Date of Conferral

2019

Degree

Ph.D.

School

Health Services

Advisor

Lee W. Bewley

Abstract

Many drug overdoses in the United States are from prescription drugs, most of which are classified as opioid pain relievers (OPRs) and commonly prescribed in emergency departments (EDs) to treat pain. OPR abuse and addiction is a major public health issue. Researchers have identified the role of various patient characteristics (race, gender, demographics, etc.) in the variation in OPR prescription rates, but the contribution of provider-type differences to that variation has not been exposed. The purpose of this study was to evaluate the strength of the association between provider type and the likelihood of an opioid prescription by ED providers using national-level population data. Drawing from symbolic interaction theory, which served as the study's theoretical framework, it was postulated that the training and background of ED providers influence their interaction and OPR prescription decisions. The National Hospital Ambulatory Medical Care Survey 2015 data were used to evaluate the association between provider type and the likelihood of an OPR prescription, and the possible confounding effect of patients' race and payment type. Logistic regression analysis showed that attending physicians, consulting physicians, and physician assistants were more likely (OR = 1.491, 1.318, and 1.315, respectively) to prescribe an OPR in the ED, while controlling for age and pain level. Both race and payment type had predictive relationships with the outcome variable, but only payment type interacted significantly with provider type. These findings can serve as the basis for evidence-based training, procedure guidelines, and policy development, as well as inform patient-provider interactions, potentially leading to safer, more effective pain management encounters in the ED.

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