{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T14:17:48Z","timestamp":1788445068361,"version":"build-2803163510"},"reference-count":34,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Continuity of care is a core element of high\u2010quality primary care and may prevent inappropriate opioid use. However, evidence on its association with opioid initiation among opioid\u2010na\u00efve adults with non\u2010cancer pain remains scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a population\u2010based cohort study using South Korea's national claims data (2015\u20132022). The study included 392,988 adults aged \u2265\u200920\u2009years diagnosed in 2016 with musculoskeletal and connective tissue disorders who received outpatient primary care without prior opioid exposure. Continuity of care was measured using the Bice\u2013Boxerman Continuity of Care Index (COCI) and categorised as high (\u2265\u20090.90), medium (0.48\u2013&lt;\u20090.90), or low (&lt;\u20090.48). The primary outcomes were the incidence of new opioid prescriptions and a composite indicator of potentially inappropriate opioid prescribing, defined by five criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 392,988 participants, 52,670 (13.4%) initiated opioid therapy. Compared with the high\u2010continuity group, the medium\u2010 and low\u2010continuity groups had 1.27\u2010fold (95% CI, 1.25\u20131.28) and 1.43\u2010fold (95% CI, 1.41\u20131.45) higher risks of opioid initiation, respectively. High continuity was associated with a median delay of 303\u2009days in opioid initiation. Potentially inappropriate prescribing occurred in 12.1% of opioid users, with higher risks in the medium\u2010 (adjusted hazard ratio [aHR]\u2009=\u20091.26; 95% CI, 1.23\u20131.28) and low\u2010continuity groups (aHR\u2009=\u20091.41; 95% CI, 1.39\u20131.44).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Higher continuity of primary care was associated with delayed opioid initiation and reduced inappropriate opioid prescribing among adults with non\u2010cancer pain. Strengthening continuity\u2010focused interventions may help mitigate opioid\u2010related harms and promote safer pain management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance Statement<\/jats:title>\n                    <jats:p>Relational continuity in primary care plays a key role in shaping opioid prescribing patterns among adults with non\u2010cancer pain. Using nationwide data, our findings suggest that stronger continuity is associated with more cautious opioid use, including delayed initiation and a lower likelihood of inappropriate prescribing. These results highlight the importance of fostering ongoing, trust\u2010based relationships between patients and primary care providers as a strategy to reduce unnecessary opioid exposure and promote safer, patient\u2010centered pain management. Strengthening continuity in primary care may therefore have meaningful implications for both clinical practice and health policy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejp.70226","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T17:12:08Z","timestamp":1770052328000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Continuity of Primary Care and Delayed Opioid Initiation in Non\u2010Cancer Pain: A Cohort Study"],"prefix":"10.1002","volume":"30","author":[{"given":"Ae Jeong","family":"Jo","sequence":"first","affiliation":[{"name":"Department of Data Sciences Gyeongkuk National University  Andong Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eunjung","family":"Choo","sequence":"additional","affiliation":[{"name":"College of Pharmacy Ajou University  Suwon Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sejung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Data Sciences Gyeongkuk National University  Andong Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nam Kyung","family":"Je","sequence":"additional","affiliation":[{"name":"College of Pharmacy Pusan National University  Busan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6644-0808","authenticated-orcid":false,"given":"Iyn\u2010Hyang","family":"Lee","sequence":"additional","affiliation":[{"name":"College of Pharmacy Yeungnam University  Gyeongsan Republic of Korea"},{"name":"Department of Health Sciences University of York  York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650\u2010197704000\u201000010"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.170363"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/0091270012436561"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/hsc.13428"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0300745"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102021\u2010053140"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.31887\/DCNS.2017.19.3\/tcicero"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.rr7103a1"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877\u2010022\u201003131\u20102"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.541782.AD"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012299.pub3"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.3399\/bjgpo.2022.0085"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1370\/afm.2285"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.245"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/1077558705285294"},{"key":"e_1_2_11_17_1","first-page":"e126","article-title":"Continuity of Outpatient Care and Avoidable Hospitalization: A Systematic Review","volume":"25","author":"Kao Y. 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