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Research ArticleOriginal Research

Chronic Opioid Therapy and Preventive Services in Rural Primary Care: An Oregon Rural Practice-based Research Network Study

David I. Buckley, James F. Calvert, Jodi A. Lapidus and Cynthia D. Morris
The Annals of Family Medicine May 2010, 8 (3) 237-244; DOI: https://doi.org/10.1370/afm.1114
David I. Buckley
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James F. Calvert
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Jodi A. Lapidus
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Cynthia D. Morris
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    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)
    CharacteristicCOT (n=234)Non-COT (n=470)P ValueaCOT (n=110)Non-COT (n=211)P ValueaCOT (n=128)Non-COT (n=297)P ValueaCOT (n=109)Non-COT (n=194)P ValueaCOT (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 y54.957.7.01548.448.1.75264.767.0.04757.360.4.07650.451.8.347
    Female, %64.163.4.856100.0100.0n/a65.659.9.26861.558.2.58464.465.5.847
    Ethnicity/race, %
        White, non-Hispanic69.760.0.01273.660.7.02171.162.0.07078.068.6.08072.368.5.505
        Other4.37.4.1054.511.8.0333.14.0.6494.65.7.6865.95.6.900
        Not specified26.132.6.07821.827.5.26925.834.0.09417.425.8.09721.825.9.435
    Insurance, %b
        Commercial32.147.2<.00126.438.9.02539.851.5.02731.242.8.04716.837.1<.001
        Medicaid38.023.6<.00146.433.2.02130.516.8.00234.924.7.06151.532.0.001
        Medicare42.740.0.48722.715.6.11756.360.3.43944.043.8.97038.626.9.038
        Uninsured6.411.5.03310.019.4.0305.56.4.7147.36.2.6988.916.2.082
        Other11.16.2.02111.86.2.07810.95.1.02711.07.2.2588.97.1.581
    History of substance abuse, %15.010.0.05621.816.6.2518.65.8.28218.37.2.00327.717.9.049
    Smoker, %44.443.4.79350.055.5.35332.035.7.46749.544.8.432100.0100.0n/a
    Number of comorbidities ≥2, %85.578.1.02080.971.1.05694.586.5.01682.673.2.06578.278.2.993
    Select comorbidities, %c
        Anxiety13.78.9.05311.812.8.80113.36.7.02815.67.2.02115.811.2.252
        Congestive heart failure5.18.1.1500.03.3.0537.812.1.1908.311.9.3285.04.6.883
        Depression48.728.1<.00159.138.9.00143.023.2<.00146.828.9.00249.536.5.031
        GERD/PUD28.219.8.01235.524.6.04127.316.2.00824.818.6.20124.823.4.788
        Hepatitis5.62.8.0649.14.3.0822.31.0.2859.22.6.0115.93.6.340
        Osteoporosis4.77.0.2312.73.8.6196.310.1.2027.36.7.8343.04.6.506
        Sleep disorder5.12.3.0506.42.8.1292.31.3.4595.51.0.0205.94.1.468
    Same zip code as clinic, %32.130.0.57830.938.4.18535.928.3.11638.533.5.38032.734.0.817
    Active months, mean No.d30.529.3.20029.429.6.90631.030.2.51028.227.2.53129.129.1.994
    Total visits, mean No.24.615.4<.00125.714.1<.00124.617.4<.00122.514.0<.00123.814.3<.001
    Visits with PCP, mean %83.079.2.03077.373.0.11684.782.7.34082.582.0.85881.175.9.064
    Record of discontinuation, %e7.73.0.00511.03.3.0066.32.7.08110.13.1.01110.02.0.002
    Preventive service received, %fn/an/an/a42.759.2.0057.813.8.08128.429.9.78961.456.9.452
    • View popup
    Table 2.

    Relative Risk of Receipt of Preventive Services by Patients on Chronic Opioid Therapy Compared With Patients Not on Chronic Opioid Therapy

    Preventive ServiceUnadjusted 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 screening0.72 (0.57–0.92)0.60 (0.47–0.76)0.60 (0.47–0.76)
    Colorectal cancer screening0.57 (0.29–1.09)0.48 (0.25–0.91)0.42 (0.22–0.80)
    Lipid screening0.95 (0.66–1.37)0.77 (0.54–1.10)0.77 (0.54–1.10)
    Smoking counseling1.08 (0.89–1.32)0.93 (0.77–1.12)0.95 (0.78–1.15)

Additional Files

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  • 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.
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The Annals of Family Medicine: 8 (3)
The Annals of Family Medicine: 8 (3)
Vol. 8, Issue 3
1 May 2010
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Chronic Opioid Therapy and Preventive Services in Rural Primary Care: An Oregon Rural Practice-based Research Network Study
David I. Buckley, James F. Calvert, Jodi A. Lapidus, Cynthia D. Morris
The Annals of Family Medicine May 2010, 8 (3) 237-244; DOI: 10.1370/afm.1114

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Chronic Opioid Therapy and Preventive Services in Rural Primary Care: An Oregon Rural Practice-based Research Network Study
David I. Buckley, James F. Calvert, Jodi A. Lapidus, Cynthia D. Morris
The Annals of Family Medicine May 2010, 8 (3) 237-244; DOI: 10.1370/afm.1114
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