Opioid Use Among Veterans of Recent Wars Receiving Veterans Affairs Chiropractic Care

Lisi, Anthony J.; Corcoran, Kelsey; DeRycke, Eric; Bastian, Lori A.; Becker, William C.; Edmond, Sara N.; Goertz, Christine; Goulet, Joseph L.; Haskell, Sally G.; Higgins, Diana M.; Kawecki, Todd; Kerns, Robert D.; Mattocks, Kristin M.; Ramsey, Christine M.; Ruser, Christopher; Brandt, Cynthia

doi:10.1093/pm/pny114

Cited by 31 publications

(21 citation statements)

References 30 publications

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“…For example, although our data were insufficient to analyze for risk of opioid use, several recent studies have found that utilization of nonpharmacologic pain therapies leads to decreased opioid use. [17][18][19][20][21] Future research could explore the benefit of the PSC model in reducing overprescription of opioids. Additionally, we cannot be certain that variation in access to care was identical across the 3 sites; however, the 3 sites are part of the same health care system that strives for standardization, including monitoring a metric from time of patient call to time seen in clinic.…”

Section: T a G G E D H 1 Discussiont A G G E D E N Dmentioning

confidence: 99%

Implementation of the Primary Spine Care Model in a Multi-Clinician Primary Care Setting: An Observational Cohort Study

Whedon

Toler

Bezdjian

et al. 2020

Journal of Manipulative and Physiological Therapeutics

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Section: T a G G E D H 1 Discussiont A G G E D E N Dmentioning

confidence: 99%

Implementation of the Primary Spine Care Model in a Multi-Clinician Primary Care Setting: An Observational Cohort Study

Whedon

Toler

Bezdjian

et al. 2020

Journal of Manipulative and Physiological Therapeutics

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“…For instance, opioid overuse/misuse has been frequently reported among individuals of low socioeconomic status and those with behavioural health problems. 36 37 Chronic pain is prevalent among these groups, [31][32][33][34][35][36][37][38][39] and a primary motivation of chronic pain sufferers for misusing opioids is to relieve physical pain. 37 Therefore, our regression analyses described below ('quantitative data analysis') will control for these variables.…”

Section: Aimmentioning

confidence: 99%

“…These variables have been shown to be associated with CNCP and opioid use. [31][32][33][34][35][36][37][38][39] In our analysis, we will explore variance inflation factors (VIFs) to assess collinearity between independent variables. If multicollinearity is detected between two or more variables (ie, VIFs ≥10), 49 then we will compare regression models, each separately containing one of the collinear variables, to one another and select the model containing the variable that produces the lowest Akaike information criterion.…”

Section: Quantitative Data Collectionmentioning

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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“…[5] The high prevalence of these pain conditions and the potential negative effects of prescription opioid use underscore the need to adhere to clinical practice guidelines -which recommend non-pharmacological therapies as frontline treatments --in the management of MSK conditions. [6,7] Prior work has shown a negative association between chiropractic use and opioid prescriptions among Veterans of recent wars [8] and other United States populations. [9] In 2016, VA Health Services Research and Development State-of-the-Art Conference on Non-Pharmacological Treatments for Chronic Pain recommended the increased uptake of evidence-based non-pharmacological approaches by VA facilities.…”

Section: Introductionmentioning

confidence: 99%

Trends in Veteran population use of Veterans Affairs chiropractic care

Burdick

Corcoran

Zhao

et al. 2021

Preprint

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Background The US Department of Veterans Affairs (VA) has initiated various approaches to provide chiropractic care to Veterans. Prior work has shown substantial increase in use of VA chiropractic care between fiscal years (FY) 2005-2016. However, the extent of the availability of these services to the Veteran population remains unclear. The purpose of this study was to analyze the rate of Veteran use of VA chiropractic services, both from on-site care at VA facilities and VA purchased care from community care providers. This study analyzed facility characteristics associated with chiropractic use by both care delivery mechanisms (on-site and in the community).Methods Cross-sectional analyses of administrative data were conducted for FY 2014-19. Data were obtained from VA’s Corporate Data Warehouse. The variables extracted included number of unique Veterans receiving VA chiropractic care on-site and in the community, total Veteran population of the VA facilities, size of the VA chiropractic workforce (measured as Full-Time Equivalent, FTE), and facility characteristics (geographic region and the facility complexity). Descriptive statistics, mixed model, and multivariant models were used to analyze data.Results Use of VA chiropractic care increased over the six-year period for both on-site and community care. National average for on-site use of the population was 1.27% in FY14 and 1.48% in FY19. Community care use was 0.29% and 1.76% for the same years. Use at individual facilities varied widely in each FY. Factors such as chiropractor FTE, geographic locations, and the complexity of the VA facility are associated with use of chiropractic services. ConclusionThe VA has expanded the non-pharmacologic treatments available to Veterans by providing chiropractic services, yet chiropractic use remains low compared to other US populations. As Veterans have a high prevalence of pain and musculoskeletal conditions, continued work to assess and achieve the optimal levels of chiropractic use in this population is warranted.

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Opioid Use Among Veterans of Recent Wars Receiving Veterans Affairs Chiropractic Care

Cited by 31 publications

References 30 publications

Implementation of the Primary Spine Care Model in a Multi-Clinician Primary Care Setting: An Observational Cohort Study

Implementation of the Primary Spine Care Model in a Multi-Clinician Primary Care Setting: An Observational Cohort Study

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

Trends in Veteran population use of Veterans Affairs chiropractic care

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