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Research ArticleOriginal Research

Prescription Opioid Use and Satisfaction With Care Among Adults With Musculoskeletal Conditions

Brian D. Sites, Jordon Harrison, Michael D. Herrick, Melissa M. Masaracchia, Michael L. Beach and Matthew A. Davis
The Annals of Family Medicine January 2018, 16 (1) 6-13; DOI: https://doi.org/10.1370/afm.2148
Brian D. Sites
1Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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  • For correspondence: brian.d.sites@hitchcock.org
Jordon Harrison
2Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania
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Michael D. Herrick
1Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Melissa M. Masaracchia
1Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Michael L. Beach
1Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
3Community Health Research Program, Hood Center for Children and Families, Lebanon, New Hampshire
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Matthew A. Davis
4Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
5Institute for Social Research, University of Michigan, Ann Arbor, Michigan
6School of Nursing, University of Michigan, Ann Arbor, Michigan
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    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.

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    Table 1

    Characteristics of Adults With Musculoskeletal Conditions According to Opioid Use Status

    CharacteristicOpioid Nonuser/ Limited Usera (n=16,046)Opioid Usera (n=2,564)P Value
    Sociodemographics
    Age, mean (SE), y53.4 (0.1)54.7 (0.1)<.001
    Sex, %.001
     Male38.635.3
     Female61.464.7
    Race and ethnicity, %<.001
     Non-Hispanic white67.065.6
     Non-Hispanic black20.224.7
     Hispanic3.43.2
     Other or multiple races9.46.6
    Marital status, %<.001
     Married55.546.3
     Divorced, separated, widowed26.138.3
     Never married18.415.4
    US Census region, %<.001
     Northeast17.912.5
     Midwest21.222.4
     South36.043.3
     West24.921.9
    Educational attainment, %<.001
     High school graduate or less63.678.3
     College degree16.78.6
     Graduate degree10.13.8
     Other degrees9.69.2
    Health insurance, %<.001
     Private64.345.1
     Public26.446.3
     Uninsured9.38.5
    Health status
    Body mass index, mean (SE), kg/m229.1 (0.1)31.3 (0.2)<.001
    SF-12 scores, mean (SE)
     PCS score46.0 (0.1)33.3 (0.2)<.001
     MCS score49.9 (0.1)44.4 (0.2)<.001
    “Fair” or “poor” overall health, %19.750.5<.001
    Higher self-reported-pain levelb30.575.5<.001
    Health care use
    Prior opioid use,c %10.367.2<.001
    Has usual source of care,d %99.799.3.02
    Prior inpatient surgery, %7.822.2<.001
    Prior outpatient surgery, %10.021.3<.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.

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    Table 2

    Odds Ratios for the Association Between Characteristics and High Satisfaction With Care

    CharacteristicOdds Ratio (95% CI) for High Satisfaction With Carea
    UnadjustedAdjustedb
    Opioid use status
    Nonuser/limited user (ref)1.001.00
    User0.97 (0.87–1.07)1.32 (1.18–1.49)
    Sociodemographics
    Age, per year1.02 (1.02–1.02)1.02 (1.02–1.02)
    Sex
     Male (ref)1.001.00
     Female1.15 (1.05–1.25)1.25 (1.16–1.34)
    Race and ethnicity
     Non-Hispanic white (ref)1.001.00
     Non-Hispanic black1.08 (1.00–1.18)1.01 (0.82–1.25)
     Hispanic or Latino0.92 (0.76–1.12)1.10 (0.89–1.38)
     Other0.76 (0.66–0.86)0.79 (0.62–1.00)
    Health status
    Body mass index, per kg/m21.01 (1.00–1.00)1.01 (1.00–1.02)
    SF-12 scores
     PCS score1.01 (1.00–1.01)1.02 (1.01–1.03)
     MCS score1.03 (1.03–1.04)1.03 (1.03–1.04)
    Self-reported health status
     Excellent to good (ref)1.001.00
     Fair or poor0.81 (0.75–0.88)1.18 (1.06–1.31)
    Self-reported pain
     Little or none (ref)1.001.00
     Moderate to severe0.74 (0.69–0.80)0.97 (0.87–1.09)
    • MCS=mental component summary; PCS=physical component summary; ref=reference group; SF-12 = 12-item Short Form Health Survey.

    • ↵a High satisfaction was defined as having a composite patient satisfaction score in the highest quartile.

    • ↵b Adjusted for all other factors in table.

Additional Files

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  • 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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Prescription Opioid Use and Satisfaction With Care Among Adults With Musculoskeletal Conditions
Brian D. Sites, Jordon Harrison, Michael D. Herrick, Melissa M. Masaracchia, Michael L. Beach, Matthew A. Davis
The Annals of Family Medicine Jan 2018, 16 (1) 6-13; DOI: 10.1370/afm.2148

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Prescription Opioid Use and Satisfaction With Care Among Adults With Musculoskeletal Conditions
Brian D. Sites, Jordon Harrison, Michael D. Herrick, Melissa M. Masaracchia, Michael L. Beach, Matthew A. Davis
The Annals of Family Medicine Jan 2018, 16 (1) 6-13; DOI: 10.1370/afm.2148
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