Dataset Information

Access to Primary Care Clinics for Patients With Chronic Pain Receiving Opioids.

ABSTRACT:

Importance

Opioid-prescribing policies and guidelines aimed at reducing inappropriate opioid prescribing may lead physicians to stop prescribing opioids. Patients may thus encounter difficulties finding primary care practitioners willing to care for them if they take opioids.

Objectives

To assess practitioner willingness to accept and continue prescribing opioids to new patients with pain and whether this willingness differs across payer types.

Design, setting, and participants

This survey study used a simulated patient call audit method. A brief telephone survey was administered to all clinics followed by a call using a patient script simulating an adult patient with chronic pain who was taking long-term opioids. The patient had Medicaid or private insurance. Calls were made between June 22 and October 30, 2018, to 667 primary care clinics that served a general adult population in Michigan. Clinics that accepted both Medicaid and private insurance, took new patient appointments, and were successfully recontacted for the simulated call were eligible for the study.

Main outcomes and measures

Prevalence of clinics' acceptance of new patients receiving prescription opioids overall and by clinic characteristics and insurance type.

Results

Of the 194 eligible clinics, 94 (48.4%) were randomized according to insurance type to receive calls from research assistants posing as children of patients with Medicaid and 100 (51.5%) to receive calls from those with private insurance. Overall, 79 (40.7%) stated that their practitioners would not prescribe opioids to the simulated patient. Thirty-three clinics (17.0%) requested more information before making a decision. Compared with single-practitioner clinics, clinics with more than 3 practitioners were more likely (odds ratio [OR], 2.99; 95% CI, 1.48-6.04) to accept new patients currently taking opioids. No difference was found in access based on insurance status (OR, 0.92; 95% CI, 0.52-1.64) or whether the clinic offered medications for opioid use disorders (OR, 1.10; 95% CI, 0.45-2.69).

Conclusions and relevance

The findings suggest that access to primary care may be reduced for patients taking prescription opioids, which could lead to unintended consequences, such as conversion to illicit substances or reduced management of other medical comorbidities.

SUBMITTER: Lagisetty PA

PROVIDER: S-EPMC6628590 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Access to Primary Care Clinics for Patients With Chronic Pain Receiving Opioids.

Lagisetty Pooja A PA Healy Nathaniel N Garpestad Claire C Jannausch Mary M Tipirneni Renuka R Bohnert Amy S B ASB

JAMA network open 20190703 7

<h4>Importance</h4>Opioid-prescribing policies and guidelines aimed at reducing inappropriate opioid prescribing may lead physicians to stop prescribing opioids. Patients may thus encounter difficulties finding primary care practitioners willing to care for them if they take opioids.<h4>Objectives</h4>To assess practitioner willingness to accept and continue prescribing opioids to new patients with pain and whether this willingness differs across payer types.<h4>Design, setting, and participants ...[more]

PMID: 31298712

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Project description:BackgroundThe Compensation and Pension (C&P) determination process is a potential gateway to accessing pain treatment in the Veterans Health Administration (VHA). However, attitudes about C&P as a gateway and about collaboration with C&P clinics among VHA staff are unknown.MethodsIn preparation for an initiative to link veterans seeking compensation for musculoskeletal disorders to treatment, clinical and administrative staff from the 8 VHA medical centers in New England were invited to complete a relational coordination survey that examined how different workgroups collaborate (communication and relationships) to provide pain care to veterans. A subset of those staff also participated in a semistructured interview about pain treatment referral practices within their medical centers. VHA staff were from primary care, administration, pain management, and C&P teams.ResultsEighty-three VHA staff were invited to complete the relational coordination survey; 66 completed the survey and 39 participated in the semistructured interview. Most C&P staff interviewed thought of the compensation examination as a forensic process and that C&P-based efforts to engage veterans might interfere with the examination or were not their responsibility. However, some examiners described their efforts to determine new veterans' eligibility for VHA care and to connect them to specific treatments. VHA staff reported that there was little communication between the C&P team and other teams. The survey results supported this finding. The C&P group's relational coordination composite scores were lower than any other workgroup.ConclusionOutreach to veterans at New England C&P clinics was inconsistent, and C&P teams rated low on a measure of coordination with workgroups involved in pain treatment. Compensation examinations appear to be underused opportunities to help veterans access treatment. C&P-based treatment engagement is feasible; it is being done by some Compensation teams.

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Dataset Information

Access to Primary Care Clinics for Patients With Chronic Pain Receiving Opioids.

Importance

Objectives

Design, setting, and participants

Main outcomes and measures

Results

Conclusions and relevance

Publications

Access to Primary Care Clinics for Patients With Chronic Pain Receiving Opioids.

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