TY - JOUR
T1 - A cross-sectional survey exploring clinician perceptions of a novel Medicaid back pain policy
AU - Livingston, Catherine J.
AU - Gray, Mary
AU - Laforge, Kate
AU - Choo, Esther K.
N1 - Funding Information:
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.
Funding Information:
Research funding: This work was supported by the National Institutes of Health, National Institute on Drug Abuse (5 R01 DA047323-01A1).
Publisher Copyright:
© 2022 Walter de Gruyter GmbH, Berlin/Boston.
PY - 2023/6/1
Y1 - 2023/6/1
N2 - 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.
AB - 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.
KW - Medicaid
KW - back pain
KW - healthcare policies
KW - non-pharmacological treatment
KW - opioids
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U2 - 10.1515/jcim-2022-0213
DO - 10.1515/jcim-2022-0213
M3 - Article
C2 - 36306465
AN - SCOPUS:85141339499
SN - 1553-3840
VL - 20
SP - 438
EP - 446
JO - Journal of Complementary and Integrative Medicine
JF - Journal of Complementary and Integrative Medicine
IS - 2
ER -