背景:为患者开阿片类药物的决定取决于许多因素,包括疾病的严重程度,疼痛评估,患者年龄,种族,种族,和性别。性别和性别差异在许多医疗保健环境中都有记录,但在住院综合医院环境中研究不足。
目的:我们评估了在大型城市学术中心普通医学服务的成人住院患者中,阿片类药物给药和处方模式的法律性别差异。
这项研究包括所有从加利福尼亚大学急性护理住院普通医疗服务出院的成年患者,旧金山(UCSF)海伦迪勒医疗中心在Parnassus高地从1/1/2013到9/30/2021。
方法:主要结果是(1)平均每日接受阿片类药物的住院患者和(2)出院时处方阿片类药物的天数。对于这两种结果,我们首先进行了逻辑回归,以评估阿片类药物的给药或处方是否存在差异.然后,我们进行了负二项回归,以评估阿片类药物给药量的差异.我们还对患有疼痛相关诊断的住院亚组进行了所有分析。
结果:我们的研究队列包括48,745例住院治疗,涉及27,777例患者。其中,24,398(50.1%)例住院患者为女性患者,24,347(49.9%)为男性患者。控制人口统计,临床,和住院水平变量,与男性患者相比,女性患者接受住院阿片类药物的可能性较低(校正OR0.87;95%CI0.82,0.92),平均每天接受吗啡毫克当量减少27.5(95%CI-39.0,-16.0).当考虑释放阿片类药物时,性别差异不显著。在疼痛相关诊断的亚组分析中,女性患者接受的住院阿片类药物较少。
结论:女性患者住院接受阿片类药物的可能性较小,处方时接受阿片类药物较少。促进公平的未来工作应确定策略,以确保所有患者都得到适当的疼痛管理。
BACKGROUND: Decisions to prescribe opioids to patients depend on many factors, including illness severity, pain assessment, and patient age, race, ethnicity, and gender. Gender and sex disparities have been documented in many healthcare settings, but are understudied in inpatient general medicine hospital settings.
OBJECTIVE: We assessed for differences in opioid administration and prescription patterns by legal sex in adult patient hospitalizations from the general medicine service at a large urban academic center.
UNASSIGNED: This study included all adult patient hospitalizations discharged from the acute care inpatient general medicine services at the University of California, San Francisco (UCSF) Helen Diller Medical Center at Parnassus Heights from 1/1/2013 to 9/30/2021.
METHODS: The primary outcomes were (1) average daily inpatient opioids received and (2) days of opioids prescribed on discharge. For both outcomes, we first performed logistic regression to assess differences in whether or not any opioids were administered or prescribed. Then, we performed negative binomial regression to assess differences in the amount of opioids given. We also performed all analyses on a subgroup of hospitalizations with pain-related diagnoses.
RESULTS: Our study cohort included 48,745 hospitalizations involving 27,777 patients. Of these, 24,398 (50.1%) hospitalizations were female patients and 24,347 (49.9%) were male. Controlling for demographic, clinical, and hospitalization-level variables, female patients were less likely to receive inpatient opioids compared to male patents (adjusted OR 0.87; 95% CI 0.82, 0.92) and received 27.5 fewer morphine milligram equivalents per day on average (95% CI - 39.0, - 16.0). When considering discharge opioids, no significant differences were found between sexes. In the subgroup analysis of pain-related diagnoses, female patients received fewer inpatient opioids.
CONCLUSIONS: Female patients were less likely to receive inpatient opioids and received fewer opioids when prescribed. Future work to promote equity should identify strategies to ensure all patients receive adequate pain management.