Relationship of Opioid Prescriptions to Physical Therapy Referral and Participation for Medicaid Patients with New-Onset Low Back Pain
Relationship of Opioid Prescriptions to Physical Therapy Referral and Participation for Medicaid Patients with New-Onset Low Back Pain
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DOI：
10.3122/jabfm.2017.06.170064
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发表时间：
2017-11-01
影响因子：
2.9
通讯作者：
Fritz, Julie
中科院分区：
文献类型：
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作者：
Thackeray, Anne;Hess, Rachel;Fritz, Julie
简介：物理治疗（PT）在腰痛（LBP）的早期管理与随后的医疗保健利用和LBP相关成本的减少有关。本研究的目的是1）检查接受PT转诊和未接受PT转诊的新咨询LBP患者之间的差异，2）检查参加PT的患者与未参加PT的患者之间的差异，3）比较PT转诊和PT参与对1年内LBP相关医疗保健利用和费用的影响。这是一项使用电子病历和索赔数据的回顾性队列研究。参与者是454名新LBP咨询的医疗补助登记者（平均年龄，40.4岁; SD = 12.0; 70%女性）。结果包括先进的成像，注射，急诊科就诊，阿片类药物处方，手术和LBP相关费用。变量与PT咨询，PT参与，随后的结果进行了评估与multivariate models.Results：共251（55%）参与者接受了PT咨询的指数LBP访问和81（19%）参加PT在7天内。如果患者接受非甾体类抗炎药（aOR = 1.81; 95%置信区间[CI]，1.0 - 3.27; P = 0.05）或肌肉松弛剂（调整后的比值比[aOR] = 2.24; 95% CI，1.03 - 4.87; P = 0.04），PT咨询的几率增加。而烟草使用者和患有多种合并症的个体不太可能接受PT咨询（aOR = 0.52; 95%CI，0.20至0.91）和0.42（95%CI，0.23至0.78））。基线时接受X线片检查（比值比[OR] = 2.63; 95% CI，1.25 - 5.53）或有多种合并症（OR = 2.96; 95% CI，1.20 - 7.20）的患者参与PT的比值更高。PT咨询（aOR = 0.65; 95% CI，0.43 - 1.00）和PT参与（aOR = 0.47; 95% CI，0.24 - 0.92）降低了在索引访视后一年内接受阿片类药物处方的几率。任何groups.Conclusions：在新发LBP的医疗补助受助人，指数供应商的处方和成像决策和患者的人口统计学与PT转诊和参与之间没有显着差异，在LBP相关的成本超过1年。转诊至PT和随后的PT参与与随访期间阿片类药物处方减少相关。与LBP相关的医疗保健费用总体上没有差异。
Introduction: Physical therapy (PT) early in the management of low back pain (LBP) is associated with reductions in subsequent health care utilization and LBP-related costs. The objectives of this study were to 1) Examine differences among newly consulting patients with LBP who received a PT referral and those who did not, 2) examine differences between patients who participated in PT to those who did not, and 3) compare the impact of a PT referral and PT participation on LBP-related health care utilization and costs over 1 year.Methods: This was a retrospective cohort study using electronic medical records and claims data. Participants were 454 Medicaid enrollees with new LBP consultations (mean age, 40.4 years; SD = 12.0; 70% women). Outcomes included advanced imaging, injections, emergency department visits, opioid prescriptions, surgery and LBP-related costs. Variables associated with a PT consult, PT participation, and subsequent outcomes were evaluated with multivariate models.Results: A total of 251 (55%) participants received a PT consult within 7 days of the index LBP visit and 81 (19%) participated in PT. The odds of a PT consult were increased if patients were prescribed non-steroidal anti-inflammatories (aOR = 1.81; 95% confidence interval [CI], 1.0 to 3.27; P = .05) or muscle relaxers (adjusted odds ratio [aOR] = 2.24; 95% CI, 1.03 to 4.87; P = .04). Whereas tobacco users and individual with multiple comorbidities were less likely to receive a PT consult (aOR = 0.52; 95% CI, 0.20 to 0.91) and 0.42 (95% CI, 0.23 to 0.78), respectively). Odds of participating in PT were higher for patients receiving an radiograph at baseline (odds ratio [OR] = 2.63; 95% CI, 1.25 to 5.53) or having multiple comorbidities (OR = 2.96; 95% CI, 1.20 to 7.20). The odds of receiving an opioid prescription over the year following the index visit reduced with a PT consult (aOR = 0.65; 95% CI, 0.43 to 1.00) and with PT participation (aOR = 0.47; 95% CI, 0.24 to 0.92). No differences in LBP related costs over 1 year were noted between any of the groups.Conclusions: Among Medicaid recipients with new-onset LBP, the index provider's prescription and imaging decisions and patient demographics were associated with PT referrals and participation. A referral to PT and subsequent PT participation was associated with reduced opioid prescriptions during follow-up. There was no difference in overall LBP-related health care costs.