Healthcare Contacts Regarding Circulatory Conditions among Swedish Patients in Opioid Substitution Treatment, with and without On-Site Primary Healthcare

Abstract

Patients in Opioid Substitution Treatment (OST) have increased mortality and morbidity, with circulatory conditions suggested to be a contributing factor. Since OST patients tend to have unmet physical healthcare needs, a small-scale intervention providing on-site primary healthcare (PHC) in OST clinics was implemented in Malmö, Sweden in 2016. In this study, we assessed registered circulatory conditions and healthcare utilization in OST patients with and without use of on-site PHC. Patients from four OST clinics in Malmö, Sweden, were recruited to a survey study in 2017–2018. Medical records for the participants were retrieved for one year prior to study participation (n = 192), and examined for circulatory diagnoses, examinations and follow-ups. Patients with and without on-site PHC were compared through descriptive statistics and univariate analyses. Eighteen percent (n = 34) of the sample had 1≤ registered circulatory condition, and 6% (n = 12) attended any clinical physiology examination or follow-up, respectively. Among patients utilizing on-site PHC (n = 26), the numbers were 27% (n = 7) for circulatory diagnosis, 15% (n = 4) for examinations, and 12% (n = 3) for follow-up. OST patients seem underdiagnosed in regard to their circulatory health. On-site PHC might be a way to diagnose and treat circulatory conditions among OST patients, although further research is needed.

Healthcare utilization for somatic conditions among Swedish patients in opioid substitution treatment, with and without on-site primary healthcare

“…These conditions were selected in compliance with side effects from OST medications, and in order to correspond to specific diagnoses assessed in previous research. Data on documented cardiovascular diseases has been previously reported [ 23 ] and was thus not included here.…”

“…In contrast to the findings indicating poor physical health and great healthcare needs among OST patients, a few previous studies have shown that patients in OST commonly have self-reported unmet healthcare needs and reluctance towards healthcare seeking [ 19 , 22 ]. A recent study from Malmö, Sweden, showed low rates of circulatory diagnoses among OST patients, which likely indicates underdiagnosing in this patient group [ 23 ]. Spithoff et al showed that patients in OST were less likely to receive diabetes monitoring than matched controls [ 24 ].…”

“…In 2016 an intervention was implemented in Malmö, Sweden, with the purpose of increasing access to PHC among OST patients by offering on-site appointment with a PHC physician at the OST clinic. This small-scale intervention, developed on the initiative from OST and PHC staff since 2014 with the aim to decrease healthcare barriers for OST patients, is described in greater detail by Bäckström et al [ 23 ].…”