Article Figures & Data
Tables
- Table 1.
Social, Demographic, and Clinical Characteristics of Patients by Chronic Opioid Therapy (COT) Status for the Total Sample, Cervical Cancer Screening, and Colorectal Cancer Screening, Chronic Opioid Therapy (COT) Status for Lipid Screening and Smoking Counseling
Total Sample (N=704) Cervical Cancer Screening (n=321) Colorectal Cancer Screening (n=425) Lipid Screening (n=303) Smoking Counseling (n=298) Characteristic COT (n=234) Non-COT (n=470) P Valuea COT (n=110) Non-COT (n=211) P Valuea COT (n=128) Non-COT (n=297) P Valuea COT (n=109) Non-COT (n=194) P Valuea COT (n=101) Non-COT (n=197) P Valuea GERD = gastroesophageal reflux disease; PUD = peptic ulcer disease; PCP = primary care physician. Note: Subgroups determined by the recommendation criteria for each preventive service: Papanicolaou testing, women aged 35 to 65 years; colorectal cancer screening, all patients aged 50 years or older; lipid screening, men aged 35 years or older and women aged 45 years or older; smoking cessation counseling, all smokers. a P values are based on comparisons of COT and non-COT patients using the independent samples t test for mean values and the Pearson χ2 test for percentages. b Because some patients had more than 1 type of insurance, totals are greater than 100%. c Comorbidities listed are those for which a difference (P ≤.20) between COT and non-COT was seen in the total study sample or in at least 1 subgroup. d Amount of time, in months, between first clinic visit and last clinic visit during the 3-year study period. e Evidence in the medical record that the patient formally discontinued receiving care at the clinic, initiated by either the patient or the clinic. f For each subgroup, this refers only to the particular preventive service pertaining to that subgroup, and indicates whether the service was received at least once during the 3-year study period. Age, mean y 54.9 57.7 .015 48.4 48.1 .752 64.7 67.0 .047 57.3 60.4 .076 50.4 51.8 .347 Female, % 64.1 63.4 .856 100.0 100.0 n/a 65.6 59.9 .268 61.5 58.2 .584 64.4 65.5 .847 Ethnicity/race, % White, non-Hispanic 69.7 60.0 .012 73.6 60.7 .021 71.1 62.0 .070 78.0 68.6 .080 72.3 68.5 .505 Other 4.3 7.4 .105 4.5 11.8 .033 3.1 4.0 .649 4.6 5.7 .686 5.9 5.6 .900 Not specified 26.1 32.6 .078 21.8 27.5 .269 25.8 34.0 .094 17.4 25.8 .097 21.8 25.9 .435 Insurance, %b Commercial 32.1 47.2 <.001 26.4 38.9 .025 39.8 51.5 .027 31.2 42.8 .047 16.8 37.1 <.001 Medicaid 38.0 23.6 <.001 46.4 33.2 .021 30.5 16.8 .002 34.9 24.7 .061 51.5 32.0 .001 Medicare 42.7 40.0 .487 22.7 15.6 .117 56.3 60.3 .439 44.0 43.8 .970 38.6 26.9 .038 Uninsured 6.4 11.5 .033 10.0 19.4 .030 5.5 6.4 .714 7.3 6.2 .698 8.9 16.2 .082 Other 11.1 6.2 .021 11.8 6.2 .078 10.9 5.1 .027 11.0 7.2 .258 8.9 7.1 .581 History of substance abuse, % 15.0 10.0 .056 21.8 16.6 .251 8.6 5.8 .282 18.3 7.2 .003 27.7 17.9 .049 Smoker, % 44.4 43.4 .793 50.0 55.5 .353 32.0 35.7 .467 49.5 44.8 .432 100.0 100.0 n/a Number of comorbidities ≥2, % 85.5 78.1 .020 80.9 71.1 .056 94.5 86.5 .016 82.6 73.2 .065 78.2 78.2 .993 Select comorbidities, %c Anxiety 13.7 8.9 .053 11.8 12.8 .801 