Introduction: A number of studies have documented inequalities in care and outcomes for a variety of clinical conditions. We sought to identify potential racial and socioeconomic disparities in the diagnosis and treatment of trigeminal neuralgia (TN) that could serve as areas of focus for future quality improvement initiatives.
Methods: Medical records of patients with an ICD-9 code of 350.1, signifying a diagnosis of TN, in the Henry Ford Medical Group (HFMG) from 2006 to 2012 were reviewed. The authors identified 652 such patients (Figure 1). Clinical and socioeconomic data were retrospectively reviewed on all patients (Table 1). Analyses were conducted to assess potential racial differences in subspecialty referral patterns and the specific type of treatment modality undertaken by patients with trigeminal neuralgia.
Results: When compared to White patients, Black patients were less likely to undergo percutaneous ablative procedures, radiation therapy, or microvascular decompressions (p<0.001). However, there was no difference in likelihood of Blacks and Whites undergoing a procedure once they saw a neurosurgeon (67% vs. 70%, respectively; p = 0.712). Blacks and Whites were equally likely to be seen by a neurologist or neurosurgeon if they were seen in the ER (38% vs. 37%, p = 0.686) or Internal Medicine (48% vs. 50%, p = 0.743). For patients diagnosed after the publication of EFNS-AAN guidelines for medical therapy of TN in 2008 (n=293), fewer than 50% of patients were on medications sanctioned by the guidelines, without statistically significant racial disparities (p = 0.059) (Table 2).
Conclusions: In a large retrospective database from one of the nation’s largest, comprehensive health systems, there were significant racial disparities in the likelihood of a patient undergoing a procedure for trigeminal neuralgia. This appeared to stem from a difference in referral patterns from outside that system.
Patient Care: The Institute of Medicine report from 2002 on “Unequal Treatment” summarized a large of body of published literature on racial/ethnic inequalities in delivery and quality of health care.12 A large number of studies since then have continued to document disparities in various dimensions of medical care, including cancer care, myocardial infarction care, management of diabetes, and asthma care.13–15 The current study was launched after it was noted that a seemingly significant underrepresentation of Black patients were being referred for surgical management of TN, in spite of a large Black population in Southeast Michigan.
It is worthwhile to point out, that while there is a disparity in referring black patients to see a neurosurgeon, there was no difference in likelihood of Blacks and Whites undergoing a procedure once they saw a neurosurgeon.
The study can be applicable to many US urban settings and should highlight the need of a more aggressive referral pattern by primary care physicians and emergency departments in under-served areas.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Realize the existing racial disparities that exist among patients suffering from facial pain.
2) Once patients see a neurosurgeon, there was no difference in likelihood of Blacks and Whites undergoing a procedure
3) A good portion of this disparity stems from poor referral patterns that exist in under-served communities
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