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

Abstract

PURPOSE For clinicians, using opioid therapy for chronic noncancer pain (CNCP) often gives rise to a confl ict between treating their patients' pain and fears of addiction, diversion of medication, or legal action. Consequent stresses on clinical encounters might adversely affect some elements of clinical care. We evaluated a possible association between chronic opioid therapy (COT) for CNCP and receipt of various preventive services. METHODSWe conducted a retrospective cohort study in 7 primary care clinics within the Oregon Rural Practice-based Research Network (ORPRN). Using medical records of 704 patients, aged 35 to 85 years, seen during a 3-year period, we compared the receipt of 4 preventive services between patients on COT for CNCP and patients not on chronic opioid therapy (non-COT). We used multivariate log-binomial regression analyses to estimate the relative risk of receipt of each preventive service. RESULTSAfter adjustment for plausible confounders, we found that patients using COT had a statistically signifi cantly lower relative risk (RR) of receipt of cervical cancer screening (RR = 0.60; 95% confi dence interval [CI], 0.47-0.76) and colorectal cancer screening (RR = 0.42; 95% CI, 0.22-0.80) when compared with non-COT patients. The RR was reduced, without statistical signifi cance, for lipid screening (RR = 0.77; 95% CI, 0.54-1.10), and not notably reduced for smoking cessation counseling (RR = 0.95; 95% CI, 0.78-1.15).CONCLUSIONS Patients using COT for CNCP were less likely to receive some preventive services. Research is needed to better understand barriers to and improved methods for providing preventive services for these patients.

Barriers and Facilitators to Chronic Non-cancer Pain Management in Primary Care: A Qualitative Analysis of Primary Care Providers? Experiences and Attitudes

“…They report that patients with chronic pain often required more time than other visits and also needed more frequent visits overall compared with other patients. This perception that CNCP patients on opioids have a higher number of clinic visits is supported by the literature [29,30]. PCPs also noted that patients with pain generate more non-visit work such as coordination of care and frequent medication refills, which result in an increased workload for PCPs and staff.…”

Barriers to Guideline-Concordant Opioid Management in Primary Care—A Qualitative Study

“…2 Findings of another recent study, that patients on long-term opioids receive fewer recommended cancer screening tests, suggest that opioid management tasks can displace other core primary care activities. 8 Together, these findings suggest that initiatives aimed at primary care provider behavior alone may not be sufficient for full implementation of opioid management guidelines. Future research should examine the utility of care models with demonstrated effectiveness in other high-risk drug management areas, such as dedicated pharmacist-run clinics in anticoagulant monitoring.…”

Opioid Use in Primary Care: Asking the Right Questions

“…Many studies have documented variation in treatment of patient groups, including urban versus rural patients [16], patients treated in primary care and by specialists [17], patients with back pain [18], and patients of different races [19]. This inconsistency arises in part because guidelines on how to use opioids to manage patients' conditions and assess its efficacy can be difficult to operationalize.…”