Geographic Variation in Health Service Use and Perceived Access Barriers for Australian Adults with Chronic Non-Cancer Pain Receiving Opioid Therapy.
Rates of chronic non-cancer pain are increasing worldwide, with concerns regarding poorer access to specialist treatment services in remote areas. The current study comprised the first in-depth examination of use and barriers to access of health services in Australia according to remoteness.



A cohort of Australian adults prescribed pharmaceutical opioids for chronic non-cancer pain (n = 1,235) were interviewed between August 2012 and April 2014, and grouped into 'major city' (49%), 'inner regional' (37%), and 'outer regional/remote' (14%) according to the Australian Standard Geographical Classification based on postcode. Multinomial logistic regression analyses were conducted to determine geographical differences in socio-demographic and clinical characteristics, health service use, and perceived barriers to health service access.



The 'inner regional group' and 'outer regional/remote group' were more likely to be male (relative risk ratio (RRR)=1.38,95%CI 1.08-1.77 and RRR = 1.60, 95%CI 1.14-2.24) and have no private health insurance (RRR = 1.53, 95%CI 1.19-1.97 and RRR = 1.65, 95%CI 1.16-2.37) than the 'major city group' (49%). However, the 'inner regional group' reported lower pain severity and better mental health relative to the 'major city group' = 0.92, 95%CI 0.86-0.98 and RRR = 1.02, 95%CI 1.01-1.03, respectively). Although rates of health service access were generally similar, the 'outer regional/remote group' were more likely to report client-practitioner communication problems (RRR = 1.57, 95%CI 1.03-2.37), difficulties accessing specialists (RRR = 1.56, 95%CI 1.01-2.39), and perception of practitioner lack of confidence in prescribing pain medication (RRR = 1.73, 1.14-2.62), relative to both groups.



Perceived communication, access, and financial barriers to healthcare indicate the need for increased efforts to address geographic inequality in pain treatment.
School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia Amy.Peacock@unsw.edu.au.|National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
Amy
A
Peacock
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
Suzanne
S
Nielsen
School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia.
Raimondo
R
Bruno
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
Gabrielle
G
Campbell
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
Briony
B
Larance
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
Louisa
L
Degenhardt
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000191:economics / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D059350:Chronic Pain / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D010465:Perception; D011446:Prospective Studies; D012111:Residence Characteristics
D000701:Analgesics, Opioid
Chronic Pain; Healthcare; Opioids; Policy; Remote; Treatment