Perspectives of Racial and Ethnic Emergency Department Patient–Clinician Concordance in Opioid Use Disorder Encounters
Edouard Coupet, Marek C. Chawarski, Kavari Hercules, Joseph L. Williams, Alexandra Murphy Ward, Patricia H. Owens, David A. Fiellin, Kathryn F. Hawk, Shara H. Martel, Gail D’OnofrioBackground:
Significant racial and ethnic disparities in the treatment of opioid use disorder (OUD) in the emergency department (ED) remain. Little is known about how ED patients with OUD perceive racial and ethnic concordance and whether these perceptions differ by race and ethnicity. This study seeks to elicit and compare perspectives on ED patient–clinician racial and ethnic concordance among Black, Hispanic, and White individuals with OUD.
Methods:
Two trained qualitative investigators conducted semi-structured individual interviews with 57 participants (20 non-Hispanic Black, 20 non-Hispanic White, and 17 Hispanic) previously enrolled in Project ED-Innovation. We used the National Institute on Minority Health and Health Disparities research framework to explore perspectives on ED patient–clinician racial and ethnic concordance. Participants were recruited using purposeful sampling from 8 ED sites: Cooper (NJ), Grady Memorial (GA), Henry Ford (MI), Maine (ME), University of New Mexico (NM), University of Utah, and the Alameda Health System (CA). Transcripts were analyzed by race and ethnicity.
Results:
The mean age (SD) of participants was 41.7 years (12.8) and 35.1% (20/57) were female. Twenty participants (35.1%) identified as Black, 17 (29.8%) as Hispanic, and 20 (35.1%) as White. A consistent theme among all groups was the importance of compassion and professionalism over racial and ethnic ED patient–clinician concordance, particularly when discussing addiction. A unique theme among Black and Hispanic participants was a feeling of comfort and connection derived from perceived shared cultural experiences and experiences of discrimination with an ED clinician of the same racial and ethnic background.
Conclusions:
Participants from all 3 groups valued the therapeutic patient–clinician relationship more than racial and ethnic concordance. Black and Hispanic participants felt comfort from shared cultural experiences with ED clinicians with racial and ethnic concordance. These findings underscore the importance of patient-centered communication in enhancing ED access to OUD treatment for all populations.