Methadone-maintained patients in primary care have higher rates of chronic disease and multimorbidity, and use health services more intensively than matched controls

Abstract

Background:Methadone maintenance treatment in primary care is cost-eff ective and improves outcomes for opiate-dependent patients. A more developed understanding of the evolving needs of this important cohort will facilitate further improvements in their integrated care within the community. Objectives: The aim of this study was to compare the burden of chronic disease, multi-morbidity and intensity of health-service use between methadone-maintained patients (MMPs) and matched controls in primary care. Methods: This is a retrospective matched case-control design. Data on chronic disease and health service use was collected in 13 computerized GP surgeries on 414 patients (207 MMPs and 207 controls). Twelve months of records were examined. MMPs were compared with controls matched by gender, age, socio-economic status (SES) and GP surgery. Results: MMPs suff ered more chronic disease (OR ϭ 9.1, 95% CI: 5.4 -15.1, P Ͻ 0.001) and multi-morbidity (OR ϭ 6.6, 95% CI: 4.3 -10.2, P Ͻ 0.001). They had higher rates of respiratory, psychiatric and infectious disease. MMPs of lower SES had more chronic disease than their peers (OR ϭ 7.2, 95% CI: 2.4 -22.0, P Ͻ 0.001). MMPs attended the doctor more often with medical problems (OR ϭ 15.4, 95% CI: 8.2 -28.7, P Ͻ 0.001), with a frequent requirement to have medical issues addressed during methadone-management visits. Their care generated more telephone calls (OR ϭ 4.4, 95% CI: 2.8 -6.8, P Ͻ 0.001), investigations (OR ϭ 1.8, 95% CI: 1.2 -2.7, P ϭ 0.003), referrals (2.6, 95% CI: 1.7 -4.0, P Ͻ 0.001), emergency department visits (2.1, 95% CI: 1.3 -3.6, P ϭ 0.004), outpatient attendances (2.3, 95% CI: 1.51 -1.43, P Ͻ 0.001) and hospital admissions (3.6, 95% CI: 1.6 -8.1, P ϭ 0.001). Conclusion:Correcting for routine methadone care and drug-related illnesses, MMPs had a higher burden of chronic disease and used both primary and secondary health services more intensively than matched controls.

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

“…Forensic data also suggest substantial comorbidity in people dying of an opioid overdose, and it has been hypothesized that systemic illnesses may compromise physiological and pharmacological responses to opioid action on respiratory depression and opioid metabolism, thereby increasing overdose risk 52, 53. A study in Scotland suggested that mortality risk increased with age in methadone patients 54, although neither study can test the mechanism of any increased risk.…”

Substance misuse in patients who have comorbid chronic pain in a clinical population receiving methadone maintenance therapy for the treatment of opioid dependence

“…Furthermore, patients in receipt of opioid agonist therapy (OAT) who have comorbid chronic pain are associated with relatively poor health and substance use treatment outcomes, further complicating the delivery of effective treatment in substance misuse services. This comorbid presentation is associated with a range of medical and psychiatric morbidities (Iskandar et al, 2013;O'Toole et al, 2013), in addition to relatively severe and enduring substance misuse problems (Dunn et al, 2014;Larson et al, 2007). In addressing this issue, many studies have focused on any substance misuse (rather than specific drug misuse) as the target variable (e.g.…”

Comorbidity and polymorbidity – a modern interpretation and urgent tasks facing the therapeutic community

“…Большое значение возрастного градиента также означает, что если не будет столь же высокого качества медицинской и социальной помощи людям с множественными хроническими заболеваниями, как и пациентам с одним заболеванием, то существует риск того, что люди в конце жизни будут получать медицинскую помощь более низкого качества, чем молодые люди, у которых меньше шансов иметь несколько заболеваний. Различия в качестве медицинской помощи в зависимости от возраста пациента должны быть причиной серьезного беспокойства медицинской общественности и государственных структур [56]. В настоящее время объем затрат на полиморбидных пациентов часто выходит за пределы возможностей страховщиков и государственного финансирования систем здравоохранения.…”

“…Пациенты вынуждены покрывать расходы из своего кармана [51,54]. Следует также отметить, что собственные расходы на лечение пациентов с полиморбидностью растут быстрее, чем уровень доходов, что оказывает негативное влияние на жизнь наиболее уязвимых в этом плане членов общества [56,57]. Возможно, одним из лучших решений, как с точки зрения медицины, так и экономики, является курс, направленный на предотвращение развития множественных хронических заболеваний в самом начале [58,59].…”