TY  - JOUR
PY  - 2024//
TI  - Outcomes after a statewide policy to improve evidence-based treatment of back pain among Medicaid enrollees in Oregon
JO  - Journal of general internal medicine
A1  - Choo, Esther K.
A1  - Charlesworth, Christina J.
A1  - Livingston, Catherine J.
A1  - Hartung, Daniel M.
A1  - El Ibrahimi, Sanae
A1  - Kraynov, Liliya
A1  - McConnell, K. John
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - BACKGROUND: A novel Oregon Medicaid policy guiding back pain management combined opioid restrictions with emphasis on non-opioid and non-pharmacologic therapies. <br><br>OBJECTIVE: To examine the effect of the policy on prescribing, health outcomes, and health service utilization. <br><br>DESIGN: Using Medicaid enrollment, medical and prescription claims, prescription drug monitoring program, and vital statistics files, we analyzed the policy's association with selected outcomes using interrupted time series models.     SUBJECTS: Adult Medicaid patients with back pain enrolled between 2014 and 2018.     INTERVENTION: The Oregon Medicaid back pain policy.     MAIN MEASURES: Opioid and non-opioid medication prescribing, procedural care, substance use and mental health conditions, and outpatient and inpatient healthcare utilization.     KEY RESULTS: The policy was associated with decreases in the percentage of Medicaid enrollees with back pain receiving any opioids (- 2.68 percentage points [95% CI - 3.14, - 2.23] level, - 1.01 pp [95% CI - 1.1, - 0.92] slope), days of short-acting opioid use (- 0.4 days [95% CI - 0.53, - 0.26] slope), receipt of more than 7 days of short-acting opioids (- 2.36 pp [95% CI - 2.76, - 1.95] level, - 0.91 pp [95% CI - 1, - 0.83] slope), chronic opioid use (- 1.27 pp [95% CI - 1.59, - 0.94] level, - 0.46 [95% CI - 0.53, - 0.39 slope), and spinal surgeries and procedures. Among secondary outcomes, we found no increase in opioid overdose and a small, statistically significant trend decrease in opioid use disorders. There were small increases in non-opioid substance use and mental health diagnoses and visits but no increase in self-harm. <br><br>CONCLUSIONS: A state Medicaid policy emphasizing evidence-based back pain management was associated with decreases in opioid prescribing, spinal surgeries, and opioid use disorder trends, but also short-term increases in mental health encounters and an increase in non-opioid substance use disorder trends. Such policies may help reinforce evidence-based care, but must be designed with consideration of potential harms.<p />  <p>Language: en</p>
LA  - en
SN  - 0884-8734
UR  - http://dx.doi.org/10.1007/s11606-024-08776-w
ID  - ref1
ER  -