Article Figures & Data
Figures
- Figure 1
Odds ratios for the associations between level of prescription opioid use and high satisfaction with care.
Note: Number of prescriptions received in rounds 3 through 5 was used to define nonuse/limited use (0–1), low use (2–4), moderate use (5–9), and heavy use (≥10).
a Adjusted for age (continuous), sex, race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic vs other).
b Further adjusted for body mass index (continuous), 12-item Short Form Health Survey mental and physical component scores (continuous), self-reported health status (fair or poor vs all others), and self-reported pain level (moderate or severe vs all others).
c High satisfaction was defined as having a composite patient satisfaction score in the highest quartile.
Tables
- Table 1
Characteristics of Adults With Musculoskeletal Conditions According to Opioid Use Status
Characteristic Opioid Nonuser/ Limited Usera (n=16,046) Opioid Usera (n=2,564) P Value Sociodemographics Age, mean (SE), y 53.4 (0.1) 54.7 (0.1) <.001 Sex, % .001 Male 38.6 35.3 Female 61.4 64.7 Race and ethnicity, % <.001 Non-Hispanic white 67.0 65.6 Non-Hispanic black 20.2 24.7 Hispanic 3.4 3.2 Other or multiple races 9.4 6.6 Marital status, % <.001 Married 55.5 46.3 Divorced, separated, widowed 26.1 38.3 Never married 18.4 15.4 US Census region, % <.001 Northeast 17.9 12.5 Midwest 21.2 22.4 South 36.0 43.3 West 24.9 21.9 Educational attainment, % <.001 High school graduate or less 63.6 78.3 College degree 16.7 8.6 Graduate degree 10.1 3.8 Other degrees 9.6 9.2 Health insurance, % <.001 Private 64.3 45.1 Public 26.4 46.3 Uninsured 9.3 8.5 Health status Body mass index, mean (SE), kg/m2 29.1 (0.1) 31.3 (0.2) <.001 SF-12 scores, mean (SE) PCS score 46.0 (0.1) 33.3 (0.2) <.001 MCS score 49.9 (0.1) 44.4 (0.2) <.001 “Fair” or “poor” overall health, % 19.7 50.5 <.001 Higher self-reported-pain levelb 30.5 75.5 <.001 Health care use Prior opioid use,c % 10.3 67.2 <.001 Has usual source of care,d % 99.7 99.3 .02 Prior inpatient surgery, % 7.8 22.2 <.001 Prior outpatient surgery, % 10.0 21.3 <.001 Annual health care spending, median (IQR), $ 2,380 (5,273) 7,414 (14,240) <.001 ED=emergency department; IQR=interquartile range; MCS=mental component summary; PCS = physical component summary; SE = standard error; SF-12 = 12-item Short Form Health Survey.
Note: The χ2 test was used to compare proportions, 2-sample t test to compare means, and Mann-Whitney test to compare medians.
↵a Opioid use defined longitudinally using prescriptions received in survey rounds 3 through 5: users (≥1 prescriptions in at least 2 rounds) or nonusers/limited users (0–1 prescriptions).
↵b Percent answering “Moderately,” “Quite a bit,” or “Extremely.”
↵c Prior opioid use defined as receiving 1 or more prescriptions in rounds 1 or 2.
↵d A usual source of care other than the emergency department.
- Table 2
Odds Ratios for the Association Between Characteristics and High Satisfaction With Care
Characteristic Odds Ratio (95% CI) for High Satisfaction With Carea Unadjusted Adjustedb Opioid use status Nonuser/limited user (ref) 1.00 1.00 User 0.97 (0.87–1.07) 1.32 (1.18–1.49) Sociodemographics Age, per year 1.02 (1.02–1.02) 1.02 (1.02–1.02) Sex Male (ref) 1.00 1.00 Female 1.15 (1.05–1.25) 1.25 (1.16–1.34) Race and ethnicity Non-Hispanic white (ref) 1.00 1.00 Non-Hispanic black 1.08 (1.00–1.18) 1.01 (0.82–1.25) Hispanic or Latino 0.92 (0.76–1.12) 1.10 (0.89–1.38) Other 0.76 (0.66–0.86) 0.79 (0.62–1.00) Health status Body mass index, per kg/m2 1.01 (1.00–1.00) 1.01 (1.00–1.02) SF-12 scores PCS score 1.01 (1.00–1.01) 1.02 (1.01–1.03) MCS score 1.03 (1.03–1.04) 1.03 (1.03–1.04) Self-reported health status Excellent to good (ref) 1.00 1.00 Fair or poor 0.81 (0.75–0.88) 1.18 (1.06–1.31) Self-reported pain Little or none (ref) 1.00 1.00 Moderate to severe 0.74 (0.69–0.80) 0.97 (0.87–1.09)
Supplemental Tables
Supplemental Tables
Files in this Data Supplement:
- Supplemental data: Tables & Figures - PDF file
The Article in Brief
Prescription Opioid Use and Satisfaction With Care Among Adults With Musculoskeletal Conditions
Brian D. Sites , and colleagues
Background Physician reimbursement is often based, at least in part, on patient satisfaction scores. This study examines the relationship between use of prescription opioids among adult patients with musculoskeletal conditions and their satisfaction with care.
What This Study Found Patients with musculoskeletal conditions who receive prescription opioids are more satisfied with their care than comparable patients who do not receive opioids. In a study of nationally representative data, 13 percent (2,564) of more than 19,000 patients with musculoskeletal conditions used prescription opioids. Among those who used opioids over time, moderate and heavy use was associated with greater likelihood (55 percent and 43 percent, respectively) of being most satisfied, compared to single or no use of opioids. Although opioids may be expected to offer patients with musculoskeletal conditions improved pain control, patients taking opioids in this study had more pain and worse health and disability than those taking limited or no opioids, suggesting a more complex picture.
Implications
- As clinician compensation is increasingly linked to patient satisfaction, and as the United States struggles with an epidemic in opioid use, the authors suggest it is imperative to determine whether improved satisfaction with care is associated with demonstrable health benefits.
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