Identification of provider characteristics influencing prescription of analgesics: a systematic literature review

Abstract

Purpose: Pain is a comorbid and aggravating symptom that in many conditions can be perceived differently and should therefore be managed accordingly. Numerous factors, both social and cultural, are thought to influence the analgesic prescription. However, elucidation of such areas is limited. We therefore conducted a systematic literature review to test the hypothesis that variations in provider characteristics predict the prescription of pain medication.

Methods: A MEDLINE and PsycINFO database search from 1960 to 2009 was conducted using the search terms of "pain" or "pain treatment" along with culture, ethnicity, race, minority, gender/sex, knowledge, attitudes, physician-patient relationship, stereotype, and physician practices. Twelve original research articles based on predefined inclusion criteria were identified and analyzed to test the hypothesis of provider characteristics influencing analgesics prescription.

Results: Of the 12 studies, 11 were cross-sectional in design, and 10 used a survey instrument or clinical vignettes to measure different pain management responses. A randomized sampling methodology was used in 5 of the studies. The majority of providers were male (64.9% in 8 studies), white (73.5% in 5 studies), internal medicine physicians (37.4% in 11 studies), and located in the United States (75% across all 12 studies). Ten studies identified at least one provider characteristic that influenced prescription practices; age, level of experience, as well as sex were listed most frequently as contributing factors. The interplay of the sex of the provider and patient characteristics were found to be important variables in pain management.

Conclusions: Our systematic review of existing literature highlights that provider's age, sex, experience, specialty, and the interplay between provider and patient characteristics are important variables in pain management. However, generalizations relating to these findings are limited by the heterogeneity of the studies and the paucity of literature in this field.

Keywords: analgesic prescription; pain; physician; provider characteristics.