Abstract：
BACKGROUND: A novel Oregon Medicaid policy guiding back pain management combined opioid restrictions with emphasis on non-opioid and non-pharmacologic therapies.
OBJECTIVE: To examine the effect of the policy on prescribing, health outcomes, and health service utilization.
METHODS: 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.
METHODS: Adult Medicaid patients with back pain enrolled between 2014 and 2018.
METHODS: The Oregon Medicaid back pain policy.
METHODS: Opioid and non-opioid medication prescribing, procedural care, substance use and mental health conditions, and outpatient and inpatient healthcare utilization.
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.
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.
OBJECTIVE: To examine the effect of the policy on prescribing, health outcomes, and health service utilization.
METHODS: 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.
METHODS: Adult Medicaid patients with back pain enrolled between 2014 and 2018.
METHODS: The Oregon Medicaid back pain policy.
METHODS: Opioid and non-opioid medication prescribing, procedural care, substance use and mental health conditions, and outpatient and inpatient healthcare utilization.
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.
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.
摘要：
背景：俄勒冈州一项新的指导背痛管理的医疗补助政策将阿片类药物限制与强调非阿片类药物和非药物治疗相结合。
目的：为了研究该政策对处方的影响，健康结果，和卫生服务利用。
方法：使用医疗补助登记，医疗和处方索赔，处方药监测计划，和生命统计文件，我们使用中断时间序列模型分析了政策与选定结果的关联。
方法：2014年至2018年招募了患有背痛的成年医疗补助患者。
方法：俄勒冈医疗补助背痛政策。
方法：阿片类药物和非阿片类药物处方，程序护理，物质使用和心理健康状况，以及门诊和住院医疗服务的利用。
结果：该政策与接受任何阿片类药物（-2.68个百分点[95%CI-3.14，-2.23]水平，-1.01页[95%CI-1.1，-0.92]斜率)，短效阿片类药物使用天数（-0.4天[95%CI-0.53，-0.26]斜率），接受超过7天的短效阿片类药物(-2.36pp[95%CI-2.76，-1.95]水平，-0.91pp[95%CI-1，-0.83]斜率），慢性阿片类药物使用（-1.27pp[95%CI-1.59，-0.94]水平，-0.46[95%CI-0.53，-0.39斜率），以及脊柱手术和程序。在次要结果中，我们没有发现阿片类药物过量的增加，阿片类药物使用障碍有统计学显著趋势下降。非阿片类物质的使用和心理健康诊断和就诊略有增加，但自我伤害没有增加。
结论：强调循证背痛管理的州医疗补助政策与阿片类药物处方的减少有关，脊柱手术,和阿片类药物使用障碍的趋势，但也有短期增加的精神健康遭遇和非阿片类物质使用障碍趋势的增加。这些政策可能有助于加强循证护理，但在设计时必须考虑潜在的危害。
目的：为了研究该政策对处方的影响，健康结果，和卫生服务利用。
方法：使用医疗补助登记，医疗和处方索赔，处方药监测计划，和生命统计文件，我们使用中断时间序列模型分析了政策与选定结果的关联。
方法：2014年至2018年招募了患有背痛的成年医疗补助患者。
方法：俄勒冈医疗补助背痛政策。
方法：阿片类药物和非阿片类药物处方，程序护理，物质使用和心理健康状况，以及门诊和住院医疗服务的利用。
结果：该政策与接受任何阿片类药物（-2.68个百分点[95%CI-3.14，-2.23]水平，-1.01页[95%CI-1.1，-0.92]斜率)，短效阿片类药物使用天数（-0.4天[95%CI-0.53，-0.26]斜率），接受超过7天的短效阿片类药物(-2.36pp[95%CI-2.76，-1.95]水平，-0.91pp[95%CI-1，-0.83]斜率），慢性阿片类药物使用（-1.27pp[95%CI-1.59，-0.94]水平，-0.46[95%CI-0.53，-0.39斜率），以及脊柱手术和程序。在次要结果中，我们没有发现阿片类药物过量的增加，阿片类药物使用障碍有统计学显著趋势下降。非阿片类物质的使用和心理健康诊断和就诊略有增加，但自我伤害没有增加。
结论：强调循证背痛管理的州医疗补助政策与阿片类药物处方的减少有关，脊柱手术,和阿片类药物使用障碍的趋势，但也有短期增加的精神健康遭遇和非阿片类物质使用障碍趋势的增加。这些政策可能有助于加强循证护理，但在设计时必须考虑潜在的危害。
