Chronic opioid therapy and preventive services in rural primary care: an Oregon rural practice-based research network study.
OBJECTIVE
For clinicians, using opioid therapy for chronic noncancer pain (CNCP) often gives rise to a conflict 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.


METHODS
We 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.


RESULTS
After adjustment for plausible confounders, we found that patients using COT had a statistically significantly lower relative risk (RR) of receipt of cervical cancer screening (RR = 0.60; 95% confidence 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 significance, 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.
Buckley
David I
DI
Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. buckleyd@ohsu.edu
Calvert
James F
JF
Lapidus
Jodi A
JA
Morris
Cynthia D
CD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002908:Chronic Disease; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008055:Lipids / Q000097:blood; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications; D009922:Oregon; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010342:Patient Acceptance of Health Care; D011315:Preventive Medicine; D011320:Primary Health Care / Q000458:organization & administration*; D012044:Regression Analysis; D012189:Retrospective Studies; D012306:Risk; D019035:Rural Health Services; D013997:Time Factors
D000701:Analgesics, Opioid; D008055:Lipids
CMAJ. 2006 May 23;174(11):1589-94
16717269
Med Econ. 2001 Nov 19;78(22):66-8
11762117
Fam Pract. 1991 Sep;8(3):276-87
1959729
South Med J. 2006 Nov;99(11):1245-55
17195420
J Pain. 2009 Feb;10(2):147-59
19187891
Pain. 2004 Sep;111(1-2):51-8
15327808
Am J Epidemiol. 2004 Apr 1;159(7):702-6
15033648
J Am Board Fam Pract. 2001 May-Jun;14(3):211-8
11355054
Lancet. 1999 Oct 9;354(9186):1248-52
10520633
Clin J Pain. 2002 Jul-Aug;18(4 Suppl):S28-38
12479252
Fam Pract. 2004 Feb;21(1):66-74
14760048
Br J Gen Pract. 1992 Nov;42(364):454-8
1472390
Clin J Pain. 2007 Nov-Dec;23(9):799-803
18075408
Curr Med Res Opin. 2005 Oct;21(10):1555-68
16238895
Med Clin North Am. 1999 May;83(3):555-83, v
10386115
Am J Epidemiol. 2005 Aug 1;162(3):199-200
15987728
Arch Phys Med Rehabil. 2008 Mar;89(3 Suppl 1):S72-6
18295654
Pain Med. 2004 Sep;5(3):309-24
15367312
Curr Opin Anaesthesiol. 2007 Oct;20(5):451-5
17873598
J Gen Intern Med. 2002 Mar;17(3):173-9
11929502
Pain Med. 2001 Dec;2(4):317-27
15102236
J Pain Symptom Manage. 2002 Feb;23(2):131-7
11844633
Curr Med Res Opin. 2006 Sep;22(9):1859-65
16968589
Am J Epidemiol. 2003 May 15;157(10):940-3
12746247
Fam Med. 2005 Jul-Aug;37(7):477-80
15988631
Adv Ther. 2000 Mar-Apr;17(2):70-83
11010058
N Engl J Med. 2007 Jun 14;356(24):2496-504
17568030
JAMA. 2003 Nov 12;290(18):2443-54
14612481
Clin Ther. 2007;29 Suppl:2589-602
18164924
Fam Med. 2003 Feb;35(2):119-23
12607809
Pain Med. 2007 Jul-Aug;8(5):433-7
17661857
Am J Manag Care. 2009 Apr;15(4):217-24
19355794
N Engl J Med. 2003 Nov 13;349(20):1943-53
14614170
Pain Med. 2007 Nov-Dec;8(8):647-56
18028043
Pain. 2007 Jun;129(3):233-234
17449177
Pain. 1999 Jul;82(1):89-96
10422664
J Fam Pract. 2004 Oct;53(10 Suppl):S23-32
15469762
J Pain Symptom Manage. 2008 Feb;35(2):214-28
18178367
JAMA. 1998 Nov 18;280(19):1690-1
9832001
J Fam Pract. 2001 Feb;50(2):145-51
11219563