--- title: "Disparities in emergency department opioid prescribing | Sutter Health" description: "Disparities in emergency department and urgent care opioid prescribing before and after randomized clinician feedback interventions" url: "https://www.sutterhealth.org/research/publications/disparities-in-emergency-department-opioid-prescribing-1055312860" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Disparities in emergency department opioid prescribing # Disparities in emergency department and urgent care opioid prescribing before and after randomized clinician feedback interventions _Academic Emergency Medicine_ 2023-03-06 ## Abstract Objectives Racial and ethnic minorities receive opioid prescriptions at lower rates and dosages than White patients. Though opioid stewardship interventions can improve or exacerbate these disparities, there is little evidence about these effects. We conducted a secondary analysis of a cluster-randomized controlled trial conducted among 438 clinicians from 21 emergency departments and 27 urgent care clinics. Our objective was to determine whether randomly allocated opioid stewardship clinician feedback interventions that were designed to reduce opioid prescriptions had unintended effects on disparities in prescribing by patient race and ethnicity. Methods The primary outcome was likelihood of receiving a low-pill prescription (low ≤10 pills, medium 11–19 pills, high ≥20 pills). Generalized mixed-effects models were used to determine patient characteristics associated with low-pill prescriptions during the baseline period. These models were then used to determine whether receipt of a low-pill prescription varied by patient race or ethnicity during the intervention period between usual care and three opioid stewardship interventions: (1) individual audit feedback, (2) peer comparison feedback, and (3) combined (individual audit + peer comparison) feedback. Results Compared with White patients, Black patients were more likely to receive a low-pill prescription during the baseline (adjusted odds ratio \[OR\] 1.18, 95% confidence interval \[CI\] 1.06–1.31,p= 0.002) and intervention (adjusted OR 1.43, 95% CI 1.07–1.91,p= 0.015). While combined feedback was associated with an overall increase in low-pill prescriptions as intended (adjusted OR 1.89, 95% CI 1.28–2.78,p= 0.001), there were no significant differences in treatment effects of any of the interventions by patient race and ethnicity. Conclusions Combined individual audit and peer comparison feedback was associated with fewer opioid pills per prescription equally by patient race and ethnicity. However, the intervention did not significantly close the baseline disparity in prescribing by race. [PubMed abstract](https://pubmed.ncbi.nlm.nih.gov/36876410/) ![Xiaowei (Sherry) Yan, Ph.D.](https://dyn.mktgcdn.com/p/NTWox_hkmxIRiqJEc5PXKeBkfR_WMtpSQbEI4J69Xls/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Xiaowei (Sherry) Yan, Ph.D. Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/xiaowei-sherry-yan-phd-1049681042) ## Research topics - [EHR Data](https://www.sutterhealth.org/research-search-results?query=%22%5C%22EHR+Data%5C%22%22) - [Pain](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Pain%5C%22%22) - [Physician Efficiency](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Physician+Efficiency%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Evaluating the effectiveness of email-based nudges to reduce postoperative opioid prescribing: study protocol of a randomised controlled trial](https://www.sutterhealth.org/research/publications/emailbased-nudges-to-reduce-postoperative-opioid-prescribing-1055312819) BMJ Open 2022 Sep 19 - Publication ### [The Effect Of Clinician Feedback Interventions On Opioid Prescribing](https://www.sutterhealth.org/research/publications/effect-of-clinician-feedback-opioid-prescribing-1055312800) Health Affairs 2022 Mar 01 - Publication ### [Relationships and resilience at work and at home: Impact of relational coordination on clinician work-life balance and well-being in times of crisis](https://www.sutterhealth.org/research/publications/relationships-resilience-impact-of-relational-coordination-on-clinician-work-life-balance-1055312859) Health Care Management Review 2022 Oct 21 - Publication ### [How Physician Self-Perceptions Affect the Impact of Peer Comparison Feedback on Opioid Prescribing](https://www.sutterhealth.org/research/publications/physician-self-perceptions-impact-on-opioid-prescribing-1055312847) American Journal of Medical Quality 2023 Apr 05 - Publication ### [Implementation of patient engagement tools in electronic health records to enhance patient-centered communication: protocol for feasibility evaluation and preliminary results](https://www.sutterhealth.org/research/publications/patient-centered-communication-1055312806) Tai-Seale M, Rosen R, Ruo B, Hogarth M, Longhurst CA, Lander L, Walker AL, Stults CD, Chan A, Mazor K, Garber L, Millen M JMIR Res Protoc.10(8):e30431. doi: 10.2196/30431. 2021 Aug 26 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/disparities-in-emergency-department-opioid-prescribing-1055312860#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Disparities in emergency department opioid prescribing"}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/disparities-in-emergency-department-opioid-prescribing-1055312860#medicalscholarlyarticle","name":"Disparities in emergency department and urgent care opioid prescribing before and after randomized clinician feedback interventions","headline":"Disparities in emergency department opioid prescribing","abstract":"Objectives Racial and ethnic minorities receive opioid prescriptions at lower rates and dosages than White patients. Though opioid stewardship interventions can improve or exacerbate these disparities, there is little evidence about these effects. We conducted a secondary analysis of a cluster-randomized controlled trial conducted among 438 clinicians from 21 emergency departments and 27 urgent care clinics. Our objective was to determine whether randomly allocated opioid stewardship clinician feedback interventions that were designed to reduce opioid prescriptions had unintended effects on disparities in prescribing by patient race and ethnicity. Methods The primary outcome was likelihood of receiving a low-pill prescription (low ≤10 pills, medium 11–19 pills, high ≥20 pills). Generalized mixed-effects models were used to determine patient characteristics associated with low-pill prescriptions during the baseline period. These models were then used to determine whether receipt of a low-pill prescription varied by patient race or ethnicity during the intervention period between usual care and three opioid stewardship interventions: (1) individual audit feedback, (2) peer comparison feedback, and (3) combined (individual audit + peer comparison) feedback. Results Compared with White patients, Black patients were more likely to receive a low-pill prescription during the baseline (adjusted odds ratio [OR] 1.18, 95% confidence interval [CI] 1.06–1.31,p= 0.002) and intervention (adjusted OR 1.43, 95% CI 1.07–1.91,p= 0.015). While combined feedback was associated with an overall increase in low-pill prescriptions as intended (adjusted OR 1.89, 95% CI 1.28–2.78,p= 0.001), there were no significant differences in treatment effects of any of the interventions by patient race and ethnicity. Conclusions Combined individual audit and peer comparison feedback was associated with fewer opioid pills per prescription equally by patient race and ethnicity. 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