Use of Medicare-subsidised treatment services among people prescribed opioids for chronic non-cancer pain

Ria E. Hopkins; Gabrielle Campbell; Louisa Degenhardt; Suzanne Nielsen; Milton Cohen; Fiona Blyth; Natasa Gisev

doi:10.1071/PU24012

RESEARCH ARTICLE (Open Access)

Use of Medicare-subsidised treatment services among people prescribed opioids for chronic non-cancer pain

Ria E. Hopkins ^A ^* , Gabrielle Campbell ^A ^B , Louisa Degenhardt ^A , Suzanne Nielsen ^C , Milton Cohen ^D , Fiona Blyth ^E and Natasa Gisev ^A

+ Author Affiliations

- Author Affiliations

^A National Drug and Alcohol Research Centre, UNSW Sydney, NSW, Australia.

^B School of Psychology, University of Queensland, Brisbane, Qld, Australia.

^C Monash Addiction Research Centre, Monash University, Melbourne, Vic, Australia.

^D School of Clinical Medicine, UNSW Sydney, NSW, Australia.

^E Concord Clinical School, University of Sydney, NSW, Australia.

^* Correspondence to: ria.hopkins@unsw.edu.au

Public Health Research and Practice 35, PU24012 https://doi.org/10.1071/PU24012

Submitted: 11 April 2024 Accepted: 9 October 2024 Published: 8 May 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of the Sax Institute. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Objectives

Australians receive healthcare services subsidised by the Medicare national health insurance scheme, including through the Chronic Disease Management Initiative supporting primary care management of chronic conditions. The use of such subsidised services by people with chronic non-cancer pain (CNCP) is unknown. This study examined Medicare-subsidised service use, including Chronic Disease Management items, allied health service use, and specialist attendances, among Australians prescribed opioids for CNCP.

Methods

Medicare Benefits Schedule claims data for the period 1 January 2012–31 December 2018 were linked to a longitudinal cohort of 1206 adults prescribed opioids for CNCP. Service use was compared with the general population to examine whether individuals with CNCP make greater use of such services and factors associated with service use (including demographics, socioeconomic status, pain scores and opioid treatment characteristics, and physical and mental health scores) were examined.

Results

Use of primary, allied health, and specialist services among adults with CNCP was high when compared with the general population. Over 3 years, 928 participants (76.9%) received Chronic Disease Management items, mostly care plans (n = 825, 68.4%). Private health insurance and living in a major city were associated with increased odds and rates of any specialist and pain medicine specialist attendances (private insurance and specialist attendances: adjusted odds ratio 4.29, 99.5% confidence interval 2.32–7.91; major city and pain specialist attendances: adjusted incident rate ratio 1.70, 99.5% confidence interval 1.12–2.56).

Conclusions

Australians prescribed opioids for CNCP have a high use of subsidised primary, allied health, and specialist services. However, sociodemographic disparities were apparent, and there remains a need to improve specialist service accessibility for Australians who are uninsured and living in regional/remote areas. There is also a need to evaluate whether care delivered through current Medicare initiatives is meeting the needs of Australians with CNCP.

Keywords: allied health services, chronic disease management, chronic non-cancer pain, chronic pain, Medicare subsidies, mental health services, opioid use, specialist services.

References

1 Deloitte Access Economics. The cost of chronic pain in Australia. Canberra, ACT: Deloitte Access Economics; 2019.

2 Skelly AC, Chou R, Dettori JR, et al. Noninvasive nonpharmacological treatment for chronic pain: A systematic review. AHRQ Comparative Effectiveness Reviews. Rockville, MD: Agency for Healthcare Research and Quality; 2018.

3 Mathieson S, Wertheimer G, Maher CG, et al. What proportion of patients with chronic noncancer pain are prescribed an opioid medicine? Systematic review and meta-regression of observational studies. J Intern Med 2020; 287(5): 458-74.
| Crossref | Google Scholar | PubMed |

4 Hogg MN, Kavanagh A, Farrell MJ, et al. Waiting in Pain II: An updated review of the provision of persistent pain services in Australia. Pain Med 2021; 22(6): 1367-75.
| Crossref | Google Scholar | PubMed |

5 Australian Institute of Health and Welfare. Use of Medicare chronic disease management items by patients with long-term health conditions. Canberra, ACT: AIHW; 2022.

6 Wilkinson D, McElroy H, Beilby J, et al. Are socio-economically disadvantaged Australians making more or less use of the Enhanced Primary Care Medicare Benefit Schedule item numbers? Aust Health Rev 2003; 26(3): 43-9.
| Crossref | Google Scholar |

7 Welberry H, Barr ML, Comino EJ, et al. Increasing use of general practice management and team care arrangements over time in New South Wales, Australia. Aust J Prim Health 2019; 25(2): 168-75.
| Crossref | Google Scholar | PubMed |

8 Australian Institute of Health and Welfare. Medicare-subsidised GP, allied health and specialist health care across local areas: 2013–14 to 2018–19. Canberra, ACT: AIHW; 2020.

