Provider Bias in Prescribing Opioid Analgesics: An Analysis of Emergency Department Electronic Medical Records

Abstract Background: Physicians do not prescribe opioid analgesics for pain treatment equally across groups, and such disparities may pose significant public health concerns. While research suggests that institutional constraints and cultural stereotypes influence doctors’ treatment of pain, prior quantitative evidence is mixed. The objective of this secondary analysis is therefore to clarify which institutional constraints and patient demographics truly bias provider prescribing of opioid analgesics.Methods: We used electronic medical record data from an emergency department of a large U.S hospital during years 2008-2014. We ran multi-level logistic regression models to estimate factors associated with providing an opioid prescription during a given visit while controlling for ICD-9 diagnosis and between-patient heterogeneity.Results: A total of 180,829 patient visits among 65,513 unique patients were recorded during the period of analysis. Overall, providers were significantly less likely to prescribe opioids to the same individual patient when the visit occurred during higher rates of emergency department crowding, earlier times of day, earlier times of the week, later years, and when the patient had received fewer previous opioid prescriptions. Across all patients, providers were significantly more likely to prescribe opioids to patients who were middle-aged, white, and married. We found no bias towards women and no interaction effects between race and crowding or between race and gender.Conclusions: Providers tend to undertreat pain during constrained diagnostic situations and undertreat pain for patients from high-risk and marginalized demographic groups. Harm from previous treatment mistakes are likely to accumulate through informing future treatment decisions.