Use of Medicare-subsidised treatment services among people prescribed opioids for chronic non-cancer pain.

Abstract

Objectives Australians receive healthcare services subsidised by the Medicare national health insurance scheme, including through the Chronic Disease Management Initiative supporting primary care management of chronic conditions. The use of such subsidised services by people with chronic non-cancer pain (CNCP) is unknown. This study examined Medicare-subsidised service use, including Chronic Disease Management items, allied health service use, and specialist attendances, among Australians prescribed opioids for CNCP. Methods Medicare Benefits Schedule claims data for the period 1 January 2012-31 December 2018 were linked to a longitudinal cohort of 1206 adults prescribed opioids for CNCP. Service use was compared with the general population to examine whether individuals with CNCP make greater use of such services and factors associated with service use (including demographics, socioeconomic status, pain scores and opioid treatment characteristics, and physical and mental health scores) were examined. Results Use of primary, allied health, and specialist services among adults with CNCP was high when compared with the general population. Over 3years, 928 participants (76.9%) received Chronic Disease Management items, mostly care plans (n =825, 68.4%). Private health insurance and living in a major city were associated with increased odds and rates of any specialist and pain medicine specialist attendances (private insurance and specialist attendances: adjusted odds ratio 4.29, 99.5% confidence interval 2.32-7.91; major city and pain specialist attendances: adjusted incident rate ratio 1.70, 99.5% confidence interval 1.12-2.56). Conclusions Australians prescribed opioids for CNCP have a high use of subsidised primary, allied health, and specialist services. However, sociodemographic disparities were apparent, and there remains a need to improve specialist service accessibility for Australians who are uninsured and living in regional/remote areas. There is also a need to evaluate whether care delivered through current Medicare initiatives is meeting the needs of Australians with CNCP.