Advancing a National Agenda to Eliminate Disparities in Pain Care: Directions for Health Policy, Education, Practice, and Research

Authors


  • Conflict of Interest/Disclosure information: There are no financial relationships of any of the author or their family members with a cumulative value of more than $10,000 per year in the last 3 years, with any company or entity whose products may be related to the topic of this manuscript for all authors.

Salimah H. Meghani, PhD, MBE, CRNP, Assistant Professor, Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions & Health, Associate Fellow, Center for Bioethics, University of Pennsylvania, Claire M. Fagin Hall, 418 Curie Boulevard, Room 337, Philadelphia, PA 19104-4217, USA. Tel: 215-573-7128, Fax: 215-573-7507; E-mail: meghanis@nursing.upenn.edu.

Abstract

Background.  Pain is strongly associated with significant personal and societal costs. A crucial element of any initiative on pain must focus on eliminating pain care disparities that are pervasive throughout the United States health care settings.

Objectives.  This report focuses on macro-level factors related to pain care disparities in the United States that may be amenable to policy interventions.

Methods.  We identify concrete opportunities for achieving equity in pain care, especially those occasioned by recent legislative changes in the United States health care system. An aggressive policy, advocacy, and research agenda is synthesized in five domains: 1) structural/system; 2) policy and advocacy; 3) workforce; 4) provider; and 5) research.

Results.  Inequities in pain care remain an important and neglected health policy concern. Many direct and indirect provisions within the Affordable Care Act (ACA) and other national initiatives that leverage on ACA offer opportunities to achieve equity in pain care. These include changes in insurance, in public, provider, and legislative education, in primary care and pain specialist training, improving workforce diversity, achieving uniformity in race/ethnicity data collection, emphasizing patient-centered outcomes research, and encouraging focus on pain care disparities within the comparative effectiveness research paradigm.

Conclusions.  Recent national legislative initiatives within ACA are expected to generate multilevel efforts that will impact the flow of funding to address the pervasive issue of disparities. It is an opportune time for the pain community to take a lead in implementing a concerted agenda on pain care disparities in order to leverage these national initiatives.

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