整脊治疗与在加拿大社区健康中心接受非癌性脊柱疼痛阿片类药物处方的关联：混合方法分析。

Association of Chiropractic Care With Receiving an Opioid Prescription for Noncancer Spinal Pain Within a Canadian Community Health Center: A Mixed Methods Analysis.

机构信息

Department of Health Research Methods, Evidence and Impact, McMaster University, Waterloo, Ontario, Canada; Chiropractic Department, D'Youville University, Buffalo, New York; Private practice, Cambridge, Ontario, Canada.

Private practice, Cambridge, Ontario, Canada.

出版信息

J Manipulative Physiol Ther. 2022 May;45(4):235-247. doi: 10.1016/j.jmpt.2022.06.009. Epub 2022 Aug 23.

DOI:10.1016/j.jmpt.2022.06.009

PMID:36008170

Abstract

OBJECTIVE

The purpose of this study was to examine the association between receipt of chiropractic services and initiating a prescription for opioids among adult patients with noncancer spinal pain in a Canadian community health center.

METHODS

In this sequential explanatory mixed methods analysis, we conducted a retrospective study of 945 patient records (January 2014 to December 2020) and completed interviews with 14 patients and 9 general practitioners. We used Cox proportional hazards regression analyses, adjusted for patient demographics, comorbidities, visit frequency, and calendar year to evaluate the association between receipt of chiropractic care and time to first opioid prescription up to 1 year after presentation. Qualitative data were analyzed thematically and integrated with our quantitative findings.

RESULTS

There were 24% of patients (227 of 945) with noncancer spinal pain who received a prescription for opioids. The risk of initiating a prescription for opioids at 1 year after presentation was 52% lower in chiropractic recipients vs nonrecipients (hazard ratio [HR], 0.48; 99% confidence interval [CI], 0.29-0.77) and 71% lower in patients who received chiropractic services within 30 days of their index visit (HR, 0.29; 99% CI, 0.13-0.68). Patients whose index visit date was in a more recent calendar year were also less likely to receive opioids (HR, 0.86; 99% CI, 0.76-0.97). Interviews suggested that self-efficacy, access to chiropractic services, opioid stigma, and treatment impact were influencing factors.

CONCLUSION

Patients with noncancer spinal pain who received chiropractic care were less likely to obtain a prescription for opioids than patients who did not receive chiropractic care.

摘要

目的

本研究旨在探讨在加拿大社区健康中心，接受脊椎指压治疗与非癌症脊柱疼痛成年患者开始开处阿片类药物处方之间的关联。

方法

在这项序贯解释性混合方法分析中，我们对 945 名患者的病历（2014 年 1 月至 2020 年 12 月）进行了回顾性研究，并对 14 名患者和 9 名全科医生进行了访谈。我们使用 Cox 比例风险回归分析，根据患者人口统计学特征、合并症、就诊频率和日历年来调整，以评估接受脊椎指压治疗与就诊后 1 年内首次开处阿片类药物处方之间的关联。对定性数据进行主题分析，并与我们的定量发现相结合。

结果

945 名非癌症脊柱疼痛患者中，有 24%（227 名）患者开处了阿片类药物处方。在就诊后 1 年内，接受脊椎指压治疗的患者开处阿片类药物处方的风险比非接受者低 52%（风险比[HR]，0.48；99%置信区间[CI]，0.29-0.77），在就诊后 30 天内接受脊椎指压治疗的患者风险比低 71%（HR，0.29；99%CI，0.13-0.68）。就诊日期在较晚日历年的患者也不太可能开处阿片类药物（HR，0.86；99%CI，0.76-0.97）。访谈表明，自我效能、获得脊椎指压治疗的机会、阿片类药物污名和治疗效果是影响因素。