People with opioid use disorder receive lower quality preventive, chronic care
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Even with health insurance, people with opioid use disorder receive lower quality preventive and chronic care as well as lower quality care coordination, according to results of a cross-sectional study.
“Opioid use disorder is often characterized by dysregulation, diminished self-efficacy, less future orientation and mental health comorbidity, and this population is therefore at particular risk of preventable conditions and complications,” Kelly E. Anderson, MPP, health services research and policy PhD candidate in the department of health policy and management at the Johns Hopkins Bloomberg School of Public Health, and colleagues wrote.
Furthermore, they added that “because OUD is stigmatized and associated with significant impairment, the quality of preventive care and treatment of other conditions could be lower, contributing to poorer health.”
Anderson and colleagues conducted a cross-sectional study using deidentified data from 125,973 people (55.1% women; 62.1% white; mean age, 59 years). The researchers evaluated quality of care by matching the outpatient data of 79,372 adults with OUD who had commercial or Medicare Advantage insurance with 46,601 comparators across preventive care, chronic illness care and care coordination. Within those domains, the researchers identified six quality indicators, including the proportion of patients who had breast cancer screening, adhered to their prescribed statin medications and had comprehensive HbA1c testing as well as the percentage of hospitalizations related to mental illness that resulted in a follow-up visit with a mental health professional, a composite percentage of potentially avoidable hospitalizations and a diabetes-specific composite of potentially avoidable hospitalizations.
The researchers found that people with OUD received lower quality of care across each indicator vs. comparators. For the breast cancer indicator, 55.4% (95% CI, 54.7-56.0) of people with OUD received regular screenings vs. 65.6% (95% CI, 64.4% vs. 66.7%) of comparators. In addition, 70.4% (95% CI, 68.7-72.1) of people with OUD adhered to statin therapy vs. 76.7% (95% CI; 74.4-78.7) of comparators, and 80.9% (95% CI, 80.4-81.5) of people with OUD had regular HbA1c testing vs. 85.8% (95% CI; 84.9-86.8) of comparators.
People with OUD also had lower quality coordination of care, including a lower proportion of mental health follow-ups (45.3% vs. 52.5%) and a higher proportion of potentially avoidable hospitalizations for chronic conditions (11.4% vs. 8.8%) and diabetes (2.4% vs. 1.9%).
“We found that insured adults with OUD had small to moderate statistically significantly lower quality of care on all six quality indicators across the domains of preventive care, chronic illness care, and care coordination compared with the matched sample of insured adults without OUD,” the researchers wrote. “Our work, which suggests policy-relevant quality of care differences among insured adults with OUD compared with their counterparts, highlights gaps in comprehensive care for those with OUD, including attention to preventive and chronic illness care needs.”