Premium
Association of Geography and Access to Health Care Providers With Long‐Term Prescription Opioid Use in Medicare Patients With Severe Osteoarthritis: A Cohort Study
Author(s) -
Desai Rishi J.,
Jin Yinzhu,
Franklin Patricia D.,
Lee Yvonne C.,
Bateman Brian T.,
Lii Joyce,
Solomon Daniel H.,
Katz Jeffrey N.,
Kim Seoyoung C.
Publication year - 2019
Publication title -
arthritis and rheumatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.106
H-Index - 314
eISSN - 2326-5205
pISSN - 2326-5191
DOI - 10.1002/art.40834
Subject(s) - medicine , confidence interval , medical prescription , cohort , prescription drug , opioid , cohort study , demography , emergency medicine , nursing , receptor , sociology
Objective To evaluate the variation in long‐term opioid use in osteoarthritis ( OA ) patients according to geography and health care access. Methods We designed an observational cohort study among OA patients undergoing total joint replacement ( TJR ) in the Medicare program (2010 through 2014). The independent variables of interest were the state of residence and health care access, which was quantified at the primary care service area ( PCSA ) level as categories of number of practicing primary care providers ( PCP s) and categories of rheumatologists per 1,000 Medicare beneficiaries. The percentage of OA patients taking long‐term opioids (≥90 days in the 360‐day period immediately preceding TJR ) within each PCSA was the outcome variable in a multilevel, generalized linear regression model, adjusting for case‐mix at the PCSA level and for policies, including rigor of prescription drug monitoring programs and legalized medical marijuana, at the state level. Results A total of 358,121 patients with advanced OA, with a mean age of 74 years, were included from 4,080 PCSA s. The unadjusted mean percentage of long‐term opioid users varied widely across states, ranging from 8.9% (Minnesota) to 26.4% (Alabama), and this variation persisted in the adjusted models. Access to PCP s was only modestly associated with rates of long‐term opioid use between PCSA s with highest (>8.6) versus lowest (<3.6) concentration of PCPs (adjusted mean difference 1.4% [95% confidence interval 0.8%, 2.0%]), while access to rheumatologists was not associated with long‐term opioid use. Conclusion We note a substantial statewide variation in rates of long‐term treatment with opioids in OA , which is not fully explained by the differences in access to health care providers, varying case‐mix, or state‐level policies.