9 Becker WC, Dorflinger L, Edmond SN, et al. Barriers and facilitators to use of nonpharmacological treatments in chronic pain. BMC Fam Pract 2017; 18: 41.
| Crossref | Google Scholar | PubMed |

10 Briggs AM, Slater H, Bunzli S, et al. Consumers’ experiences of back pain in rural Western Australia: Access to information and services, and self-management behaviours. BMC Health Serv Res 2012; 12: 357.
| Crossref | Google Scholar | PubMed |

11 Hopkins RE, Degenhardt L, Campbell G, et al. “Frustrated with the whole system”: A qualitative framework analysis of the issues faced by people accessing health services for chronic pain. BMC Health Serv Res 2022; 22(1): 1603.
| Crossref | Google Scholar | PubMed |

12 Campbell G, Mattick R, Bruno R, et al. Cohort protocol paper: The Pain and Opioids In Treatment (POINT) study. BMC Pharmacol Toxicol 2014; 15(1): 17.
| Crossref | Google Scholar | PubMed |

13 Hopkins RE, Campbell G, Degenhardt L, et al. Use of pharmacological and non-pharmacological treatments for chronic non-cancer pain among people using opioids: A longitudinal cohort study. Pain 2022; 163(6): 1049-59.
| Crossref | Google Scholar | PubMed |

14 Nielsen S, Campbell G, Peacock A, et al. Health service utilisation by people living with chronic non-cancer pain: Findings from the Pain and Opioids IN Treatment (POINT) study. Aust Health Rev 2016; 40(5): 490-9.
| Crossref | Google Scholar | PubMed |

15 Australian Bureau of Statistics. Socio-Economic Indexes for Areas (SEIFA) Technical Paper. Canberra: ABS; 2016.

16 Australian Bureau of Statistics. Australian Statistical Geography Standard (ASGS): Volume 5 - Remoteness Structure, July 2016. Cat. no. 1270.0.55.005. Canberra, ACT: ABS; 2018.

17 Nielsen S, Degenhardt L, Hoban B, et al. A synthesis of oral morphine equivalents (OME) for opioid utilisation studies. Pharmacoepidemiol Drug Saf 2016; 25(6): 733-7.
| Crossref | Google Scholar | PubMed |

18 Manchikanti L, Abdi S, Atluri S, et al. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part 2-Guidance. Pain Physician 2012; 15(Suppl 3): S67-116.
| Google Scholar | PubMed |

19 Cleeland CS, Ryan KM. Pain assessment: Global use of the Brief Pain Inventory. Ann Acad Med Singap 1994; 23(2): 129-38.
| Google Scholar | PubMed |

20 Sanderson K, Andrews G. The SF-12 in the Australian population: Cross-validation of item selection. Aust N Z J Public Health 2002; 26(4): 343-5.
| Crossref | Google Scholar | PubMed |

21 Kroenke K, Spitzer RL, Williams JB, et al. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: A systematic review. Gen Hosp Psychiatry 2010; 32(4): 345-59.
| Crossref | Google Scholar | PubMed |

22 Pulok MH, van Gool K, Hall J. Horizontal inequity in the utilisation of healthcare services in Australia. Health Policy 2020; 124(11): 1263-71.
| Crossref | Google Scholar |

23 Korda RJ, Banks E, Clements MS, et al. Is inequity undermining Australia’s ‘universal’ health care system? Socio-economic inequalities in the use of specialist medical and non-medical ambulatory health care. Aust N Z J Public Health 2009; 33(5): 458-65.
| Crossref | Google Scholar | PubMed |

24 Haines TP, Foster MM, Cornwell P, et al. Impact of Enhanced Primary Care on equitable access to and economic efficiency of allied health services: A qualitative investigation. Aust Health Rev 2010; 34(1): 30-5.
| Crossref | Google Scholar | PubMed |

25 Foster MM, Cornwell PL, Fleming JM, et al. Better than nothing? Restrictions and realities of Enhanced Primary Care for allied health practitioners. Aust J Prim Health 2009; 15(4): 326-34.
| Crossref | Google Scholar |

26 Yang SY, Bogosian A, Moss-Morris R, et al. Mixed experiences and perceptions of psychological treatment for chronic pain in Singapore: Skepticism, ambivalence, satisfaction, and potential. Pain Med 2015; 16(7): 1290-300.
| Crossref | Google Scholar | PubMed |

27 Dalziel K, Li J, Scott A, et al. Accuracy of patient recall for self-reported doctor visits: Is shorter recall better? Health Econ 2018; 27(11): 1684-98.
| Crossref | Google Scholar | PubMed |