The Incidence and Disparities in Use of Stigmatizing Language in Clinical Notes for Patients With Substance Use Disorder.

Autor:	Weiner SG; From the Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts (SGW); Harvard Medical School, Boston, Massachusetts (SGW, LZ, DBH, CPR, SEW); Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts (YCL, LZ); Mass General Brigham, Enterprise Analytics, Boston, Massachusetts (ADC, AN); Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts (CPR); Department of Medicine, Massachusetts General Hospital, Boston, MA (SEW); and Mass General Brigham, Office of the Chief Medical Officer, Boston, Massachusetts (SEW)., Lo YC, Carroll AD, Zhou L, Ngo A, Hathaway DB, Rodriguez CP, Wakeman SE
Jazyk:	angličtina
Zdroj:	Journal of addiction medicine [J Addict Med] 2023 Jul-Aug 01; Vol. 17 (4), pp. 424-430. Date of Electronic Publication: 2023 Jan 31.
DOI:	10.1097/ADM.0000000000001145
Abstrakt:	Objective: The language used to describe people with substance use disorder impacts stigma and influences clinical decision making. This study evaluates the presence of stigmatizing language (SL) in clinical notes and detects patient- and provider-level differences. Methods: All free-text notes generated in a large health system for patients with substance-related diagnoses between December 2020 and November 2021 were included. A natural language processing algorithm using the National Institute on Drug Abuse's "Words Matter" list was developed to identify use of SL in context. Results: There were 546,309 notes for 30,391 patients, of which 100,792 (18.4%) contained SL. A total of 18,727 patients (61.6%) had at least one note with SL. The most common SLs used were "abuse" and "substance abuse." Nurses were least likely to use SL (4.1%) while physician assistants were most likely (46.9%). Male patients were more likely than female patients to have SL in their notes (adjusted odds ratio [aOR], 1.17; 95% confidence internal [CI], 1.11-1.23), younger patients aged 18 to 24 were less likely to have SL than patients 45 to 54 years (aOR, 0.55; 95% CI, 0.50-0.61), Asian patients were less likely to have SL than White patients (aOR, 0.45; 95% CI, 0.36-0.56), and Hispanic patients were less likely to have SL than non-Hispanic patients (aOR, 0.88; 95% CI, 0.80-0.98). Conclusions: The majority of patients with substance-related diagnoses had at least one note containing SL. There were also several patient characteristic disparities associated with patients having SL in their notes. The work suggests that more clinician interventions about use of SL are needed. Competing Interests: Dr Weiner is funded by National Institutes of Health grants 5R01DA044167 and 5R01HS026753. Dr Lo’s work was funded by Mass General Brigham’s United Against Racism initiative. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Dr Weiner is on the acute pain committee of Vertex Pharmaceuticals, Inc, and also employed by Bicycle Health, Inc. The other authors report no conflicts of interest. (Copyright © 2023 American Society of Addiction Medicine.)
Databáze:	MEDLINE
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