190 Health Disparities in Emergency Department Administration of Buprenorphine for Treatment of Opioid Use Disorder

Document Type

Conference Proceeding

Publication Date

10-2-2023

Publication Title

Ann Emerg Med

Abstract

Objectives: Buprenorphine use in the emergency department contributes to decreased frequency of opioid overdose, reduced emergency room visits, and decreased associated health care costs. However, racial and ethnic disparities in buprenorphine prescription contribute to fewer prescriptions of buprenorphine for Black and Hispanic patients when compared to White patients. The objectives of our study were to 1) examine whether buprenorphine administration in an urban emergency department varies by patient demographics including race and ethnicity; and 2) examine other structural determinants of health to expand upon why these differences may exist. Methods: This is a retrospective analysis of electronic health records from patients who presented to the emergency room at Henry Ford Hospital between January 1, 2021, and December 31, 2021. Included patients were 18 years of age or older and screened positive for opioid use disorder (OUD) in the emergency room at Henry Ford Hospital. Area deprivation index (ADI) was determined based on patients’ documented street addresses to serve as a proxy for measuring income, education, employment, and housing quality. Univariate and multivariate analyses were conducted using SAS 9.4. Statistical significance was set at p<0.05. The institutional IRB approved this study. Results: There were 1082 patients included in our final analysis. Patients had a mean age of 48.1 years and were largely male (n=721, 66.8%). The majority of patients were Black (n=682, 63.0%), had Medicaid insurance (n=667, 61.6%), and were from the most disadvantaged ADI group (n=624, 62.7%). Patients that received buprenorphine had on average longer length of stay (LOS) with a mean of 844.2 minutes (p=0.016). Patients who identified as Black or Other Race were less likely to receive buprenorphine, and patients who identified as White were more likely to receive buprenorphine (p=0.021). After adjusting for age, LOS, sex, insurance type, and ADI, Black patients were less likely to receive buprenorphine as compared to White patients (p=0.0237). There were no significant differences found when comparing ADI among those who received buprenorphine. There were no differences among demographics for patients receiving buprenorphine for first-time induction compared to those receiving a maintenance dose. Conclusions: Our study demonstrates that the majority of patients at risk of opioid use disorder in our hospital sample were patients who were Black, male, had Medicaid insurance, and were from the most disadvantaged communities. However, White patients were still more likely to receive buprenorphine in our ED for treatment of OUD after controlling for other structural determinants of health. Limitations include the inherent inability of electronic medical records to accurately document a patient’s identified race and ethnicity. Future studies should include prospective analyses that better capture the very complex relationships of unconscious bias in medicine and structural determinants of health. Furthermore, we can utilize multifaceted education and training for ED providers and advocate for systemic changes at the hospital and policy level. Equitable administration of buprenorphine in the ED can contribute to decreased health disparities in the treatment of OUD. No, authors do not have interests to disclose

PubMed ID

Not assigned

Volume

82

Issue

1097-6760, 0196-0644

First Page

S87

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