Social and health care utilization before and after opioid initiation in home care recipients with and without dementia: a nationwide register-based cohort study

Abstract

Background: Opioid use is associated with increased health care service utilization but home care recipients and patients with dementia have been mostly ignored in earlier studies, although changes in their health status can have dramatic cost consequences. This study examined social and health care utilization and costs among older home care recipients before and after opioid initiation, with persons with dementia as a subgroup of interest. Methods: This retrospective nationwide register-linkage study included Finnish regular home care recipients aged ≥ 65 years with opioid initiation between 1st March 2015 and 31st December 2016. Recipients with health care contacts due to cancer and palliative care were excluded. Incidence rate ratios of social and health care service use during the observation period starting one year before and ending one year after opioid initiation were calculated using nationwide register data. The utilization costs of various social and health care service categories were compared before and after the opioid initiation. Recipients with and without dementia were analysed separately. Results: Home care recipients had 1.76 (95% CI 1.75 − 1.78) times more inpatient days, 1.31 (1.26 − 1.36) times more emergency care admissions, and recipients without dementia had more outpatient service use (secondary care 1.10 [1.06 − 1.13], primary care 1.06 [1.04 − 1.07]) after opioid initiation compared to the preceding year. Home care service use decreased (0.85 [0.85 − 0.85]) in recipients with dementia but increased in those without (1.08 [1.08 − 1.08]). Of the recipients, 20.8% were admitted to long-term residential care during the follow-up year. The mean annual total costs per recipient were 21% higher during the year following opioid initiation compared to the preceding year. A peak in the costs, consisting largely of inpatient costs, was observed about a month before opioid initiation, after which costs showed a declining trend but remained above the baseline level. Conclusions: Recipients’ monthly health care resource use started to increase already before opioid initiation, after which monthly expenditures declined steadily, which may reflect mostly recipients’ worsened health status before opioid initiation. Most of the expenditures arose from housing services. The relationship between opioid use and utilization of residential care and home care services should be further examined. Trial registration: Not applicable (a retrospective register-based study).