Relationship of Opioid Prescriptions to Physical Therapy Referral and Participation for Medicaid Patients with New-Onset Low Back Pain

Thackeray, Anne; Hess, Rachel; Dorius, Josette; Brodke, Darrel S.; Fritz, Julie M.

doi:10.3122/jabfm.2017.06.170064

Cited by 55 publications

(32 citation statements)

References 30 publications

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“…Fritz et al found that early PT was associated with decreased opioid prescriptions,32 and a review by Ojha et al noted that early PT as treatment for musculoskeletal disorders was associated with decreased frequency of opioid prescriptions, although this was based on a limited number of outcomes 33. Thackerary et al also suggested that the odds of receiving an opioid prescription among Medicaid beneficiaries were reduced for those who had a PT consult, as compared with those who did not 34. While these studies did not measure the odds of opioid use among patients who initially saw physical therapists compared with other initial providers, our results are consistent with previously published reports that PT is associated with lower odds of opioid use.…”

Section: Discussionmentioning

confidence: 99%

Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use

et al. 2019

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ObjectiveThis study examined the association of initial provider treatment with early and long-term opioid use in a national sample of patients with new-onset low back pain (LBP).DesignA retrospective cohort study of patients with new-onset LBP from 2008 to 2013.SettingThe study evaluated outpatient and inpatient claims from patient visits, pharmacy claims and inpatient and outpatient procedures with initial providers seen for new-onset LBP.Participants216 504 individuals aged 18 years or older across the USA who were diagnosed with new-onset LBP and were opioid-naïve were included. Participants had commercial or Medicare Advantage insurance.ExposuresThe primary independent variable is type of initial healthcare provider including physicians and conservative therapists (physical therapists, chiropractors, acupuncturists).Main outcome measuresShort-term opioid use (within 30 days of the index visit) following new LBP visit and long-term opioid use (starting within 60 days of the index date and either 120 or more days’ supply of opioids over 12 months, or 90 days or more supply of opioids and 10 or more opioid prescriptions over 12 months).ResultsShort-term use of opioids was 22%. Patients who received initial treatment from chiropractors or physical therapists had decreased odds of short-term and long-term opioid use compared with those who received initial treatment from primary care physicians (PCPs) (adjusted OR (AOR) (95% CI) 0.10 (0.09 to 0.10) and 0.15 (0.13 to 0.17), respectively). Compared with PCP visits, initial chiropractic and physical therapy also were associated with decreased odds of long-term opioid use in a propensity score matched sample (AOR (95% CI) 0.21 (0.16 to 0.27) and 0.29 (0.12 to 0.69), respectively).ConclusionsInitial visits to chiropractors or physical therapists is associated with substantially decreased early and long-term use of opioids. Incentivising use of conservative therapists may be a strategy to reduce risks of early and long-term opioid use.

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Section: Discussionmentioning

confidence: 99%

Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use

et al. 2019

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“…The aim of this study was to derive a CPR to identify patients who might be more likely to become chronic users of prescription opioids after orthopedic hip surgery. While other studies have utilized prescription data to define chronic opioid use (Fritz et al 2018 ; Sites et al 2018 ; Thackeray et al 2017 ), this study is the first to develop a clinical prediction rule based on opioid prescription patterns validated from pharmacy data in claims records. The focus of our investigation was to better understand variables that may improve clinical decision-making related to managing patients that are taking opioids after surgery and at the same time generate hypotheses for future trials.…”

Section: Discussionmentioning

confidence: 99%

Predictors of chronic prescription opioid use after orthopedic surgery: derivation of a clinical prediction rule.