13.3 6.7 .028 15.6 7.2 .021 15.8 11.2 .252 Congestive heart failure 5.1 8.1 .150 0.0 3.3 .053 7.8 12.1 .190 8.3 11.9 .328 5.0 4.6 .883 Depression 48.7 28.1 <.001 59.1 38.9 .001 43.0 23.2 <.001 46.8 28.9 .002 49.5 36.5 .031 GERD/PUD 28.2 19.8 .012 35.5 24.6 .041 27.3 16.2 .008 24.8 18.6 .201 24.8 23.4 .788 Hepatitis 5.6 2.8 .064 9.1 4.3 .082 2.3 1.0 .285 9.2 2.6 .011 5.9 3.6 .340 Osteoporosis 4.7 7.0 .231 2.7 3.8 .619 6.3 10.1 .202 7.3 6.7 .834 3.0 4.6 .506 Sleep disorder 5.1 2.3 .050 6.4 2.8 .129 2.3 1.3 .459 5.5 1.0 .020 5.9 4.1 .468 Same zip code as clinic, % 32.1 30.0 .578 30.9 38.4 .185 35.9 28.3 .116 38.5 33.5 .380 32.7 34.0 .817 Active months, mean No.d 30.5 29.3 .200 29.4 29.6 .906 31.0 30.2 .510 28.2 27.2 .531 29.1 29.1 .994 Total visits, mean No. 24.6 15.4 <.001 25.7 14.1 <.001 24.6 17.4 <.001 22.5 14.0 <.001 23.8 14.3 <.001 Visits with PCP, mean % 83.0 79.2 .030 77.3 73.0 .116 84.7 82.7 .340 82.5 82.0 .858 81.1 75.9 .064 Record of discontinuation, %e 7.7 3.0 .005 11.0 3.3 .006 6.3 2.7 .081 10.1 3.1 .011 10.0 2.0 .002 Preventive service received, %f n/a n/a n/a 42.7 59.2 .005 7.8 13.8 .081 28.4 29.9 .789 61.4 56.9 .452 - Table 2.
Relative Risk of Receipt of Preventive Services by Patients on Chronic Opioid Therapy Compared With Patients Not on Chronic Opioid Therapy
Preventive Service Unadjusted RR (95% CI) Common Modela RR (95% CI) Final Modelb RR (95% CI) CI = confidence interval; RR = relative risk. a Adjusted for age, clinic, and total number of clinic visits. b Adjusted for age, clinic, and total number of clinic visits. In addition, the colorectal cancer screening model adjusted for diagnosis of gastroesophageal reflux disease; and the smoking cessation counseling model adjusted for percentage of visits with primary clinician. Cervical cancer screening 0.72 (0.57–0.92) 0.60 (0.47–0.76) 0.60 (0.47–0.76) Colorectal cancer screening 0.57 (0.29–1.09) 0.48 (0.25–0.91) 0.42 (0.22–0.80) Lipid screening 0.95 (0.66–1.37) 0.77 (0.54–1.10) 0.77 (0.54–1.10) Smoking counseling 1.08 (0.89–1.32) 0.93 (0.77–1.12) 0.95 (0.78–1.15)
Additional Files
The Article in Brief
Chronic Opioid Therapy and Preventive Services in Rural Primary Care: An Oregon Rural Practice-based Research Network Study
David I. Buckley , and colleagues
Background Opioid medication is a controversial treatment for chronic noncancer pain. Prescribing opioids can be time consuming and may detract from other aspects of clinical care. This study examines whether patients who receive opioid therapy for noncancer pain are less likely than other patients to receive preventive services during primary care office visits.
What This Study Found Patients receiving chronic opioid therapy for noncancer pain are less likely to receive some preventive services, particularly screening for cervical or colorectal cancer.
Implications
- Providing appropriate preventive services for patients with chronic pain may present particular challenges.
- Future research should explore the relationships between chronic noncancer pain, chronic opioid therapy, and preventive care to help ensure that patients with chronic pain receive preventive services.
