162. Opioid usage patterns, patient characteristics, and the role of chiropractic services in a publicly funded inner city health care facility

Passmore, Steven; Manansala, Christian; Malone, Quinn; Toth, E.A.; Olin, Gerald

doi:10.1016/j.spinee.2019.05.179

Cited by 5 publications

(12 citation statements)

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“…Similar findings have been reported by two other recent observational studies [20,21]; however, the association between receipt of chiropractic services and continued opioid use in patients with existing opioid prescriptions is uncertain [22][23][24]. Moreover, previously published studies on the topic of chiropractic care and opioid prescribing have lacked in-depth, contextual understanding because they have been exclusively quantitative in nature [17][18][19][20][21][22][23][24].…”

supporting

confidence: 73%

“…A subsequent observational study of 216,504 opioid-naive patients with new-onset low back pain who received initial treatment from chiropractors versus primary care physicians had 90% lower odds of short-term opioid use (adjusted OR = 0.10; 95% CI, 0.09 to 0.10) and 78% lower odds of long-term opioid use (adjusted OR = 0.22; 95% CI, 0.18 to 0.26) [18,19]. Similar findings have been reported by two other recent observational studies [20,21]; however, the association between receipt of chiropractic services and continued opioid use in patients with existing opioid prescriptions is uncertain [22][23][24]. Moreover, previously published studies on the topic of chiropractic care and opioid prescribing have lacked in-depth, contextual understanding because they have been exclusively quantitative in nature [17][18][19][20][21][22][23][24].…”

mentioning

confidence: 59%

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The association between chiropractic integration in an Ontario community health centre and continued prescription opioid use for chronic non-cancer spinal pain: a sequential explanatory mixed methods study

Emary

Brown²,

Oremus

et al. 2022

BMC Health Serv Res

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Background: Emerging evidence suggests that access to chiropractic care may reduce the likelihood of initiating an opioid prescription for spinal pain; however, the impact of chiropractic care for patients already prescribed opioids is uncertain. We undertook a sequential explanatory mixed methods study to evaluate the association between initiating chiropractic care and continued opioid use among adult patients attending an Ontario community health centre (CHC) and receiving opioid therapy for chronic non-cancer spinal pain. Methods: We conducted a retrospective cohort study of 210 patient records between January 1, 2014 and December 31, 2020. We used generalized estimating equations, adjusted for patient demographics, co-morbidities, visit frequency, and calendar year, to evaluate the association between receipt versus non-receipt of chiropractic services and continued opioid use (e.g., unique opioid fills, number of refills, and dosages) up to one year following the index chiropractic visit. We also completed follow-up interviews with 14 patients and nine general practitioners from the CHC and integrated these data with our quantitative findings. Results: Over 12-month follow-up, there were lower rates of opioid fills (incidence rate ratio [IRR] = 0.66; 95% confidence interval [CI], 0.52–0.83) and refills (IRR = 0.27; 95% CI, 0.17–0.42) among chiropractic recipients (n = 49) versus non-recipients (n = 161). Although patients who did and did not receive chiropractic care began the study with the same dose of opioids, recipients were less likely to be prescribed higher-dose opioids (i.e., ≥ 50 mg morphine equivalents daily) compared to non-recipients at three months (odds ratio [OR] = 0.14; 95% CI, 0.04–0.47), six months (OR = 0.14; 95% CI, 0.05–0.40), nine months (OR = 0.19; 95% CI, 0.07–0.57), and 12 months (OR = 0.22; 95% CI, 0.08–0.62). Interviews suggested that patient self-efficacy, limited effectiveness of opioids for chronic pain, stigma regarding use of opioids, and access to chiropractic treatment were important influencing factors. Conclusion: We found that continued prescription opioid use among patients with chronic non-cancer spinal pain who received chiropractic care was lower than in patients who did not receive chiropractic care. Four themes emerged in our qualitative interviews to help provide a richer understanding of this association. Randomized controlled trials are needed to establish the effect of chiropractic care on opioid use for chronic spinal pain.

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confidence: 73%

mentioning

confidence: 59%

The association between chiropractic integration in an Ontario community health centre and continued prescription opioid use for chronic non-cancer spinal pain: a sequential explanatory mixed methods study

Emary

Brown²,

Oremus

et al. 2022

BMC Health Serv Res

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“… 16 - 19 Integrating chiropractic care in a low-income, urban clinic in Winnipeg, Canada not only reduced spinal and extremity pain, but also decreased opioid use. 20 There is also a foundation for on-site integration for pain management at the primary care level within the community health center (CHC), with proven feasibility and patient satisfaction, and opportunity for inter-professional collaboration. 5 , 21 - 25 However, there are few quantitative studies of pain management integration into CHCs.…”

Section: Introductionmentioning

confidence: 99%

Integrating a Multidisciplinary Pain Team and Chiropractic Care in a Community Health Center: An Observational Study of Managing Chronic Spinal Pain

