encounters, 45% were among Black and Hispanic patients. Hispanic and Black men had significantly lower odds of having a barrier to inpatient OUD detox than white men (OR = 0.734, 95% CI 0.542-0.995). No significant difference was found for Hispanic and Black women (OR = 1.212, 95% CI 0.705-2.082). More Black and Hispanic patients experienced >3 referrals to inpatient detox compared to white patients (19.2% vs 12.9%, p = 0.016).
Conclusions: This study suggests in the context of near-universal health insurance coverage, an ED-based OUD support program staffed by diverse community members can mitigate inequities in access to inpatient detox. However, the increased number of ED visits for OUD detox placement by Black and Hispanic patients suggests racial inequities in OUD treatment exist after linkage to care. Additional research should explore the causes, specifically structural and interpersonal racism, and determine solutions to address racial inequities in detox placement as well as maintenance in treatment programs.
Competing Interests: Declaration of Competing Interest No authors have any relevant conflict of interests to disclose.
(Published by Elsevier Inc.)
Databáze: MEDLINE
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