Cross-Sectional Analysis of Per Capita Supply of Doctors of Chiropractic and Opioid Use in Younger Medicare Beneficiaries

Weeks, William B.; Goertz, Christine

doi:10.1016/j.jmpt.2016.02.016

Cited by 18 publications

(16 citation statements)

References 12 publications

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“…The provision of chiropractic care is inversely correlated with opioid prescriptions among younger disabled Medicare beneficiaries under 65 years of age [ 12 ]. In the study by Kazis et al [ 9 ] 15% of subjects were beneficiaries of Medicare Advantage plans; otherwise, studies on the association between use of chiropractic care and use of opioids have been conducted on mostly younger populations of adults.…”

Section: Chiropractic Care As An Alternative To Opioid Analgesia For Spinal Painmentioning

confidence: 99%

Association between chiropractic care and use of prescription opioids among older medicare beneficiaries with spinal pain: a retrospective observational study

Whedon

Uptmor²,

Toler

et al. 2022

Chiropr Man Therap

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Background The burden of spinal pain can be aggravated by the hazards of opioid analgesics, which are still widely prescribed for spinal pain despite evidence-based clinical guidelines that identify non-pharmacological therapies as the preferred first-line approach. Previous studies have found that chiropractic care is associated with decreased use of opioids, but have not focused on older Medicare beneficiaries, a vulnerable population with high rates of co-morbidity and polypharmacy. The purpose of this investigation was to evaluate the association between chiropractic utilization and use of prescription opioids among older adults with spinal pain. Methods We conducted a retrospective observational study in which we examined a nationally representative multi-year sample of Medicare claims data, 2012–2016. The study sample included 55,949 Medicare beneficiaries diagnosed with spinal pain, of whom 9,356 were recipients of chiropractic care and 46,593 were non-recipients. We measured the adjusted risk of filling a prescription for an opioid analgesic for up to 365 days following diagnosis of spinal pain. Using Cox proportional hazards modeling and inverse weighted propensity scoring to account for selection bias, we compared recipients of both primary care and chiropractic to recipients of primary care alone regarding the risk of filling a prescription. Results The adjusted risk of filling an opioid prescription within 365 days of initial visit was 56% lower among recipients of chiropractic care as compared to non-recipients (hazard ratio 0.44; 95% confidence interval 0.40–0.49). Conclusions Among older Medicare beneficiaries with spinal pain, use of chiropractic care is associated with significantly lower risk of filling an opioid prescription.

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Section: Chiropractic Care As An Alternative To Opioid Analgesia For Spinal Painmentioning

confidence: 99%

Association between chiropractic care and use of prescription opioids among older medicare beneficiaries with spinal pain: a retrospective observational study

Whedon

Uptmor²,

Toler

et al. 2022

Chiropr Man Therap

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“…Non-opioid pharmacological (e.g., acetaminophen and nonsteroidal anti-inflammatory drugs) and non-pharmacological treatments (e.g., physical therapy, chiropractic, acupuncture, relaxation techniques, etc.) are not only shown to be associated with lower rates of opioid prescription and misuse [ 36 , 37 , 38 , 39 ], but reported to be as effective as opioids in managing pain conditions, especially chronic conditions [ 40 , 41 , 42 ]. As another medium, cannabis use or legalizing it in many U.S. states has been shown to be associated with lower rates of opioid prescriptions [ 43 , 44 , 45 , 46 ].…”

Section: Resultsmentioning

confidence: 99%

Misalignment of Stakeholder Incentives in the Opioid Crisis

Boloori

Arnetz

Viens

et al. 2020

IJERPH

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The current opioid epidemic has killed more than 446,000 Americans over the past two decades. Despite the magnitude of the crisis, little is known to what degree the misalignment of incentives among stakeholders due to competing interests has contributed to the current situation. In this study, we explore evidence in the literature for the working hypothesis that misalignment rooted in the cost, quality, or access to care can be a significant contributor to the opioid epidemic. The review identified several problems that can contribute to incentive misalignment by compromising the triple aims (cost, quality, and access) in this epidemic. Some of these issues include the inefficacy of conventional payment mechanisms in providing incentives for providers, practice guidelines in pain management that are not easily implementable across different medical specialties, barriers in adopting multi-modal pain management strategies, low capacity of providers/treatments to address opioid/substance use disorders, the complexity of addressing the co-occurrence of chronic pain and opioid use disorders, and patients’ non-adherence to opioid substitution treatments. In discussing these issues, we also shed light on factors that can facilitate the alignment of incentives among stakeholders to effectively address the current crisis.

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“…As noted by Weeks et al, 15 benefits of manipulation for low back pain, neck pain, and headaches are now reflected in guidelines recommendations internationally. Some evidence suggests that chiropractic care provides cost savings 15 and has been found to reduce the use of opioids and lower odds of developing long-term disability in workman’s compensation patients 16, 17. At least for lower back complaints, doctors of chiropractic (DCs) are increasingly being the first provider consulted 18 .…”

Section: Progress In Cultural Authoritymentioning

confidence: 99%

Core and Complementary Chiropractic: Lowering Barriers to Patient Utilization of Services

Triano

McGregor

2016

Journal of Chiropractic Humanities

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ObjectiveThe use of chiropractic services has stalled while interest in accessing manipulation services is rising. The purpose of this paper is to consider this dilemma in the context of the dynamics of professional socialization, surveys of public attitudes, and a potential strategic action.DiscussionThis is a reflection work grounded in the literature on professional socialization and the attitudes held regarding chiropractic in modern society, to include its members, and in original data on training programs. Data were interpreted on the background of the authors’ cross-cultural experiences spanning patient care, research, education, and interprofessional collaboration. Recommendation on a strategic action to counter barriers in patient referrals was synthesized. Professional socialization is the process by which society enables professional privilege. Illustration of typical and divergent professional socialization models emerged that explain cognitive dissonance toward the profession. Questions of trust are commensurate with the experiences during patient encounters rather than with a common identity for the profession. Diversity among encounters perpetuates the uncertainty that affects referral sources. Commonality as an anchor for consistent professional identity and socialization through the content of core chiropractic, defined by training and practice, offers a means to offset uncertainty. Complementary chiropractic, analogous to complementary medicine, provides an outlet under professional socialization for the interests to explore additional methods of care.ConclusionThe practice workplace is an effective lever for altering barriers to the use of services. Clarifying rhetoric through conceptualization of core and complementary practices simplifies the socialization dynamic. Further, it takes advantage of accepted cultural semantics in meaningful analogy while continuing to empower practical diversity in care delivery in response to evolving scientific evidence.

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Cross-Sectional Analysis of Per Capita Supply of Doctors of Chiropractic and Opioid Use in Younger Medicare Beneficiaries

Cited by 18 publications

References 12 publications

Association between chiropractic care and use of prescription opioids among older medicare beneficiaries with spinal pain: a retrospective observational study

Association between chiropractic care and use of prescription opioids among older medicare beneficiaries with spinal pain: a retrospective observational study

Misalignment of Stakeholder Incentives in the Opioid Crisis

Core and Complementary Chiropractic: Lowering Barriers to Patient Utilization of Services

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