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. 2019 Jul 3;2(7):e196928.
doi: 10.1001/jamanetworkopen.2019.6928.

Access to Primary Care Clinics for Patients With Chronic Pain Receiving Opioids

Pooja A Lagisetty  1   2   3 , Nathaniel Healy  4 , Claire Garpestad  1 , Mary Jannausch  4 , Renuka Tipirneni  1   2 , Amy S B Bohnert  2   3   4
Affiliations

Access to Primary Care Clinics for Patients With Chronic Pain Receiving Opioids

Pooja A Lagisetty et al. JAMA Netw Open. .

Abstract

Importance: Opioid-prescribing policies and guidelines aimed at reducing inappropriate opioid prescribing may lead physicians to stop prescribing opioids. Patients may thus encounter difficulties finding primary care practitioners willing to care for them if they take opioids.

Objectives: To assess practitioner willingness to accept and continue prescribing opioids to new patients with pain and whether this willingness differs across payer types.

Design, setting, and participants: This survey study used a simulated patient call audit method. A brief telephone survey was administered to all clinics followed by a call using a patient script simulating an adult patient with chronic pain who was taking long-term opioids. The patient had Medicaid or private insurance. Calls were made between June 22 and October 30, 2018, to 667 primary care clinics that served a general adult population in Michigan. Clinics that accepted both Medicaid and private insurance, took new patient appointments, and were successfully recontacted for the simulated call were eligible for the study.

Main outcomes and measures: Prevalence of clinics' acceptance of new patients receiving prescription opioids overall and by clinic characteristics and insurance type.

Results: Of the 194 eligible clinics, 94 (48.4%) were randomized according to insurance type to receive calls from research assistants posing as children of patients with Medicaid and 100 (51.5%) to receive calls from those with private insurance. Overall, 79 (40.7%) stated that their practitioners would not prescribe opioids to the simulated patient. Thirty-three clinics (17.0%) requested more information before making a decision. Compared with single-practitioner clinics, clinics with more than 3 practitioners were more likely (odds ratio [OR], 2.99; 95% CI, 1.48-6.04) to accept new patients currently taking opioids. No difference was found in access based on insurance status (OR, 0.92; 95% CI, 0.52-1.64) or whether the clinic offered medications for opioid use disorders (OR, 1.10; 95% CI, 0.45-2.69).

Conclusions and relevance: The findings suggest that access to primary care may be reduced for patients taking prescription opioids, which could lead to unintended consequences, such as conversion to illicit substances or reduced management of other medical comorbidities.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Lagisetty reported receiving grants from the Michigan Health Endowment Fund during the conduct of the study and from the Substance Abuse and Mental Health Services Administration outside the submitted work. Dr Tipirneni reported receiving grants from the Michigan Health Endowment Fund during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flow Diagram of Clinic Allocation
Figure 2.
Figure 2.. Percentage of 194 Clinics Accepting New Patients Currently Taking Opioids
Error bars indicate 95% CIs.
See this image and copyright information in PMC

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