The case of alternatives to opioids: How much do physician characteristics matter when treating a diverse population?

RationaleThere is little understanding of the prescription patterns of alternatives to opioids (ALTOS). Monitoring gender and racial health disparities can help with healthcare planning, workforce training, patient education, and awareness. ObjectiveThis study asks whether healthcare professionals, when treating patients of the same race and sex, increase their likelihood of prescribing ALTOs relative to opioids. MethodsWe use national Medicare Part D data from 2013 to 2017 and a machine-learning algorithm informed by census data to define the race of prescribers. We use multivariate regression models to understand the impact of race and sex biases on the extensive margin (e.g., percentage of people receiving ALTOs) and the intensive margin (e.g., the number of ALTOs prescriptions per capita). ResultsBetween 2013 and 2017, there has been an 8.7% increase in the prescriptions of ALTOs. The number of beneficiaries receiving ALTOs increased by 11.4%. In 2017, the number of ALTOs prescriptions per capita written as a fraction of all painkillers was 45%, and the number of beneficiaries receiving ALTOs prescriptions as a fraction of people receiving at least one form of painkillers (ALTOs or opioids) was 49%. A male doctor is 20.4% more likely to prescribe ALTOs as the percentage of same-sex patients increases. A white doctor is 7.4% more likely to prescribe ALTOs as the percentage of same-race patients increases, even when controlling for the socioeconomic status of patients, their age and risk factor, and the state and specialty of the prescriber. ConclusionSex and race concordance between providers and patients are significantly associated with prescribing alternatives to opioids. These systematic differences could be addressed by supporting diversity in the workforce, training, and increasing the minimum amount of time a visit should last.