New research from Women’s College Hospital & Unity Health Toronto shows physician discretion in taking on new patients with opioid use disorder.
Toronto, ON – September 27, 2022 – A new study in JAMA Network Open shows that family physicians were almost three times less likely to offer a new patient appointment to a person with opioid use disorder than a person with diabetes. These findings suggest that physician discretion in accepting new patients contributes to poor access to primary care for patients with opioid use disorder, highlighting a need for health system change.
In this Ontario study, the research team called family doctors’ offices asking for a new patient appointment. They used one of two randomly assigned scenarios (a patient with diabetes receiving treatment from an endocrinologist or a patient with opioid use disorder receiving methadone treatment from an addictions physician) to identify a potential bias. The researchers found that a greater proportion of family physicians offered a new patient appointment to a patient with diabetes (11.4 per cent) than with opioid use disorder (four per cent). In addition, physicians with more than 20 years in practice were almost 13 times less likely to offer an appointment to a patient with opioid use disorder compared to one with diabetes. This may be attributed to better knowledge and training, as well as changing attitudes and behaviours, among newly trained physicians. The findings identify a need for improved and more equitable access to primary care in Ontario.
“High-quality primary care has a huge impact on our lives and health outcomes, particularly for those with complex health conditions like opioid use disorder,” says Dr. Sheryl Spithoff, study lead author and a family physician and researcher at Women’s College Hospital. “It is unacceptable that not everyone has access to a family doctor or nurse practitioner.”
Access to high-quality primary care has the potential to improve care and health outcomes for this complex group, as well as being beneficial for the health system by potentially preventing emergency department visits and monitoring associated chronic conditions such as diabetes. Previous research provides some insight into why family physicians may be reluctant to take on patients with opioid use disorder. In surveys, physicians report lack of supports and proper training, as well as high levels of stigma toward people with substance use disorders.
“Deaths from opioids have skyrocketed during the pandemic,” says Dr. Tara Kiran, study co-author and a family physician and researcher at St. Michael’s Hospital, a site of Unity Health Toronto. “Access to methadone or buprenorphine-naloxone can be lifesaving for people who are struggling with opioid use. It’s important for people on these treatments to also have access to good primary care so all their health needs can be met.”
To address this systemic failure in providing an essential component of healthcare for people with opioid use disorder, the authors call for policy improvements, such as anti-oppression training and improved medical education and compensation, as well as policies to guarantee that people have automatic access to a primary care provider (or team) within their catchment area. These steps, among others, will help ensure equitable access to high quality primary care for complex and stigmatized populations.
About Women’s College Hospital
For more than 100 years Women’s College Hospital (WCH) has been developing revolutionary advances in healthcare. Today, WCH is a world leader in the health of women and Canada’s leading academic ambulatory hospital. A champion of health equity, WCH advocates for the health of all women from diverse cultures and backgrounds and ensures their needs are reflected in the care they receive. It focuses on delivering innovative solutions that address Canada’s most pressing issues related to population health, patient experience and system costs. The WCH Institute for Health System Solutions and Virtual Care (WIHV) is developing new, scalable models of care that deliver improved outcomes for patients and sustainable solutions for the health system. www.womenscollegehospital.ca
About Unity Health Toronto
Unity Health Toronto, comprised of St. Joseph’s Health Centre, St. Michael’s Hospital and Providence Healthcare, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.
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