Higher rates of chemical sedation among black psychiatric patients in emergency departments indicate inequity, Penn study finds
PHILADELPHIA — Black patients presenting to emergency departments (EDs) across the country with psychiatric problems are 63% more likely to be chemically sedated than their white counterparts. But the researchers also found that, in hospitals that serve a high proportion of black patients, white patients were more likely to be chemically sedated for psychiatric disorders compared to hospitals that primarily serve white patients. The findings were published in Annals of Epidemiology by researchers at the Perelman School of Medicine at the University of Pennsylvania.
“When a hospital has fewer resources, it often does not have the staff or the time to defuse a patient in distress, and may resort to chemical sedation more quickly than a hospital with enough staff and resources,” said the lead author. Ari Friedman, MD, PhD, assistant professor of emergency medicine and medical ethics and health policy at Penn Medicine. “A visit to the emergency department is traumatic in itself, and we want to avoid escalating a patient’s distress to the point where they need to be restrained or sedated, so the feedback provided by scans like this sheds light on the issues we can use to advocate for more resources to provide more equitable care.
Researchers analyzed data from 2008 to 2018 through the National Hospital Ambulatory Medical Survey (NHAMCS) database to examine the association of race and administration of chemical sedation (an antipsychotic or ketamine ) during emergency department visits for psychiatric disorders, defined as any visit where the stated reason for the visit was “symptoms related to psychological and mental disorders”. Chemical sedation can be used to calm and help protect patients from harming themselves or others, and previous research into racial differences in caring for agitated patients in the emergency setting suggests there may be have disparities in treatment.
Of the 76.2 million total ER visits assessed, 5.7% of black patients with a psychiatric disorder received chemical sedation, while 3.6% of white patients with the same conditions received chemical sedation. However, when researchers determined whether the hospital in which patients were receiving care was high-proportion black patients or high-proportion white patients, they found that patient race no longer had an impact on probability of being under chemical sedation. That is, the data suggests that in a hospital whose emergency department saw more black patients, white patients were also more likely to be chemically sedated.
While the NHAMCS data did not include the reasons patients were chemically sedated, the researchers pointed to important themes that these disparities highlight.
“Structural factors, such as redlining or systemic disinvestment in majority black neighborhoods, can result in segregated health care systems, which has ripple effects on practice patterns, from funding to staffing levels, which which in turn impacts the care patients receive,” said lead author Utsha. Khatri, MD, a former member of the National Clinician Scholars Program at Penn Medicine and now an assistant professor of emergency medicine at the Icahn School of Medicine at Mount Sinai. “Healthcare providers should closely monitor metrics like these to guide physicians toward more equitable practices.”
Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the University of Pennsylvania Raymond and Ruth Perelman School of Medicine (founded in 1765 as the first medical school in the country) and the University of Pennsylvania Health Systemwhich together make up a $9.9 billion business.
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