Department of Health Services Administration and Policy, Temple University College of Public Health, Philadelphia, PA.
Office of Biostatistics, US Food and Drug Administration, Silver Spring, MD.
Pain Physician. 2019 May;22(3):E147-E155.
Pain is common among cancer patients. Nonclinical factors may affect receipt of pain management among Medicaid beneficiaries with cancer.
To examine associations of patient characteristics and US state-level Medicaid policies on receipt of interventional pain management among Medicaid beneficiaries with breast or colorectal cancer.
A retrospective analysis of 2006-2008 Medicaid claims data.
Claims data from facilities providing care to Medicaid beneficiaries.
Interventional pain management among Medicaid beneficiaries aged 18-64 years with breast or colorectal cancer was identified using procedure codes in Medicaid claims data. State-level Medicaid policy variables included physician visit reimbursements, required patient copayments, and time period for Medicaid eligibility recertification (12 vs. < 12 months). Analyses also examined beneficiary race/ethnicity, age, comorbidities, and cancer treatment. Generalized estimating equations controlling for clustering by state assessed factors influencing receipt of interventional pain management.
The study included 8,438 Medicaid beneficiaries with breast or colorectal cancer. Colorectal cancer (vs. breast cancer) patients were significantly more likely to receive interventional pain management. Medicaid policies were not significantly associated with receipt of interventional pain services. Among breast cancer patients, older age and non-Hispanic white race/ethnicity were associated with decreased likelihood of receiving interventional pain management; more comorbidities and receipt of breast conserving surgery were associated with increased likelihood. Demographic characteristics were not significantly associated with receipt of interventional pain management among colorectal cancer patients.
Sample size of Medicare beneficiaries with cancer receiving interventional pain management; limited information included in Medicare claims data.
State-level Medicaid policies were not significantly associated with receipt of interventional pain management for breast or colorectal cancer patients; disparities in receipt of these services were observed only for breast cancer patients. These results may help develop policies to enhance access to appropriate pain management services.
Cancer pain, pain management, Medicaid, health care disparities, breast neoplasms, colorectal neoplasms, health policies, physician practice patterns, retrospective studies, claims analyses.
癌症患者常伴有疼痛。非临床因素可能会影响癌症医疗补助受益人的疼痛管理。
研究患者特征和美国各州医疗补助政策与乳腺癌或结直肠癌医疗补助受益人的介入性疼痛管理之间的关系。
对 2006-2008 年医疗补助索赔数据的回顾性分析。
来自为医疗补助受益人设医疗机构的索赔数据。
利用医疗补助索赔数据中的程序代码，确定 18-64 岁患有乳腺癌或结直肠癌的医疗补助受益人的介入性疼痛管理。州级医疗补助政策变量包括医生就诊报销、患者自付额要求和医疗补助资格重新认证的时间周期（12 个月与<12 个月）。分析还检查了受益人的种族/民族、年龄、合并症和癌症治疗。使用广义估计方程控制按州聚类，评估影响介入性疼痛管理的因素。
本研究纳入了 8438 名患有乳腺癌或结直肠癌的医疗补助受益。结直肠癌（与乳腺癌相比）患者更有可能接受介入性疼痛管理。医疗补助政策与介入性疼痛服务的获得无显著相关性。在乳腺癌患者中，年龄较大和非西班牙裔白人种族/民族与接受介入性疼痛管理的可能性降低相关；合并症更多和接受保乳手术与接受介入性疼痛管理的可能性增加相关。在结直肠癌患者中，人口统计学特征与接受介入性疼痛管理无显著相关性。
接受介入性疼痛管理的医疗保险受益人的癌症患者样本量小；医疗保险索赔数据中包含的信息有限。
州级医疗补助政策与乳腺癌或结直肠癌患者接受介入性疼痛管理之间无显著相关性；仅在乳腺癌患者中观察到这些服务的获得存在差异。这些结果可能有助于制定政策以增强获得适当疼痛管理服务的机会。
癌症疼痛，疼痛管理，医疗补助，卫生保健差异，乳腺肿瘤，结直肠肿瘤，卫生政策，医生实践模式，回顾性研究，索赔分析。
