Transcript Disparities in Pain Management for African

Disparities in Pain Management
for African Americans
Megan Conner, CRNA, MSN
Background Problem Information
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African Americans – 14% of
population
Pain management is burden on
health care system
Racial and ethnical differences in
care
Contributing Factors
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Biological
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Possible difference in endogenous pain
inhibition
Lower pain tolerance
Lower cortisol concentrations, blunted
plasma norepinephrine and SBP
Contributing Factors
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Socio-cultural
Impact decision to seek care
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Health insurance status & type of policy
Income
Stretch time between prescription refills
Narcotics limits on refills
Fear of substance abuse or secondary
gain by providers
Fear of addiction by African Americans
Contributing Factors
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Stigma related to certain diseases
Stoicism
Family oriented, putting self last
Spirituality
Communicating pain related to
gender and race
Nutritional deficiencies
Contributing Factors
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Health Behaviors
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Total pain sites, level of interferences,
and feeling frustrated most predictive
for number of pain reducing behaviors
African Americans employ a wide
variety pain reducing strategies
Greater psychological burden due to
chronic pain (PTSD, depression,
disability, irritability)
Fear of discrimination by providers
Contributing Factors
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Health Literacy
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44% of African Americans have low health
literacy
41% of English speaking patients are unable to
understand direction for taking medicine on an
empty stomach
Leads to higher rates of hospitalization, and
difficulty communicating with provider
Physicians over estimated literacy 25% of the
time (mean practice years 15.2)
Issues and Trends Related to Access
Use, Costs, and Quality of Health Care
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Health insurance most significant
factor influencing access to care
Not referred to pain specialist (95%
of all patients)
Difficulty finding provider
Seek treatment in Emergency Room
African Americans more likely to
extend time between onset and
pursuit of treatment
Issues and Trends Related to Access
Use, Costs, and Quality of Health Care
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No difference nor significance in
pharmacy geographical distribution
Those in white zip codes more likely
to have sufficient stock of opioids
New drugs are targeted a
physicians with more affluent
educated white demographic patient
population
Issues and Trends Related to Access
Use, Costs, and Quality of Health Care
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25% never filled prescription
42% filled prescription, but never
took it
Patient preferences effected by
individual meaning of pain, side
effects, fears related to analgesic
use, and cultural preferences
One study found: 11% against
using analgesics; 20% believed in
taking pain medications
Issues and Trends Related to Access
Use, Costs, and Quality of Health Care
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Health insurance & policy type
Out-of-pocket expenses
Large number of pain relievers sold
1.2 million emergency room visits
associated with pharmaceutical
abuse or misuses
Procedures for pain reduction
Issues and Trends Related to Access
Use, Costs, and Quality of Health Care
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Male physicians prescribed twice the
amount of pain medications for whites
compared to African Americans. The
opposite is true for females physicians.
“less intelligent, less educated, more likely
to abuse drugs and alcohol, and more likely
to fail to comply with medical advice, and
more likely to lack social support”
Inadequate assessment of pain
Affected by health literacy and patientprovider communication
Issues Related to Outcome
Measurement and Data Collection
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Cultural distrust
Lack of understanding of research
process
Inadequate recruitment efforts by
researchers
Economic considerations
Research associated with social
stigma (mental health)
Strategies for Culturally Sensitive
Services
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Cultural Encounter
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Be aware of own cultural bias
Prefer formal title, and use of their
surname
Depend more on non-verbal
communication
Comfortable with closer personal space
compare to other cultures
Address health literacy
Cultural Skill
Intervention
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Focused on education with
pretest/post-test design
Topics
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Cultural Skill/Competency
Fact or Fiction
Medication Information
For: Patients and Health Care
providers
Outcome Variables
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Post-test scores
Change in pain scores
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