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A cross-sectional survey exploring clinician perceptions of a novel Medicaid back pain policy

  • Catherine J. Livingston ORCID logo EMAIL logo , Mary Gray , Kate LaForge und Esther K. Choo
Veröffentlicht/Copyright: 31. Oktober 2022
Journal of Complementary and Integrative Medicine
Aus der Zeitschrift Journal of Complementary and Integrative Medicine Band 20 Heft 2

Abstract

Objectives

Oregon Medicaid (Oregon Health Plan, or OHP) implemented an innovative policy in 2016 that increased coverage of evidence-based non-pharmacologic therapies (NPT, including physical therapy, massage, chiropractic, and acupuncture) while restricting opioids, epidural steroid injections, and surgeries. The objective of this study was to compare the perspectives of clinicians who see back pain patients and can prescribe pharmacologic therapies and/or refer to NPTs and clinicians who directly provide NPT therapies affected by the policy.

Methods

A cross-sectional online survey was administered to Oregon prescribing clinicians and NPT clinicians between December 2019 and February 2020. The survey was completed by 107 prescribing clinicians and 83 NPT clinicians.

Results

Prescribing clinicians and NPT clinicians had only moderate levels of familiarity with core elements of the policy. Prescribing clinicians had higher levels of frustration caring for OHP patients with back pain than NPT clinicians (83 vs. 34%, p<0.001) and were less confident in their ability to provide effective care (73 vs. 85%, p = .025). Eighty-six percent of prescribing clinicians and 83% of NPT clinicians thought active NPT treatments were effective; 74 and 70% thought passive NPT treatments were effective. Forty percent of prescribing clinicians and 25% of NPT clinicians (p<0.001) thought medically-light therapies were effective, while 29% of prescribing clinicians and 10% of NPT clinicians thought medically-intensive treatments were effective (p=0.001). Prescribing clinicians thought increased access to NPTs improved outcomes, while opinions were less consistent on the impact of restricting opioid prescribing.

Conclusions

Prescribing clinicians and NPT clinicians had varying perspectives of a Medicaid coverage policy to increase evidence-based back pain care. Understanding these perspectives is important for contextualizing policy effectiveness.

Keywords: back pain; healthcare policies; Medicaid; non-pharmacological treatment; opioids
Corresponding author: Catherine J. Livingston, MD, MPH, Department of Family Medicine, Oregon Health & Science University, 3930 SE Division Street, Portland, Oregon, 97202, USA, Phone: 97202 (503) 957-1392, E-mail:

Funding source: National Institute on Drug Abuse

Award Identifier / Grant number: 5 R01 DA047323-01A1

Acknowledgments

The authors would like to acknowledge Gillian Leichtling for editorial review, and Rani George and Diana Flores for project support.

  1. Research funding: This work was supported by the National Institutes of Health, National Institute on Drug Abuse (5 R01 DA047323-01A1).

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission. CRediT author statement: Catherine Livingston: Writing – Original Draft, Formal analysis, Investigation, Supervision, Funding acquisition, Conceptualization. Mary Gray: Writing – Review & Editing, Software, Formal analysis, Investigation, Methodology, Supervision, Conceptualization. Kate LaForge: Conceptualization, Writing – Review & Editing. Esther Choo: Writing – Review & Editing, Methodology, Investigation, Supervision, Funding acquisition, Conceptualization.

  3. Competing interests: Dr. Livingston reports grants from the National Institute on Drug Abuse (NIDA/NIH) for this research and a previous contract with the Kaiser Permanente Health Research Institute for an advisory role of a research study on this back pain policy. Dr. Livingston previously served as the Associate Medical Director of the Health Evidence Review Commission and is currently employed as the Medical Director of Health Share of Oregon. This potential conflict of interest has been reviewed and managed by Oregon Health & Science University.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The study was approved by the OHSU Institutional Review Board (IRB#18725).

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Received: 2022-06-09
Accepted: 2022-10-03
Published Online: 2022-10-31

