Forty percent of primary care clinics limit patient care access for those using prescription opioids for pain management.
New data from the University of Michigan revealed considerable challenges to patient care access for those who take prescription opioids to manage chronic pain or a lingering injury.
As the medical industry continues to contend with a formidable opioid crisis, leadership has created a number of regulations to quell the use of prescription opioids. After all, experts have cited legal and appropriate use of a prescription opioid as one key contributor to the opioid epidemic.
In some states, primary care providers need to check prescription drug monitoring databases, follow dosage limits, and provide patient education about opioid use. Other states, like Michigan, take protocol one step further and ask providers to have an existing relationship with their patients before prescribing an opioid.
“Patients may thus encounter difficulties finding primary care practitioners willing to care for them if they take opioids,” researchers explained in JAMA Open Access. “Popular media outlets have described this population that is now being displaced from health care systems as opioid refugees. Primary care practitioners may still be willing to provide care for other medical issues, such as hypertension, but they may turn away new patients who need opioids for pain.”
A secret shopper survey involving a total of 194 primary care clinics across the country showed that patients who use Percocet to manage a lingering injury and chronic pain may face challenges when trying to get into a clinic as a new patient.
Nearly 40 percent of primary care clinics across the country are turning away these patients, at least on the pretense that clinicians have to prescribe that opioid for new patients. Seventeen percent of clinics said they would need more information before taking on the patient, while two-thirds said they would want to hold a visit with the patient before deciding to take on the patient and prescribe an opioid.
Larger clinics with three or more clinicians were three times more likely to accept the new patient than smaller clinics with only one clinician.
“These clinics may have more resources to care for this population and follow new time-consuming policies, such as checking state prescription drug monitoring programs,” the research team posited. “In addition, compared with single-practitioner clinics, practitioners in larger group practices may benefit from peer-to-peer practitioner support, which could potentially decrease stress and burnout associated with caring for this population.”
However, there were no differences between simulated patient insurance types and whether the clinic traditionally offered opioid access to treat chronic pain, findings that surprised the research team.
“Our results did not differ by insurance status, which was surprising because previous studies on primary care access have showed that patients on Medicaid tend to have lower access to primary care than those with private insurance,” study lead Pooja Lagisetty, MD, MSc, said in a statement. “This may indicate that providers and clinics are not making these decisions to restrict access based upon reimbursement. Larger clinics and community health centers were more likely to accept new patients suggesting that there may be some system level factors that affect access to care.”
Nonetheless, the results are cause for alarm for Lagisetty and colleagues. Access to primary care is essential for all patients, considering the preventive care and screening that take place during appointments.
But for patients managing chronic pain with an opioid, primary care has added benefits.
Primary care providers can be leaders in identifying a new, effective pain management strategy that could address the need for opioid use. Providers are also important in managing opioid use and detecting when a patient may be getting hooked on the drugs.
Industry leaders also have concerns about where a patient may get her pain management drugs if she is turned away from primary care.
“Many experts have expressed concern that abandoning this population could lead to unintended consequences, such as increased use of more potent illicit opioids or potentially even increased risk of suicide,” the researchers pointed out.
The study also raised a lot of questions about opioid alternatives or the medications used to treat opioid use disorder, namely medication assisted treatment (MAT), which many regard as the gold standard in opioid use care.
Forty-one percent of administrative staff said they did not know if their clinic offered access to MAT. Only 12 percent could confirm MAT access.
Going forward, Lagisetty and team want to investigate why clinics may not have the supports in place to manage new chronic pain patients. Some theories are at play, including clinic reactions to the CDC chronic pain management guide, which outlined potential plans to regulate and limit the number of opioids prescribed.
“These findings may also reflect practitioners’ discomfort with managing opioid therapy for chronic pain or treating patients with OUD as a result of pressures to decrease overall opioid prescribing,” the research team wrote. “In addition, the findings may reflect frontline staff bias against what may be perceived as drug-seeking behavior and may not actually indicate prescriber decision-making or clinic-level policies.”
In order to truly address this care access gap, Lagisetty said researchers need to focus on the factors at play that are shaping primary care clinics’ new patient policies.
“We hope to use this information to identify a way for us to fix the policies to have more of a patient-centered approach to pain management,” says Lagisetty. “Everyone deserves equitable access to health care, irrespective of their medical conditions or what medications they may be taking.”
Primary care clinics’ limitations for opioid treatment and prescription access are not arbitrary. Over 70,000 Americans died of an opioid overdose in 2017, the most recent year for which the National Institute for Drug Abuse has data. Industry leaders are reacting to that trend, putting in place regulations that could quell the use of opioids and ideally reduce the number of individuals who may become addicted.
However, cancer patients and those facing other serious chronic pain issues are feeling the burden, leading to research like Lagisetty’s. Industry leaders have begun to acknowledge that population that truly does need access to opioid prescriptions, working to connect them to pain management solutions in a safe way.
Date: July 19, 2019