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Disparities in Pain Management for African Americans. Megan Conner, CRNA, MSN. Background Problem Information. African Americans – 14% of population Pain management is burden on health care system Racial and ethnical differences in care. Contributing Factors. Biological
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Disparities in Pain Management for African Americans Megan Conner, CRNA, MSN
Background Problem Information • African Americans – 14% of population • Pain management is burden on health care system • Racial and ethnical differences in care
Contributing Factors • Biological • Possible difference in endogenous pain inhibition • Lower pain tolerance • Lower cortisol concentrations, blunted plasma norepinephrine and SBP
Contributing Factors • Socio-cultural • Impact decision to seek care • 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 • Stigma related to certain diseases • Stoicism • Family oriented, putting self last • Spirituality • Communicating pain related to gender and race • Nutritional deficiencies
Contributing Factors • Health Behaviors • 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 • Health Literacy • 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 AccessUse, Costs, and Quality of Health Care • 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 • 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 • 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 • 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 • 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 patient-provider communication
Issues Related to Outcome Measurement and Data Collection • 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 • Cultural Encounter • 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 • Focused on education with pretest/post-test design • Topics • Cultural Skill/Competency • Fact or Fiction • Medication Information • For: Patients and Health Care providers • Outcome Variables • Post-test scores • Change in pain scores
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