et al. 2018

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BackgroundPrescription opioid use at high doses or over extended periods of time is associated with adverse outcomes, including dependency and abuse. The aim of this study was to identify mediating variables that predict chronic opioid use, defined as three or more prescriptions after orthopedic surgery.MethodsIndividuals were ages between 18 and 50 years and undergoing arthroscopic hip surgery between 2004 and 2013. Two categories of chronic opioid use were calculated based on individuals (1) having three or more unique opioid prescriptions within 2 years and (2) still receiving opioid prescriptions > 1 year after surgery. Univariate elationships were identified for each predictor variable, then significant variables (P > 0.15) were entered into a multivariate logistic regression model to identify the most parsimonious group of predictor variables for each chronic opioid use classification. Likelihood ratios were derived from the most robust groups of variables.ResultsThere were 1642 participants (mean age 32.5 years, SD 8.2, 54.1% male). Nine predictor variables met the criteria after bivariate analysis for potential inclusion in each multivariate model. Eight variables: socioeconomic status (from enlisted rank family), prior use of opioid medication, prior use of non-opioid pain medication, high health-seeking behavior before surgery, a preoperative diagnosis of insomnia, mental health disorder, or substance abuse were all predictive of chronic opioid use in the final model (seven variables for three or more opioid prescriptions; four variables for opioid use still at 1 year; all< 0.05). Post-test probability of having three or more opioid prescriptions was 93.7% if five of seven variables were present, and the probability of still using opioids after 1 year was 69.6% if three of four variables were present.ConclusionA combination of variables significantly predicted chronic opioid use in this cohort. Most of these variables were mediators, indicating that modifying them may be feasible, and the potential focus of interventions to decrease the risk of chronic opioid use, or at minimum better inform opioid prescribing decisions. This clinical prediction rule needs further validation.

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“…This contrasts with a number of claims-based studies indicating lower opioid prescribing in those patients engaging in PT. [35,36] However, these studies focus on outpatients, in whom our population of patients in the ED may significantly differ, both in terms of urgency of encounter and acute pain score. It may also be the case that PT has a more protective effect against opioid prescribing long-term, and is less effective as an opioid substitution therapy acutely at the point of ED discharge Further research may clarify the comparable rates of outpatient opioid prescribing between those who receive ED-PT and those who do not.…”

Section: Plos Onementioning

confidence: 99%

Dedicated emergency department physical therapy is associated with reduced imaging, opioid administration, and length of stay: A prospective observational study

et al. 2020

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Background Emergency department based Physical Therapy (ED-PT) has been practiced globally in various forms for over 20 years and is an emerging resource in the US. While there is a growing body of evidence suggesting that ED-PT has a positive effect on a number of clinical and operational outcomes in patients presenting with musculoskeletal (MSK) pain, there are few published narratives that quantify this in the US. Although there are international papers that offer outcome data on reduction of pain, imaging, throughput time, and the ability of physical therapists to appropriately manage MSK conditions in the ED setting, most papers to date have been descriptive in nature. The purpose of this study is to assess the impact of ED-PT on imaging studies obtained, rates of opioids prescribed, and ED length of stay. Methods We prospectively identified patients presenting with musculoskeletal pain to an urban academic ED in Salt Lake City between January 2017 and June 2018. During the study, a physical therapist was in the ED three days (24 hours) per week and was available to evaluate and treat patients after consultation by the ED provider. We noted patient demographic information, imaging performed in the ED, medications administered and prescribed, and ED length of stay. We classified patients as those who received PT in the ED and those who did not and compared clinical outcomes between groups. We performed a subgroup analysis of patients presenting with low back pain and matched patients by age and gender. Results Over the 18-month study period, we identified 524 patients presenting to the ED with musculoskeletal pain. 381 (72.7%) received ED-initiated PT. The PT and non-PT groups were similar in average age (42.8 years vs. 45.1 years, p = 0.155), gender (% female: 53% vs. 46.9%, p-0.209), and primary presenting chief complaint (cervical, thoracic, or lumbar pain:

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Relationship of Opioid Prescriptions to Physical Therapy Referral and Participation for Medicaid Patients with New-Onset Low Back Pain

Cited by 55 publications

References 30 publications

Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use

Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use

Predictors of chronic prescription opioid use after orthopedic surgery: derivation of a clinical prediction rule.

Dedicated emergency department physical therapy is associated with reduced imaging, opioid administration, and length of stay: A prospective observational study

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