Opioids Associated With Higher Satisfaction With Care

Norra MacReady

January 09, 2018

Prescription opioid use is associated with greater satisfaction with care among people with musculoskeletal conditions compared with nonuse, a large, cross-sectional study found. The findings highlight the need to examine whether satisfaction is actually related to greater health benefits, the authors warn.

Moderate and heavy opioid users were 55% and 43% more likely, respectively, to report high satisfaction with care than nonusers or light users, Brian D. Sites, MD, from the Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, and colleagues write in an article published online January 8 in the Annals of Family Medicine.

The reasons for this finding are unclear and are unlikely to be related to better pain control, they add.

Patients who used opioids reported more pain and worse health than those who did not, and the authors controlled for pain levels between the two groups.

In addition, the researchers point out, sales of prescription opioids in the United States have nearly quadrupled since 1999, "yet there has not been an overall change in the amount of pain that Americans actually report."

Given current levels of opioid abuse, the data "suggest that there is an urgent need to establish, on a population health level, whether the observed greater satisfaction with care is associated with demonstrable health benefits," they explain.

The findings also raise questions about including patient satisfaction scores as a factor in the reimbursement of hospitals and clinicians.

The researchers conducted their study using data from the Medical Expenditure Panel Survey. Conducted annually by the Agency for Healthcare Research and Quality, the survey surveys a nationally representative sample of the noninstitutionalized population of the United States and includes information on prescription medications and healthcare expenditures, as well as utilization of healthcare services.

The survey, in which participants are assessed at baseline and then every 6 months for 2 years, also includes questionnaires on sociodemographic characteristics and satisfaction with care. The authors used longitudinal data from 2008 through 2014 on adults with self-reported arthritis or chronic joint pain, or who had a specific diagnosis code matching a musculoskeletal condition.

The Medical Expenditure Panel Survey measures patient satisfaction using a Consumer Assessment of Health Plans Survey. The researchers focused on patient satisfaction with clinician communication "because it strongly correlates with the various [Consumer Assessment of Health Plans Survey] dimensions and with overall satisfaction," they explain.

The final sample consisted of 19,566 adults with musculoskeletal conditions, of whom 2564 (13.1%) used prescription opioids. Opioid users had a mean age of 54.7 years (standard error, 0.1) compared with nonusers, whose mean age was 53.4 years (standard error, 0.1; P < .001).

Fair or poor overall health was reported by 50.5% of opioid users vs 19.7% of nonusers. Similarly, 75.5% of opioid users reported moderate to high levels of pain compared with 30.5% of nonusers (P < .001 for both comparisons).

On logistic regression analysis adjusted for health status (including pain level) and sociodemographic characteristics such as race, educational level, and marital status, the use of opioid medications was associated with a 32% increase in the likelihood that patients reported high satisfaction with care. This translated into an odds ratio (OR) for high satisfaction of 1.32 (95% confidence interval [CI], 1.18 - 1.49). Fair to poor health status also was associated with higher satisfaction in the adjusted analysis (OR, 1.18; 95% CI, 1.06 - 1.31).

There was also an association between satisfaction with care and level of opioid use. Moderate users, defined as patients receiving 5 to 9 prescriptions during the 2-year survey period, were 55% more likely than low or nonusers to have satisfaction scores in the highest quartile (OR, 1.55; 95% CI, 1.29 - 1.86). Heavy users, defined as those receiving 10 or more prescriptions, were 43% more likely to report high satisfaction (OR, 1.43; 95% CI, 1.20 - 1.70).

Overall, the authors write, "each increase in category [of use] was associated with a 15.0% increase in the odds of being in the highest quartile of satisfaction scores (P for test of trend <.001)."

These findings were surprising, given the propensity of opioids to cause unpleasant adverse effects and longer-term health challenges, such as sexual dysfunction and psychomotor disturbances, as well as the risk for addiction and misuse, the authors add. Two possible explanations for the increase in satisfaction might be that clinicians had met patients' expectations for receiving a prescription, or that undiagnosed mood disorders may have improved with opioid treatment.

Study limitations include the inclusion of only noninstitutionalized Americans, making the data ungeneralizable to other populations; the observational nature of the study and reliance on self-reported information; the lack of specific information on dose and duration of opioid treatment; and the need for caution when interpreting the poorer health and disability metrics among the opioid users. It is possible that, had those agents not been prescribed, the health and disability metrics among some patients may have been even worse, the authors explain.

This study underscores the need for a deeper understanding of the relationship between patient satisfaction and better health or improved functional status, they conclude. What is more, the decision to prescribe opioids "is made more complicated by a health care reimbursement model that may favor overprescribing to optimize patient satisfaction."

The authors have disclosed no relevant financial relationships.

Ann Fam Med. Published online January 8, 2018. Abstract

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