Examination of financial barriers to medical care in opioid medication usage for pain control Kevin Tong,
1 BA ,
Joseph Conigliaro MD MPH, Eun Ji Kim, MD MS
and Barbara Zucker School of Medicine at Hofstra/Northwell 2Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research
Background • Opioid epidemic is a public health – there has been an increase in opioid overdose deaths 1 • Although non-pharmacologic therapy and non-opioid pharmacologic therapy are recommended as first-line treatment for pain management, patients are frequently prescribed with opioid medications for pain control. 2 • No study has examined the role of financial barriers to medical care as a primary mediator in increased opioid prescription.
1Donald
2 Msc ,
Conceptual Framework Patient characteristics Age Race Sex Social determinants of health history of substances abuse Mental health disorder
Opioid use/dependence
Insurance Insurance type Underinsurance
• Patients with cost barriers to health care are more likely to use opioid medications for pain management compared to people without cost barriers to health care
Methods • Retrospective data analysis conducted using the Medical Expenditure Panel Survey 2018 • Descriptive statistics used to characterize demographic information • Multivariate logistic regression analysis used to determine odds of opioid usage by group
Table 1. Predictors of opioid medication use (odds ratio [95% confidence interval]) Odds ratio [95% CI] P-value Male 1.26 [1.13-1.41] <0.001 Age group (reference: 18-34 years old) 35-49 years old 1.57 [1.29-1.91] 0.001 50-64 years old 2.08 [1.74-2.50] <0.001 65-79 years old 1.99 [1.63-2.42] <0.001 80+ years old 1.13 [0.86-1.50] 0.008 Race/ethnicity (reference: non-Hispanic White) Black 0.49 [0.40-0.60] <0.001 Hispanic 0.77 [0.66-0.91] <0.001 Asian 0.28 [0.18-0.45] <0.001 Other 1.10 [0.81-1.50] 0.95 Health insurance (reference: private insurance) Public insurance 1.80 [1.55-2.08] <0.001 No insurance 0.52 [0.38-0.71] <0.001 Financial barrier to medical care
1.48 [1.26-1.73]
• People with financial barriers to medical care had increased odds of using opioids compared to patients without financial barriers. • Higher percentage of patients with public health insurance (Medicaid/ Medicare) or no health insurance face financial barriers to medical care compared to patients with private health insurance. • Improving access to medical care has a potential to decrease opioid use, which can subsequently address opioid epidemic.
Future Direction/Model
Results
Hypothesis
Conclusions
<0.001
• Analyze the role of employment status as a mediator of insurance status in patients with significant pain. This will shed light on the role of employer on opioid usage and prescription rates
Resources 1. National Institute on Drug Abuse. “Prescription Opioids DrugFacts.” National Institute on Drug Abuse, 24 July 2020. 2. Centers for Disease Control and Prevention. “CDC Guideline for Prescribing Opioids for Chronic Pain.” U.S. Department of Health and Human Services, 2020. 3. Missouri Department of Social Services. “DSS Caseload Counter.” Sept. 2020. 4. Tardelli, Vitor et al. “Medical Use, non-medical use and use disorders of benzodiazepines and prescription opioids in adults: Differences by insurance status.” Drug and Alcohol Dependence, vol. 204 (2019): 1-10, doi:10.1016/j.drugalcdep.2019.107573.