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Context Inappropriate pain documentation is likely to be an important contributor to the poor management of pain in elderly patients in the emergency department (ED). Failure to assess pain limits ability to treat pain. Objectives The objectives of this study were to examine the relationship between visit characteristics of elderly patients and pain score documentation in the ED, and to determine predictors of analgesic use in the ED. Methods This was a cross-sectional analysis of documented ED visits by elderly patients from the National Hospital Ambulatory Medical Care Survey (2003–2006). The study included 5661 ED visits by patients aged 65 years and older, representing an estimated 18 million ED visits during the four-year study period. Univariate logistic regression was used to analyze associations among independent variables and documentation of pain. Multivariate logistic regression was used to determine whether nonopioid and opioid analgesic prescribing disparities existed and were associated with pain level. Results Pain score documentation was found to be suboptimal in the elderly population in this study, with only 75% of visits having documented pain scores. Older age, self-pay, patients residing in the Western region of the United States, and emergent ED visits were associated with decreased pain score documentation. Documentation of pain score was associated with increased odds of an analgesic prescription and opioid analgesic prescription. Odds of prescribing an opioid increased significantly with increasing level of pain severity. Conclusion ED pain score documentation is suboptimal in the elderly population. Disparity in the use of analgesic prescriptions and opioid analgesics exists and may result in patients not receiving analgesics. Improving pain assessment and documentation, changes in attitude toward analgesic prescribing, and recognition of ethnic, racial, and age differences in patients with pain have the potential to contribute to effective management of pain in the ED.

This study compared three medical care services provided by a physician, a nonphysician clinician (NPC), and an NPC with a physician in ambulatory settings while measuring the trend in patients with essential hypertension and allergic rhinitis seen by these clinicians for the years 1999 through 2006. Multivariate analysis of variance and Z-test were used to analyze the data, while post hoc comparisons were performed using Scheffe test. There was a significant increase in the proportion of patients seen by an NPC with a physician for both diagnoses compared with the other two types of clinicians. The combination type prescribed significantly more medications than the other types, while there was moderate to substantial agreement in the choice of medications. Clinician type emerged as a prominent variable to explain the differences in how counseling services are provided, medications are prescribed, and diagnostic and screening services are ordered for patients with essential hypertension or allergic rhinitis in ambulatory settings.