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The Association Between the Supply of Nonpharmacologic Providers, Use of Nonpharmacologic Pain Treatments, and High-risk Opioid Prescription Patterns Among Medicare Beneficiaries With Persistent Musculoskeletal Pain.

Publication ,  Journal Article
Karmali, RN; Skinner, AC; Trogdon, JG; Weinberger, M; George, SZ; Hassmiller Lich, K
Published in: Med Care
May 2020

BACKGROUND: Opioids are prescribed more frequently than nonpharmacologic treatments for persistent musculoskeletal pain (MSP). We estimate the association between the supply of physical therapy (PT) and mental health (MH) providers and early nonpharmacologic service use with high-risk opioid prescriptions among Medicare beneficiaries with persistent MSP. RESEARCH DESIGN: We retrospectively studied Medicare beneficiaries (>65 y) enrolled in Fee-for-Service and Part D (2007-2014) with a new persistent MSP episode and no opioid prescription during the prior 6 months. Independent variables were nonpharmacologic provider supply per capita and early nonpharmacologic service use (any use during first 3 mo). One year outcomes were long-term opioid use (LTOU) (≥90 days' supply) and high daily dose (HDD) (≥50 mg morphine equivalent). We used multinomial regression and generalized estimating equations and present adjusted odds ratios (aORs). RESULTS: About 2.4% of beneficiaries had LTOU; 11.9% had HDD. The supply of MH providers was not associated with LTOU and HDD. Each additional PT/10,000 people/county was associated with greater odds of LTOU [aOR: 1.06; 95% confidence interval (CI), 1.01-1.11). Early MH use was associated with lower odds of a low-risk opioid use (aOR: 0.81; 95% CI, 0.68-0.96), but greater odds of LTOU (aOR: 1.93; 95% CI, 1.28-2.90). Among beneficiaries with an opioid prescription, early PT was associated with lower odds of LTOU (aOR: 0.75; 95% CI, 0.64-0.89), but greater odds of HDD (aOR: 1.25; 95% CI, 1.15-1.36). CONCLUSIONS: The benefits of nonpharmacologic services on opioid use may be limited. Research on effective delivery of nonpharmacologic services to reduce high-risk opioid use for older adults with MSP is needed.

Duke Scholars

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Published In

Med Care

DOI

EISSN

1537-1948

Publication Date

May 2020

Volume

58

Issue

5

Start / End Page

433 / 444

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • Physical Therapy Modalities
  • Musculoskeletal Pain
  • Mental Health Services
  • Medicare
  • Male
  • Humans
  • Health Policy & Services
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Karmali, R. N., Skinner, A. C., Trogdon, J. G., Weinberger, M., George, S. Z., & Hassmiller Lich, K. (2020). The Association Between the Supply of Nonpharmacologic Providers, Use of Nonpharmacologic Pain Treatments, and High-risk Opioid Prescription Patterns Among Medicare Beneficiaries With Persistent Musculoskeletal Pain. Med Care, 58(5), 433–444. https://doi.org/10.1097/MLR.0000000000001299
Karmali, Ruchir N., Asheley C. Skinner, Justin G. Trogdon, Morris Weinberger, Steven Z. George, and Kristen Hassmiller Lich. “The Association Between the Supply of Nonpharmacologic Providers, Use of Nonpharmacologic Pain Treatments, and High-risk Opioid Prescription Patterns Among Medicare Beneficiaries With Persistent Musculoskeletal Pain.Med Care 58, no. 5 (May 2020): 433–44. https://doi.org/10.1097/MLR.0000000000001299.

Published In

Med Care

DOI

EISSN

1537-1948

Publication Date

May 2020

Volume

58

Issue

5

Start / End Page

433 / 444

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • Physical Therapy Modalities
  • Musculoskeletal Pain
  • Mental Health Services
  • Medicare
  • Male
  • Humans
  • Health Policy & Services
  • Female