Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Oakland, California, USA.
Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
Health Serv Res. 2021 Apr;56(2):275-288. doi: 10.1111/1475-6773.13561. Epub 2020 Oct 1.
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.
DATA SOURCES/STUDY SETTING: 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).
DATA COLLECTION/EXTRACTION METHODS: 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.
测试在患有持续性肌肉骨骼疼痛（MSP）发作的老年人中，选择非药物提供者（物理治疗（PT）和心理健康（MH））供应与非药物服务使用之间的关系。
数据来源/研究设置：来自 Medicare 按服务收费计划（2007-2014 年）的 5%随机样本的索赔数据和区域卫生资源文件（AHRF）。
这项回顾性研究使用广义估计方程来估计县非药物提供者供应与个体服务使用之间的关联，这些服务使用与在第 1 阶段（发作的头三个月）和第 2 阶段（第 1 阶段后三个月）期间填写的阿片类药物处方有关。
数据收集/提取方法：我们确定了≥2 次 MSP 诊断间隔≥90 天且在第一次疼痛诊断前六个月内没有阿片类药物处方的≥65 岁受益人的病例（N=69456）。使用 AHRF 为受益人分配县特征。
在持续性 MSP 发作的头三个月中，约有 13.9%的受益人使用了 PT，1.8%使用了 MH 服务，10.7%的受益人开了阿片类药物处方。每 10000 人/县增加一名 MH 提供者[aOR：0.97，95%CI：0.96-0.98]和每 10000 人/县增加一名 PT[aOR：0.98，95%CI：0.97-1.00]与第 1 阶段开具阿片类药物处方的可能性降低相关。每 10000 人/县增加一名 MH 提供者[aOR：0.97，95%CI：0.96-0.98]和第 1 阶段使用 PT[aOR：0.62，95%CI：0.58-0.67]与第 2 阶段开具阿片类药物处方的可能性降低相关。提供者供应和第 1 阶段非药物服务使用与第 1 阶段阿片类药物处方之间的关联在大都市和农村县之间存在显著差异（P 值：<.019）。
在持续性 MSP 发作开始时，非药物服务的获取有限与阿片类药物处方有关。在发作开始时进行 PT 可能会减少未来的阿片类药物使用。为大都市和农村县量身定制的吸引受益人使用非药物服务的策略。
