Rosa Chiropractic and Physical Therapy Center, Rockville, Maryland.
Research, New York Chiropractic College, Seneca Falls, New York.
J Manipulative Physiol Ther. 2021 Mar;44(3):186-195. doi: 10.1016/j.jmpt.2021.01.003. Epub 2021 Apr 18.
The purpose of this study was to describe changes in opioid-therapy prescription rates after a family medicine practice included on-site chiropractic services.
The study design was a retrospective analysis of opioid prescription data. The database included opioid prescriptions written for patients seeking care at the family medicine practice from April 2015 to September 2018. In June 2016, the practice reviewed and changed its opioid medication practices. In April 2017, the practice included on-site chiropractic services. Opiod-therapy use was defined as the average rate of opioid prescriptions over all medical providers at the practice.
There was a significant decrease of 22% in the average monthly rate of opioid prescriptions after the inclusion of chiropractic services (F = 10.69; P < .05). There was a significant decrease of 32% in the prescribing rate of schedule II opioids after the inclusion of chiropractic services (F = 6.07 for the Group × Schedule interaction; P < .05). The likelihood of writing schedule II opioid prescriptions decreased by 27% after the inclusion of chiropractic services (odds ratio, 0.73; 95% confidence interval, 0.59-0.90). Changes in opioid medication practices by the medical providers included prescribing a schedule III or IV opioid rather than a schedule II opioid (F = 29.81; P < .05) and a 30% decrease in the daily doses of opioid prescriptions (odds ratio, 0.70; 95% confidence interval, 0.50-0.98).
This study demonstrates that there were decreases in opioid-therapy prescribing rates after a family medicine practice included on-site chiropractic services. This suggests that inclusion of chiropractic services may have had a positive effect on prescribing behaviors of medical physicians, as they may have been able to offer their patients additional nonpharmaceutical options for pain management.
本研究旨在描述家庭医学实践中增加现场整脊服务后阿片类药物治疗处方率的变化。
研究设计是对阿片类药物处方数据的回顾性分析。该数据库包括 2015 年 4 月至 2018 年 9 月期间在家庭医学实践中寻求治疗的患者的阿片类药物处方。2016 年 6 月，该实践审查并改变了其阿片类药物治疗方案。2017 年 4 月，该实践增加了现场整脊服务。阿片类药物治疗的使用定义为该实践中所有医疗提供者开具阿片类药物的平均处方率。
在增加整脊服务后，阿片类药物的平均每月处方率显著下降 22%（F=10.69；P<0.05）。在增加整脊服务后，开处 II 类阿片类药物的处方率显著下降 32%（F=6.07，组×时间表交互；P<0.05）。在增加整脊服务后，开处 II 类阿片类药物的可能性降低了 27%（优势比，0.73；95%置信区间，0.59-0.90）。医疗提供者改变阿片类药物治疗方案包括开 III 类或 IV 类阿片类药物而不是 II 类阿片类药物（F=29.81；P<0.05），以及阿片类药物处方的每日剂量减少 30%（优势比，0.70；95%置信区间，0.50-0.98）。
本研究表明，家庭医学实践中增加现场整脊服务后，阿片类药物治疗处方率下降。这表明，增加整脊服务可能对医疗医生的处方行为产生了积极影响，因为他们可能能够为患者提供额外的非药物疼痛管理选择。
