Accepting new patients who require opioids into family practice: results from the MAAP-NS census survey study

Abstract

Background: Acceptance to a family practice is key to access and continuity of care. While Canadian patients increasingly report not being able to acquire acceptance to a family practice, little is known about the association between requiring opioids and acceptance. We aim to determine the proportion of family physicians who would accept new patients who require opioids and describe physician and practice characteristics associated with willingness to accept these patients. Methods: Census telephone survey of family physicians' practices in Nova Scotia, Canada. Measures: physician (i.e., age, sex, years in practice) and practice (i.e., number/type of provider in the practice, care hours/week) characteristics and practice-reported willingness to accept new patients who require opioids. Results: The survey was completed for 587 family physicians (83.7% response rate). 354 (60.3%) were taking new patients unconditionally or with conditions; 326 provided a response to whether they would accept new patients who require opioids; 91 (27.9%) reported they would not accept a new patient who requires opioids. Compared to family physicians who would not accept patients who require opioids, in bivariate analysis, those who would, tended to work in larger practices; had fewer years in practice; are female; and provided more patient care. The relationship to number of providers in the practice, having a nurse, and experience persisted in multivariate analysis. Conclusions: The strongest predictors of willingness to accept patients who require opioids are fewer years in practice (OR = 0.96 [95% CI 0.93, 0.99]) and variables indicating a family physician has support of a larger (OR = 1.19 [95% CI 1.00, 1.42]), interdisciplinary team (e.g., nurses, mental health professionals) (OR = 1.15 [95% CI 1.11, 5.05]). Almost three-quarters (72.1%) of surveyed family physicians would accept patients requiring opioids.

Inequities in access to primary care among opioid recipients in Ontario, Canada: A population-based cohort study

“…Our findings among OAT recipients align with recently published studies employing surveys and qualitative analyses. In a Canadian survey of 354 family physicians accepting new patients, nearly one-third would not accept patients who required opioids [15], and participants in 2 qualitative studies among people with an OUD cited challenges securing ongoing primary care, perceived as being associated with stigma relating to their SUD [9,11]. The effect of stigma on barriers to primary care access may also be evident in our study, as nearly 90% of OAT recipients had their physician end their initial primary care enrolment compared to approximately 80% among chronic pain patients and opioid-unexposed individuals.…”

“…Therefore, we are unable to determine whether their patterns of primary care access differ from those receiving treatment for OUD. However, based on the literature regarding negative physician perceptions of people who use drugs [9,11,15], we anticipate that the findings among OAT recipients would be similar for those with OUD who are not actively receiving treatment. Fourth, we cannot confirm whether patients who lost their PCP were actively looking for another provider over the follow-up period.…”

“…However, recent research has demonstrated that achieving this quality of care can be particularly challenging for these patients, who may be labeled as "undesirable" to physicians due to stigma, high healthcare needs, or physicians' lack of comfort prescribing opioids and concerns of adverse events [6,[11][12][13]. Surveys conducted among physicians reinforce this, showing that up to 40% of primary care physicians would not accept a patient who required opioid treatment into their practice [12,14,15]. There is particular concern that this has been exacerbated in recent years with the publication of clinical guidelines for opioid prescribing in chronic non-cancer pain [16,17] that recommended changes in opioid prescribing patterns across North America, sometimes straining the patient-physician relationship [11,18,19].…”

“What do you mean I can’t have a doctor? This is Canada!” – A Qualitative Study of the Myriad Consequences for Unattached Patients Awaiting Primary Care Attachment

“…Patients may also have differential capacity to pursue attachment and may face discrimination in that process (Marshall et al, 2019). Hence, first-come-first-served centralized waitlists may be an insufficient approach that has the potential to be unfair and result in inequitable care and reattachment along socio-demographic axes.…”

Self-Reported Practices in Opioid Management of Chronic Noncancer Pain: An Updated Survey of Canadian Family Physicians

“…The unintended consequence of this finding is that it may become difficult for some patients who need legitimate opioid prescriptions to find a family physician to prescribe for them. A recent survey in Nova Scotia showed that 28% of family physicians accepting new patients would not accept a new patient if the person is on opioids [ 11 ].…”