The association between the supply of select nonpharmacologic providers for pain and use of nonpharmacologic pain management services and initial opioid prescribing patterns for Medicare beneficiaries with persistent musculoskeletal pain.
Age Factors
Aged
Aged, 80 and over
Analgesics, Opioid
/ administration & dosage
Comorbidity
Drug Prescriptions
/ statistics & numerical data
Drug Utilization
Fee-for-Service Plans
Female
Humans
Insurance Claim Review
Male
Medicare
/ statistics & numerical data
Mental Health Services
/ statistics & numerical data
Musculoskeletal Pain
/ drug therapy
Pain Management
/ methods
Physical Therapy Modalities
/ statistics & numerical data
Practice Patterns, Physicians'
/ statistics & numerical data
Residence Characteristics
Retrospective Studies
Sex Factors
Socioeconomic Factors
United States
access to care
mental health services
musculoskeletal pain
older adults
opioid prescribing
physical therapy
Journal
Health services research
ISSN: 1475-6773
Titre abrégé: Health Serv Res
Pays: United States
ID NLM: 0053006
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
pubmed:
3
10
2020
medline:
12
10
2021
entrez:
2
10
2020
Statut:
ppublish
Résumé
To test the relationship between the supply of select nonpharmacologic providers (physical therapy (PT) and mental health (MH)) and use of nonpharmacologic services among older adults with a persistent musculoskeletal pain (MSP) episode. Claims data from a 5 percent random sample of Medicare beneficiaries enrolled fee-for-service (2007-2014) and the Area Health Resource File (AHRF). This retrospective study used generalized estimating equations to estimate the association between the county nonpharmacologic provider supply and individual service use with opioid prescriptions filled during Phase 1 (first three months of an episode) and Phase 2 (three months following Phase 1). We identified beneficiaries (>65 years) with ≥2 MSP diagnoses ≥90 days apart and no opioid prescription six months before the first pain diagnosis (N = 69 456). Beneficiaries' county characteristics were assigned using the AHRF. About 13.9 percent of beneficiaries used PT, 1.8 percent used MH services, and 10.7 percent had an opioid prescription during the first three months of a persistent MSP episode. An additional MH provider/10 000 people/county [aOR: 0.97, 95% CI: 0.96-0.98] and PT/10 000 people/county [aOR: 0.98, 95% CI: 0.97-1.00] was associated with lower odds of filling an opioid prescription in Phase 1. An additional MH provider/10 000 people/county [aOR: 0.97, 95% CI: 0.96-0.98] and PT use in Phase 1 [aOR: 0.62, 95% CI: 0.58-0.67] were associated with lower odds of filling an opioid prescription in Phase 2. The associations between the supply of providers and nonpharmacologic service use in Phase 1 and Phase 1 opioid prescriptions significantly differed by metropolitan and rural counties (P-value: .019). Limited access to nonpharmacologic services is associated with opioid prescriptions at the onset of a persistent MSP episode. Initiating PT at the onset of an episode may reduce future opioid use. Strategies for engaging beneficiaries in nonpharmacologic services should be tailored for metropolitan and rural counties.
Identifiants
pubmed: 33006158
doi: 10.1111/1475-6773.13561
pmc: PMC7969208
doi:
Substances chimiques
Analgesics, Opioid
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
275-288Subventions
Organisme : NCCIH NIH HHS
ID : UG3 AT009790
Pays : United States
Organisme : NCCIH NIH HHS
ID : UH3 AT009790
Pays : United States
Informations de copyright
© 2020 Health Research and Educational Trust.
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