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BACKGROUND: Racial disparities exist in access to health care and management of multiple health conditions including chronic pain; however, racial disparities in pre- and postoperative pain management in lower extremity amputation are not well-studied. Our objective was to examine the association between different racial and ethnic groups and prescription opioid and other analgesics use before and after lower extremity amputation. We hypothesize prescription opioid and other analgesic use among Black, Hispanic, and Native American US Medicare beneficiaries undergoing lower extremity amputations will be lower compared to White US Medicare beneficiaries. METHODS: This retrospective cohort study included a 5% national sample of all Medicare beneficiaries from 2011 to 2015 and 15% national sample of fee-for-service Medicare beneficiaries from 2016 to 2018 undergoing nontraumatic, lower extremity amputations. The exposure of interest was racial and ethnic group membership (ie, Black, Hispanic, Native American, White, and others-with others being the combination of the categories Asian and other) as provided in Medicare claims data. Using multivariable generalized estimating equations with a logistic link to account for repeated measurements over time, we estimated the odds of prescription opioid use within 6 months before and after lower extremity amputation across different racial and ethnic groups separately, adjusting for sociodemographic and health status factors (eg, Elixhauser index). Adjusted odds ratios (aORs) and 95% confidence intervals (95% CI) were reported. RESULTS: Among 16,068 eligible beneficiaries who underwent major and minor amputations (mean age = 65.1 ± 12.7 years; female = 36.1%), 10,107 (62.9%) were White, 3462 (21.5%) were Black, 1959 (12.2%) were Hispanic, 247 (1.5%) were Native American, and 151 (2.9%) were beneficiaries of other races. During the 6 months before lower extremity amputation, Hispanic beneficiaries (aOR, 0.71, 95% CI, 0.65-0.78) and beneficiaries of other races (aOR, 0.60, 95% CI, 0.47-0.76) had significantly lower odds of using prescription opioids compared to White beneficiaries. Similarly, Hispanic beneficiaries (aOR, 0.78, 95% CI, 0.71-0.84) and beneficiaries of other races (aOR, 0.63, 95% CI, 0.51-0.78) were associated with lower odds of opioid use in the 6 months after amputation compared to White beneficiaries. CONCLUSIONS: Among fee-for-service Medicare beneficiaries, Hispanic and other (eg, Asian) fee-for-service Medicare beneficiaries had lower odds of prescription opioid use than their White counterparts before and after nontraumatic, lower extremity amputations. Efforts to determine the underlying reasons are needed to ensure equitable health care access.
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Objective Identify and address potential obstacles to initiation of older population-related research within the NF/SG VHS through the provision of a concise flowchart. Setting North Florida/South Georgia Veterans Health System (NF/SG VHS). Practice Description The Department of Veterans Affairs (VA) Research Service with connection to the University of Florida facilitates research that contributes to improving the delivery of inpatient/outpatient care to veterans and their families. Practice Innovation A compendium of a senior care pharmacist's experiences will be compiled and reviewed by other specialists within the field while attempting to submit research protocols for publication within the VHS through the use of data platforms such as VINCI (VA Informatics and Computing Infrastructure) and the Corporate Data Warehouse. Main Outcome Measurements Impact of navigating research websites affiliated with and directly pertaining to the NF/SG VHS upon clinicians attempting to begin research processes within the institution. Results It was determined that for the most expeditious publication experience to result the following six steps had to be pursued sequentially: VA Institutional Review Board (IRB) Net documentation/ submission, local myIRB submission, Data Access Request Tracker/VINCI access request, setup of VINCI workspace, drafting of VINCI cohort specification, data analysis and tracking, statistical methods, abstract, and manuscript production. Conclusion This study outlines a consistent/clear method from first-hand experiences on how to navigate, more efficiently, complex research processes to produce successful future impacts on patient care.