Opioid prescribing patterns for non-malignant chronic pain for rural versus non-rural US adults: a population-based study using 2010 NAMCS data

BMC Health Services Research

M Nawal Lutfiyya⁴  Grant W Anderson³  Michael T Swanoski³  Andrine M Lemieux¹  Keri D Hager³  Catherine A St. Hill⁵  Jacob P Prunuske² 

[1] Behavioral Medicine Laboratory, School of Medicine, University of Minnesota, 1033 Kirby Drive, Duluth, MN, USA;Department of Family Medicine and Community Health, School of Medicine, University of Minnesota, Duluth, MN, USA;Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, 1033 Kirby Drive, Duluth, MN, USA;National Center for Interprofessional Education and Practice, University of Minnesota, R685 Children’s Rehab Center, 426 Church Street SE, Minneapolis 55455, MN, USA;Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, 308 Harvard St. SE, Minneapolis, MN, USA

关键词: NMCP;    Non-malignant chronic pain;    Opioids;    Health care disparities;    Rural health;    NAMCS data;   

Others  :  1091543
DOI  :  10.1186/s12913-014-0563-8

 received in 2014-01-31, accepted in 2014-10-24,  发布年份 2014

【 摘 要 】

Background

Non-malignant chronic pain (NMCP) is one of the most common reasons for primary care visits. Pain management health care disparities have been documented in relation to patient gender, race, and socioeconomic status. Although not studied in relation to chronic pain management, studies have found that living in a rural community in the US is associated with health care disparities. Rurality as a social determinant of health may influence opioid prescribing. We examined rural and non-rural differences in opioid prescribing patterns for NMCP management, hypothesizing that distinct from education, income, racial or gender differences, rural residency is a significant and independent factor in opioid prescribing patterns.

Methods

2010 National Ambulatory Medical Care Survey (NAMCS) data were examined using bivariate and multivariate techniques. NAMCS data were collected using a multi-stage sampling strategy. For the multivariate analysis performed the SPSS complex samples algorithm for logistic regression was used.

Results

In 2010 an estimated 9,325,603 US adults (weighted from a sample of 2745) seen in primary care clinics had a diagnosis of NMCP; 36.4% were prescribed an opioid. For US adults with a NMCP diagnosis bivariate analysis revealed rural residents had higher odds of having an opioid prescription than similar non-rural adults (OR = 1.515, 95% CI 1.513-1.518). Complex samples logistic regression analysis confirmed the importance of rurality and yielded that US adults with NMCP who were prescribed an opioid had higher odds of: being non-Caucasian (AOR =2.459, 95% CI 1.194-5.066), and living in a rural area (AOR =2.935, 95% CI 1.416-6.083).

Conclusions

Our results clearly indicated that rurality is an important factor in opioid prescribing patterns that cannot be ignored and bears further investigation. Further research on the growing concern about the over-prescribing of opioids in the US should now include rurality as a variable in data generation and analysis. Future research should also attempt to document the ecological, sociological and political factors impacting opioid prescribing and care in rural communities. Prescribers and health care policy makers need to critically evaluate the implications of our findings and their relationship to patient needs, best practices in a rural setting, and the overall consequences of increased opioid prescribing on rural communities.

【 授权许可】

   
2014 Prunuske et al.; licensee BioMed Central Ltd.

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