Chronic pain: opioid users face limited access to primary care

  • Lagisetty PA & al.
  • JAMA Netw Open
  • 03/07/2019

  • Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • 40.7% of primary care clinics would not accept a new patient who needed opioid therapy for pain, regardless of insurance type.
  • The effect was greater in single-practitioner clinics.

Why this matters

  • Lack of access to primary care for people who use opioids for pain management reduces their access to proper opioid tapers, nonopioid pain management, and proper opioid use disorder diagnosis and harm prevention.
  • Limited access could have consequences such as illicit opioid use.

Study design

  • 194 primary care clinics were assigned to receive simulated patient calls with Medicaid (48.4%) or private insurance (51.5%).
  • Funding: Michigan Health Endowment Fund. 

Key results

  • 40.7% of the clinics denied primary care to new patients taking opioids.
  • 41.8% of the clinics were ready to schedule an initial appointment for new patients receiving opioids; 17.0% requested more information.
  • Acceptance of patients taking opioids was higher in:
    • Clinics with >3 vs 1 practitioner (OR, 2.99; 95% CI, 1.48-6.04).
    • Community health centers (OR, 3.10; 95% CI, 1.11-8.65).
  • Patient acceptance rate was independent of insurance type (OR, 0.92; 95% CI, 0.52-1.64).

Limitations

  • Survey-based study.
  • Results may not be generalizable.

Coauthored with Antara Ghosh, PhD