- Patients using prescription opioids to manage their pain are 32 percent more likely to report high patient satisfaction scores, according to recent research out of Dartmouth-Hitchcock Medical Center.
The association between opioid use and patient satisfaction has come into question as of late, as the nation grapples with a nationwide opioid misuse crisis. Patient satisfaction surveys such as the CAHPS surveys help inform value-based reimbursements for hospitals.
But with the rise of opioid use and other drug abuse disorders, some healthcare experts are reconsidering whether pain management questions should factor into reimbursement rates.
“Against the backdrop of excessive health care use, the United States is facing a crisis of prescription opioid drug misuse and diversion resulting in epidemic levels of morbidity and mortality,” the researcher team said.
“The rise in the prescription of opioids was presumably initially driven by a desire to improve the well-being of patients having pain,” the team continued. “If, in fact, prescription opioid use is associated with higher patient satisfaction with care, such payment incentives may be perpetuating the prescribing of these medications.”
The researchers assessed the relationship between prescription opioid use in patients with musculoskeletal issues using data from the Medical Expenditure Panel Survey and CAHPS. The team condensed the five patient-provider communication CAHPS domains because they are most closely related to overall patient satisfaction, they said.
Of the over 19,500 adult patients who experienced a musculoskeletal issue during the study test period, 2,564 used an opioid to manage pain, meaning patients received a prescription at least once within two six-month periods.
Overall, opioid users were 32 percent more likely to report high patient satisfaction, or rank in the top quartile for patient satisfaction.
After adjusting for comorbidities and other factors, the researchers found that moderate and heavy prescription opioid users were 55 and 43 percent more likely to report high patient satisfaction, respectively.
However, leaving these numbers unadjusted revealed only a statistically significant difference in moderate opioid users. These individuals were the only cohort with an increased likelihood of reporting high patient satisfaction.
This may be because heavy prescription opioid users may be managing extreme pain that is not well-suited to a prescription opioid treatment regimen.
The researchers reported slight surprise at their findings. Initially, the team predicted that the highly publicized dangers of opioid misuse would turn patients away from using these pain killers. Media portrayals of the risks of opioid misuse would limit the relationship between drug use and patient satisfaction, the researchers had hypothesized.
Likewise, with opioid use comes a litany of negative side effects including tolerance, sedation, dizziness, nausea, vomiting, and respiratory depressions. These side effects could also have limited the association between satisfaction and opioid use, the researchers had predicted.
Upon further reflection, the researchers reconciled their findings.
“We hypothesize that perhaps the improved satisfaction from opioids may partially be explained by an analogous situation that has been previously documented with antibiotics prescribed for likely viral upper respiratory infections,” the team explained. “Several studies indicate that the clinician’s desire to accommodate patient and parent expectations actually leads to overtreatment and overprescribing of oral antibiotics.”
Patient satisfaction that occurs with opioid use could also be tied to clinicians meeting patient expectations of treatment after they have broken a bone, the team offered. Additionally, opioids can sometimes improve untreated mood disorders, which are surprisingly prevalent.
These results highlight the need for healthcare professionals to reevaluate how clinicians decide to prescribe an opioid, the researchers said.
“This decision is made more complicated by a health care reimbursement model that may favor overprescribing to optimize patient satisfaction through such mechanisms as the Hospital Consumer Assessment of Healthcare Providers and Systems,” the team noted.
“Our findings do not allow us to determine if overprescribing or unnecessary prescribing of opioids is actually occurring, but highlight the future need to establish whether the greater patient satisfaction is actually associated with better health or less disability,” they continued.
For its credit, CMS has made some moves to separate value-based reimbursement from pain management and patient satisfaction scores. In November of 2016, the agency finalized the Hospital Outpatient Prospective Payment System and removed pain management and opioid prescribing questions from the reimbursement formula.
Regardless of that move, there is a conversation surrounding pain management, patient satisfaction, and the opioid crisis that healthcare professionals must focus on, the researchers said.
“Given the opioid-related health crisis in the United States, our data suggest that there is an urgent need to establish, on a population health level, whether the observed greater satisfaction with care is associated with demonstrable health benefits,” the team concluded.