一项探索临床医生对新的医疗补助腰痛政策看法的横断面调查。
A cross-sectional survey exploring clinician perceptions of a novel Medicaid back pain policy.
机构信息
Department of Emergency Medicine, Oregon Health & Science University, OR, USA.
Comagine Health, OR, USA.
出版信息
J Complement Integr Med. 2022 Oct 31;20(2):438-446. doi: 10.1515/jcim-2022-0213. eCollection 2023 Jun 1.
OBJECTIVES
Oregon Medicaid (Oregon Health Plan, or OHP) implemented an innovative policy in 2016 that increased coverage of evidence-based non-pharmacologic therapies (NPT, including physical therapy, massage, chiropractic, and acupuncture) while restricting opioids, epidural steroid injections, and surgeries. The objective of this study was to compare the perspectives of clinicians who see back pain patients and can prescribe pharmacologic therapies and/or refer to NPTs and clinicians who directly provide NPT therapies affected by the policy.
METHODS
A cross-sectional online survey was administered to Oregon prescribing clinicians and NPT clinicians between December 2019 and February 2020. The survey was completed by 107 prescribing clinicians and 83 NPT clinicians.
RESULTS
Prescribing clinicians and NPT clinicians had only moderate levels of familiarity with core elements of the policy. Prescribing clinicians had higher levels of frustration caring for OHP patients with back pain than NPT clinicians (83 vs. 34%, p<0.001) and were less confident in their ability to provide effective care (73 vs. 85%, p = .025). Eighty-six percent of prescribing clinicians and 83% of NPT clinicians thought active NPT treatments were effective; 74 and 70% thought passive NPT treatments were effective. Forty percent of prescribing clinicians and 25% of NPT clinicians (p<0.001) thought medically-light therapies were effective, while 29% of prescribing clinicians and 10% of NPT clinicians thought medically-intensive treatments were effective (p=0.001). Prescribing clinicians thought increased access to NPTs improved outcomes, while opinions were less consistent on the impact of restricting opioid prescribing.
CONCLUSIONS
Prescribing clinicians and NPT clinicians had varying perspectives of a Medicaid coverage policy to increase evidence-based back pain care. Understanding these perspectives is important for contextualizing policy effectiveness.
目的
俄勒冈医疗补助计划（俄勒冈健康计划，OHP）于 2016 年实施了一项创新政策，增加了循证非药物治疗（NPT，包括物理治疗、按摩、脊椎按摩和针灸）的覆盖范围，同时限制了阿片类药物、硬膜外类固醇注射和手术。本研究的目的是比较接受过背部疼痛患者治疗培训、可开具药物治疗和/或转介至 NPT 治疗的临床医生以及受该政策影响的直接提供 NPT 治疗的临床医生的观点。
方法
2019 年 12 月至 2020 年 2 月期间，对俄勒冈州的处方临床医生和 NPT 临床医生进行了横断面在线调查。共有 107 名处方临床医生和 83 名 NPT 临床医生完成了这项调查。
结果
处方临床医生和 NPT 临床医生对该政策的核心要素仅有中等程度的熟悉度。与 NPT 临床医生相比，照顾 OHP 背部疼痛患者的处方临床医生感到更加沮丧（83% vs. 34%，p<0.001），对提供有效治疗的能力信心较低（73% vs. 85%，p =.025）。86%的处方临床医生和 83%的 NPT 临床医生认为积极的 NPT 治疗有效；74%和 70%的人认为被动的 NPT 治疗有效。40%的处方临床医生和 25%的 NPT 临床医生（p<0.001）认为轻度医学治疗有效，而 29%的处方临床医生和 10%的 NPT 临床医生认为强化医学治疗有效（p=0.001）。处方临床医生认为增加 NPT 的可及性可以改善治疗效果，而对于限制阿片类药物处方的影响，意见则不太一致。
结论
处方临床医生和 NPT 临床医生对增加循证治疗腰痛的医疗补助覆盖政策有不同的看法。了解这些观点对于背景化政策效果很重要。
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