© 2022 Walter de Gruyter GmbH, Berlin/Boston

Artikel in diesem Heft

  1. Frontmatter
  2. Reviews
  3. Osteopathic structure/function models renovation for a person-centered approach: a narrative review and integrative hypothesis
  4. Exploring the scope of homoeopathy in combating the unfortunate consequences of post-COVID-19 survivors based on non-COVID conditions: a narrative review
  5. Efficacy and safety of Ayurveda interventions for sinusitis: a systematic review and meta-analysis
  6. Evening primrose oil for cervical ripening in term pregnancies: a systematic review and meta-analysis
  7. Effect of cell phone use on salivary components; a review of literature
  8. Research Articles
  9. Bombax ceiba Linn. leaf extract rich in phenolic compounds to mitigate non-alcoholic fatty liver-related complications in experimental model
  10. Antidiabetic, antihyperlipidemic and protective effects of Gladiolus psittacinus on hyperglycemia-mediated oxidative stress in streptozotocin-induced diabetic rats
  11. In vitro immunomodulatory activity study of Garcinia cowa Roxb. fraction
  12. Crude extract from Euphorbia prostrata extended curative period of glibenclemide in alloxan-induced diabetic rats
  13. Milicia excelsa (Moraceae) reversed the effects of letrozole-induced aromatase inhibition in rats with polycystic ovary syndrome
  14. Protective effects of cinnamon on acetylcholinesterase activity and memory dysfunction in diabetic rats
  15. Anti-osteoporotic effect of Terminalia arjuna (Roxb.) Wight & Arn. in bilateral ovariectomized induced post-menopausal osteoporosis in experimental rats
  16. Anti-inflammatory effect of polyherbal composition with hepatoprotective and choleretic properties on LPS-stimulated murine macrophages
  17. Degradation product of curcumin restrain Salmonella typhimurium virulent protein L-asparaginase
  18. β-Elemene regulates epithelial-mesenchymal transformation and inhibits invasion and metastasis of colorectal cancer cells
  19. Palpatory tests in manual therapies: an international survey on osteopathic clinical practice
  20. A cross-sectional survey exploring clinician perceptions of a novel Medicaid back pain policy
  21. A neurotherapy protocol to remediate cognitive deficits after adjuvant chemotherapy: a pilot study
  22. Evaluation of the effectiveness of Lactuca Sativa syrup in controlling pain after periodontal flap surgery: a split-mouth, randomized, double-blind placebo-controlled trial
  23. Variation determinants within massage therapists’ professional identity
  24. Effects of complementary spiritual therapy on stress, anxiety, burnout syndrome and hematological parameters of professionals in a public hospital: a randomized controlled trial
  25. Effects of Yogic practices on cardiovascular system and salivary alpha amylase on Indian healthy jail inmates
  26. Short-term effects of a maqui-based nutraceutical on heart rate variability, psycho-physical resilience and on a few metabolic biomarkers: a randomized controlled study
  27. Screening and validation of the iris manifestation among patients with hemiplegia – an observational study
  28. Case Report
  29. Case study of clinical improvement of atopic dermatitis in a patient treated with herbal-based parapharmaceuticals
  30. Congress Abstracts
  31. Abstracts from 2020 INCAM Research Symposium: Integrative Health at the Crossroads: Learning from the Past, Co-Creating the Future
https://doi.org/10.1515/jcim-2022-0213
Schlagwörter für diesen Artikel
back pain; healthcare policies; Medicaid; non-pharmacological treatment; opioids

Artikel in diesem Heft

  1. Frontmatter
  2. Reviews
  3. Osteopathic structure/function models renovation for a person-centered approach: a narrative review and integrative hypothesis
  4. Exploring the scope of homoeopathy in combating the unfortunate consequences of post-COVID-19 survivors based on non-COVID conditions: a narrative review
  5. Efficacy and safety of Ayurveda interventions for sinusitis: a systematic review and meta-analysis
  6. Evening primrose oil for cervical ripening in term pregnancies: a systematic review and meta-analysis
  7. Effect of cell phone use on salivary components; a review of literature
  8. Research Articles
  9. Bombax ceiba Linn. leaf extract rich in phenolic compounds to mitigate non-alcoholic fatty liver-related complications in experimental model
  10. Antidiabetic, antihyperlipidemic and protective effects of Gladiolus psittacinus on hyperglycemia-mediated oxidative stress in streptozotocin-induced diabetic rats
  11. In vitro immunomodulatory activity study of Garcinia cowa Roxb. fraction
  12. Crude extract from Euphorbia prostrata extended curative period of glibenclemide in alloxan-induced diabetic rats
  13. Milicia excelsa (Moraceae) reversed the effects of letrozole-induced aromatase inhibition in rats with polycystic ovary syndrome
  14. Protective effects of cinnamon on acetylcholinesterase activity and memory dysfunction in diabetic rats
  15. Anti-osteoporotic effect of Terminalia arjuna (Roxb.) Wight & Arn. in bilateral ovariectomized induced post-menopausal osteoporosis in experimental rats
  16. Anti-inflammatory effect of polyherbal composition with hepatoprotective and choleretic properties on LPS-stimulated murine macrophages
  17. Degradation product of curcumin restrain Salmonella typhimurium virulent protein L-asparaginase
  18. β-Elemene regulates epithelial-mesenchymal transformation and inhibits invasion and metastasis of colorectal cancer cells
  19. Palpatory tests in manual therapies: an international survey on osteopathic clinical practice
  20. A cross-sectional survey exploring clinician perceptions of a novel Medicaid back pain policy
  21. A neurotherapy protocol to remediate cognitive deficits after adjuvant chemotherapy: a pilot study
  22. Evaluation of the effectiveness of Lactuca Sativa syrup in controlling pain after periodontal flap surgery: a split-mouth, randomized, double-blind placebo-controlled trial
  23. Variation determinants within massage therapists’ professional identity
  24. Effects of complementary spiritual therapy on stress, anxiety, burnout syndrome and hematological parameters of professionals in a public hospital: a randomized controlled trial
  25. Effects of Yogic practices on cardiovascular system and salivary alpha amylase on Indian healthy jail inmates
  26. Short-term effects of a maqui-based nutraceutical on heart rate variability, psycho-physical resilience and on a few metabolic biomarkers: a randomized controlled study
  27. Screening and validation of the iris manifestation among patients with hemiplegia – an observational study
  28. Case Report
  29. Case study of clinical improvement of atopic dermatitis in a patient treated with herbal-based parapharmaceuticals
  30. Congress Abstracts
  31. Abstracts from 2020 INCAM Research Symposium: Integrative Health at the Crossroads: Learning from the Past, Co-Creating the Future
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