Prater

Tepe²,

Battaglia

2020

J Prim Care Community Health

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Background Chronic spinal pain is one of the most common diseases in the United States. Underserved patients are most affected, and disproportionately may use opioid medications as they lack access to other therapies. It is therefore important to develop systems to treat spinal pain within the primary medical home. Methods We designed a prospective observational pilot study at a community health center to measure the effectiveness of two interventions among an underserved population: a multidisciplinary pain team and chiropractic care. Study outcomes were pain and functional disability measured by the Pain Disability Questionnaire (PDQ), and reduction of opioid dose at baseline and 6-12 months. Multivariate linear regression was used to determine associating factors for change in PDQ scores. Results Thirty-five individuals completed baseline and follow-up PDQs from August 2018 to May 2020. Overall, the mean baseline PDQ was 92.4 +/− 6.1 and the mean follow-up PDQ was 81.9 +/− 7.7, resulting in a mean improvement of −10.6 (95% CI 1.2 - −22.3, P = .08). Participants in the chiropractic team (mean change −25.0, P = .01) and those completing the study before COVID-19 (mean change = −22.6, P < .01) were found to have significantly greater improvement at follow-up. Conclusion This observational study within a community health center resulted in improvement in spinal pain and disability with chiropractic care versus a multidisciplinary pain team. Offering similar services in primary care may help to address pain and disability, and hopefully limit external referrals, advanced imaging, and opioid prescriptions.

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“…11 Since 2007, a growing number of primary care centres in Canada have reported on their experiences with integration of chiropractic services into chronic pain management. [12][13][14][15][16][17][18][19] Findings from these reports describe Strengths and limitations of this study ► We will link electronic medical records with medical drug claims data from the Institute for Clinical Evaluative Sciences to validate patient opioid prescriptions and dosages. ► Generalised estimating equations will be used to account for hierarchical clustering and to control for differences in confounding factors between our exposure and comparison groups.…”

Section: Introductionmentioning

confidence: 99%

“…Open access improvements in pain intensity and disability and high levels of patient satisfaction; additional outcomes include reductions in physician visits, specialist referrals, advanced imaging and prescribing of opioid and non-opioid analgesics. [12][13][14][15][16][17][18][19] However, these studies [12][13][14][15][16][17][18][19] employed single cohort, pre-post designs (ie, no comparison groups), thereby preventing a formal assessment of whether chiropractic integration improved chronic pain management compared with standard practice. 20 Comparative assessments of the integration of chiropractic services into primary care settings are sparse, 21 22 and the impact of such integration on prescription opioid use in chronic pain management remains uncertain.…”

mentioning

confidence: 99%

Association of chiropractic integration in an Ontario community health centre with prescription opioid use for chronic non-cancer pain: a mixed methods study protocol

et al. 2021

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IntroductionEmerging evidence from a number of primary care centres suggests that integration of chiropractic services into chronic pain management is associated with improved clinical outcomes and high patient satisfaction as well as with reductions in physician visits, specialist referrals use of advanced imaging and prescribing of analgesics. However, formal assessments of the integration of chiropractic services into primary care settings are sparse, and the impact of such integration on prescription opioid use in chronic pain management remains uncertain. To help address this knowledge gap, we will conduct a mixed methods health service evaluation of an integrated chiropractic back pain programme in an urban community health centre in Ontario, Canada. This centre provides services to vulnerable populations with high unemployment rates, multiple comorbidities and musculoskeletal disorders that are commonly managed with prescription opioids.Methods and analysisWe will use a sequential explanatory mixed methods design, which consists of a quantitative phase followed by a qualitative phase. In the quantitative phase, we will conduct a retrospective chart review and evaluate whether receipt of chiropractic services is associated with reduced opioid use among patients already prescribed opioid therapy for chronic pain. We will measure opioid prescriptions (ie, opioid fills, number of refills and dosages) by reviewing electronic medical records of recipients and non-recipients of chiropractic services between 1 January 2014 and 31 December 2020 and use multivariable regression analysis to examine the association. In the qualitative phase, we will conduct in-depth, one-on-one interviews of patients and their general practitioners to explore perceptions of chiropractic integration and its impact on opioid use.Ethics and disseminationThis study was approved by the Hamilton Integrated Research Ethics Board at McMaster University (approval number 2021–10930). The results will be disseminated via peer-reviewed publications, conference presentations and in-person or webinar presentations to community members and healthcare professionals.

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162. Opioid usage patterns, patient characteristics, and the role of chiropractic services in a publicly funded inner city health care facility

Cited by 5 publications

References 0 publications

The association between chiropractic integration in an Ontario community health centre and continued prescription opioid use for chronic non-cancer spinal pain: a sequential explanatory mixed methods study

The association between chiropractic integration in an Ontario community health centre and continued prescription opioid use for chronic non-cancer spinal pain: a sequential explanatory mixed methods study

Integrating a Multidisciplinary Pain Team and Chiropractic Care in a Community Health Center: An Observational Study of Managing Chronic Spinal Pain

Association of chiropractic integration in an Ontario community health centre with prescription opioid use for chronic non-cancer pain: a mixed methods study protocol

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