Anisha P Ganguly1, Marlene C Lira2, Sara Lodi3, Leah S Forman4, Jonathan A Colasanti5, Emily C Williams6, Jane M Liebschutz7, Carlos Del Rio5, Jeffrey H Samet8, Judith I Tsui9. 1. Internal Medicine Residency, University of Washington, Seattle, WA, United States. 2. Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, United States. 3. Boston University School of Public Health, Boston, MA, United States. 4. Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, United States. 5. Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States. 6. University of Washington School of Public Health, Department of Health Services, Seattle, WA, United States; VA Puget Sound Health Care System, Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, United States. 7. Division of General Internal Medicine, Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States. 8. Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, United States; Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, United States; Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States. 9. Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, United States. Electronic address: tsuij@uw.edu.
Abstract
INTRODUCTION: Management of chronic pain is an essential aspect of HIV primary care. Previous literature in the general population has elucidated racial disparities in the evaluation and treatment of pain. This study examined racial/ethnic differences in patient satisfaction and barriers to pain management among a cohort of PWH receiving LTOT. MATERIALS AND METHODS: Patient-reported survey and EMR data were compared between non-white (n = 135; 81.3 %) and white (n = 31; 18.7 %) patients in a cohort of 166 PWH receiving LTOT in two clinics in Atlanta and Boston. Quantile and linear regression were used to evaluate the association between race and pain management outcomes: 1) satisfaction with pain management (0-10) and 2) patient-related barriers to pain management, including patient perceptions of pain medications, fatalism, and communication about pain. Models were adjusted for sex, age, clinical site, and baseline general health. RESULTS: Non-white participants were noted to receive chronic opioids for a shorter mean duration of time than white participants (6.0 versus 11.0 years, p < 0.001) and lower mean morphine equivalent daily dose (MEDD) than white participants (28.1 versus 66.9 mg, p < 0.001). In adjusted analyses, there was no significant difference in satisfaction with pain management among non-white and white participants (p = 0.101). There was no significant difference in barriers to pain management in unadjusted (p = 0.335) nor adjusted models (p = 0.397). CONCLUSION: While non-white PWH were noted to have received lower doses of chronic opioids and for shorter duration than white PWH, satisfaction with pain management was similar. Patient-related barriers to pain management were similar among non-white and white PWH.
INTRODUCTION: Management of chronic pain is an essential aspect of HIV primary care. Previous literature in the general population has elucidated racial disparities in the evaluation and treatment of pain. This study examined racial/ethnic differences in patient satisfaction and barriers to pain management among a cohort of PWH receiving LTOT. MATERIALS AND METHODS: Patient-reported survey and EMR data were compared between non-white (n = 135; 81.3 %) and white (n = 31; 18.7 %) patients in a cohort of 166 PWH receiving LTOT in two clinics in Atlanta and Boston. Quantile and linear regression were used to evaluate the association between race and pain management outcomes: 1) satisfaction with pain management (0-10) and 2) patient-related barriers to pain management, including patient perceptions of pain medications, fatalism, and communication about pain. Models were adjusted for sex, age, clinical site, and baseline general health. RESULTS: Non-white participants were noted to receive chronic opioids for a shorter mean duration of time than white participants (6.0 versus 11.0 years, p < 0.001) and lower mean morphine equivalent daily dose (MEDD) than white participants (28.1 versus 66.9 mg, p < 0.001). In adjusted analyses, there was no significant difference in satisfaction with pain management among non-white and white participants (p = 0.101). There was no significant difference in barriers to pain management in unadjusted (p = 0.335) nor adjusted models (p = 0.397). CONCLUSION: While non-white PWH were noted to have received lower doses of chronic opioids and for shorter duration than white PWH, satisfaction with pain management was similar. Patient-related barriers to pain management were similar among non-white and white PWH.
Authors: Erin E Krebs; Amy Gravely; Sean Nugent; Agnes C Jensen; Beth DeRonne; Elizabeth S Goldsmith; Kurt Kroenke; Matthew J Bair; Siamak Noorbaloochi Journal: JAMA Date: 2018-03-06 Impact factor: 56.272
Authors: Jessica S Merlin; Dustin Long; William C Becker; Edward R Cachay; Katerina A Christopoulos; Kasey Claborn; Heidi M Crane; E Jennifer Edelman; Richard Harding; Stefan G Kertesz; Jane M Liebschutz; W Christopher Mathews; Michael J Mugavero; Sonia Napravnik; Connall C OʼCleirigh; Michael S Saag; Joanna L Starrels; Robert Gross Journal: J Acquir Immune Defic Syndr Date: 2018-09-01 Impact factor: 3.731