# Patient-reported quality of outpatient healthcare in patients with chronic back or arthrosis pain with long-term opioid therapy in Germany

## TL;DR

This study assesses the quality of outpatient healthcare for German patients on long-term opioid therapy for chronic back or arthrosis pain.

## Contribution

The study evaluates healthcare quality using the Chronic Care Model and identifies factors associated with better care.

## Key findings

- Healthcare quality according to the Chronic Care Model was low, with a summary score of 2.4 out of 5.
- Guideline-compliant treatment aspects correlated positively with higher healthcare quality ratings.
- Higher education and younger age were associated with better perceived healthcare quality.

## Abstract

Managing patients with chronic non-cancer pain (CNCP) in outpatient healthcare is challenging. Long-term opioid therapy is an option for treatment responders with guideline recommended indications. However, opioid use poses risks of severe side effects, including misuse, and therefore needs to be integrated into a high-quality healthcare process. This analysis evaluates the association between healthcare quality according to the evidence-based Chronic Care Model (CCM) in the treatment process of patients receiving long-term opioid therapy for chronic back and/or arthrosis pain, and patient-related or healthcare related variables.

A cross-sectional patient survey was sent to a random sample of 3,037 individuals with long-term opioid therapy and chronic back and/or arthrosis pain insured by a large nationwide German statutory health insurance. Healthcare quality according to the CCM was assessed by the Patient Assessment of Chronic Illness Care (PACIC-5A) questionnaire. Internal reliability of the assessment instrument was determined using Cronbach’s α. Descriptive analysis of the outcome scales were conducted, alongside subgroup analyses considering patient characteristics, patient’s health situation, and pain treatment aspects. Testing for statistical significance was performed by Mann-Whitney U test and Kruskal-Wallis test. Effect sizes, namely Eta and Spearman’s Rank correlation coefficient, were calculated.

The analysis included 661 individuals. Participants were predominantly female (76%) with an average age of 69 years (SD 12.5). PACIC-5A score ratings across all (sub)scales were low, with a summary score rating of 2.4 (on a scale ranging from 1 (worst) to 5 (best)). Positive correlations with treatment quality were observed in the subgroup analysis concerning guideline-compliant pain treatment aspects such as setting therapy goals or a comprehensive treatment concept. Patient characteristics showed little to no correlations, except for a positive correlation between higher PACIC-5A rating and both lower age and higher education. Patient’s health situation presented a mixed picture, with no clear correlation between pain intensity/impairment, and PACIC-5A scores.

The provision of healthcare for patients with long-term opioid therapy for CNCP seems to be inadequate according to the CCM. Guideline-recommended pain treatment aspects exhibited a positive correlation with healthcare quality according to CCM. Enhancing the implementation of the CCM in the outpatient healthcare process may improve healthcare quality.

German Clinical Trials Register, DRKS00024854. Registered 04/28/2021.

The online version contains supplementary material available at 10.1186/s12875-025-02881-3.