title: Methadone-maintained patients in primary care have higher rates of chronic disease and multimorbidity, and use health services more intensively than matched controls.
abstract: BACKGROUND
  Methadone maintenance treatment in primary care is cost-effective and improves outcomes for opiate-dependent patients. A more developed understanding of the evolving needs of this important cohort will facilitate further improvements in their integrated care within the community.
  
  
  OBJECTIVE
  The aim of this study was to compare the burden of chronic disease, multi-morbidity and intensity of health-service use between methadone-maintained patients (MMPs) and matched controls in primary care.
  
  
  METHODS
  This is a retrospective matched case-control design. Data on chronic disease and health service use was collected in 13 computerized GP surgeries on 414 patients (207 MMPs and 207 controls). Twelve months of records were examined. MMPs were compared with controls matched by gender, age, socio-economic status (SES) and GP surgery.
  
  
  RESULTS
  MMPs suffered more chronic disease (OR = 9.1, 95% CI: 5.4-15.1, P < 0.001) and multi-morbidity (OR = 6.6, 95% CI: 4.3-10.2, P < 0.001). They had higher rates of respiratory, psychiatric and infectious disease. MMPs of lower SES had more chronic disease than their peers (OR = 7.2, 95% CI: 2.4-22.0, P < 0.001). MMPs attended the doctor more often with medical problems (OR = 15.4, 95% CI: 8.2-28.7, P < 0.001), with a frequent requirement to have medical issues addressed during methadone-management visits. Their care generated more telephone calls (OR = 4.4, 95% CI: 2.8-6.8, P < 0.001), investigations (OR = 1.8, 95% CI: 1.2-2.7, P = 0.003), referrals (2.6, 95% CI: 1.7-4.0, P < 0.001), emergency department visits (2.1, 95% CI: 1.3-3.6, P = 0.004), outpatient attendances (2.3, 95% CI: 1.51-1.43, P < 0.001) and hospital admissions (3.6, 95% CI: 1.6-8.1, P = 0.001).
  
  
  CONCLUSIONS
  Correcting for routine methadone care and drug-related illnesses, MMPs had a higher burden of chronic disease and used both primary and secondary health services more intensively than matched controls.
authors.affiliation: TCD/HSE Specialist Training Programme in General Practice, Department of Public Health & Primary Care, Trinity College Centre for Health Sciences, Tallaght Hospital , Tallaght, Dublin 24 , Ireland.
authors.forename: John
authors.initials: J
authors.lastname: O'Toole
authors.forename: Róisín
authors.initials: R
authors.lastname: Hambly
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Cox
authors.forename: Brendan
authors.initials: B
authors.lastname: O'Shea
authors.forename: Catherine
authors.initials: C
authors.lastname: Darker
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000494:pharmacology; D002908:Chronic Disease / Q000628:therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D007494:Ireland; D008297:Male; D008691:Methadone / Q000494:pharmacology*; D058850:Opiate Substitution Treatment / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone
keywords: Methadone; chronic disease; health care costs; health policy; primary health care