Medicare

Care for Low Back Pain: Can Health Systems Deliver?

By Frank M. Painter|March 30, 2020|Alternative Medicine, Low Back Pain, Medicare|

Care for Low Back Pain: Can Health Systems Deliver?

SOURCE: Bulletin of the World Health Organization 2019 (Jun 1)

Adrian C Traeger, Rachelle Buchbinder, Adam G Elshaug, Peter R Croft, and Chris G Mahera

Institute for Musculoskeletal Health,
University of Sydney,
PO Box M179, Missenden Road,
Camperdown NSW 2050, Australia.

Low back pain is the leading cause of years lived with disability globally. In 2018, an international working group called on the World Health Organization to increase attention on the burden of low back pain and the need to avoid excessively medical solutions. Indeed, major international clinical guidelines now recognize that many people with low back pain require little or no formal treatment. Where treatment is required the recommended approach is to discourage use of pain medication, steroid injections and spinal surgery, and instead promote physical and psychological therapies. Many health systems are not designed to support this approach.

In this paper we discuss why care for low back pain that is concordant with guidelines requires system-wide changes. We detail the key challenges of low back pain care within health systems. These include the financial interests of pharmaceutical and other companies; outdated payment systems that favour medical care over patients’ self-management; and deep-rooted medical traditions and beliefs about care for back pain among physicians and the public. We give international examples of promising solutions and policies and practices for health systems facing an increasing burden of ineffective care for low back pain.

We suggest policies that, by shifting resources from unnecessary care to guideline-concordant care for low back pain, could be cost-neutral and have widespread impact. Small adjustments to health policy will not work in isolation, however. Workplace systems, legal frameworks, personal beliefs, politics and the overall societal context in which we experience health, will also need to change.

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The Role of Chiropractic Care in Older Adults

By Frank M. Painter|July 31, 2017|Medicare|

The Role of Chiropractic Care in Older Adults

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2012 (Feb 21); 20 (1): 3

Paul E Dougherty, Cheryl Hawk,
Debra K Weiner, Brian Gleberzon,
Kari Andrew and Lisa Killinger

Research Department,
New York Chiropractic College,
2360 State Route 89,
Seneca Falls, NY 13148, USA.

There are a rising number of older adults; in the US alone nearly 20% of the population will be 65 or older by 2030. Chiropractic is one of the most frequently utilized types of complementary and alternative care by older adults, used by an estimated 5% of older adults in the U.S. annually. Chiropractic care involves many different types of interventions, including preventive strategies. This commentary by experts in the field of geriatrics, discusses the evidence for the use of spinal manipulative therapy, acupuncture, nutritional counseling and fall prevention strategies as delivered by doctors of chiropractic. Given the utilization of chiropractic services by the older adult, it is imperative that providers be familiar with the evidence for and the prudent use of different management strategies for older adults.

From the Full-Text Article:

Introduction

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Regional Supply of Chiropractic Care and Visits to Primary Care Physicians for Back and Neck Pain

By Frank M. Painter|May 8, 2016|Medicare|

Regional Supply of Chiropractic Care and Visits to Primary Care Physicians for Back and Neck Pain

The Chiro.Org Blog

SOURCE: J Am Board Fam Med. 2015 (Jul); 28 (4): 481–490

Matthew A. Davis, MPH, DC, PhD, Olga Yakusheva, PhD,
Daniel J. Gottlieb, MS and Julie P.W. Bynum, MD, MPH

Dartmouth Institute for Health Policy and Clinical Practice,
Dartmouth College,
Geisel School of Medicine,
Hanover, NH

BACKGROUND: Whether availability of chiropractic care affects use of primary care physician (PCP) services is unknown.

METHODS: We performed a cross-sectional study of 17.7 million older adults who were enrolled in Medicare from 2010 to 2011. We examined the relationship between regional supply of chiropractic care and PCP services using Spearman correlation. Generalized linear models were used to examine the association between regional supply of chiropractic care and number of annual visits to PCPs for back and/or neck pain.

RESULTS: We found a positive association between regional supply of chiropractic care and PCP services (rs = 0.52; P <.001). An inverse association between supply of chiropractic care and the number of annual visits to PCPs for back and/or neck pain was apparent. The number of PCP visits for back and/or neck pain was 8% lower (rate ratio, 0.92; 95% confidence interval, 0.91-0.92) in the quintile with the highest supply of chiropractic care compared to the lowest quintile. We estimate chiropractic care is associated with a reduction of 0.37 million visits to PCPs nationally, at a cost of $83.5 million.

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Cross-Sectional Analysis of Per Capita Supply of Doctors of Chiropractic and Opioid Use

By Frank M. Painter|May 7, 2016|Medicare|

Cross-Sectional Analysis of Per Capita Supply of Doctors of Chiropractic and Opioid Use in Younger Medicare Beneficiaries

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2016 (Mar 28) [Epub]

William B Weeks, MD, PhD, MBA, Christine M Goertz, DC, PhD

The Dartmouth Institute for
Health Policy and Clinical Practice,
Lebanon, NH

OBJECTIVE: The purpose of this study was to determine whether the per-capita supply of doctors of chiropractic (DCs) or Medicare spending on chiropractic care was associated with opioid use among younger, disabled Medicare beneficiaries.

METHODS: Using 2011 data, at the hospital referral region level, we correlated the per-capita supply of DCs and spending on chiropractic manipulative therapy (CMT) with several measures of per-capita opioid use by younger, disabled Medicare beneficiaries.

RESULTS: Per-capita supply of DCs and spending on CMT were strongly inversely correlated with the percentage of younger Medicare beneficiaries who had at least 1, as well as with 6 or more, opioid prescription fills. Neither measure was correlated with mean daily morphine equivalents per opioid user or per chronic opioid user.

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Best Practices Recommendations for Chiropractic Care for Older Adults

By Frank M. Painter|March 12, 2016|Medicare|

Best Practices Recommendations for Chiropractic Care for Older Adults: Results of a Consensus Process

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2010 (Jul); 33 (6): 464-473

Cheryl Hawk, DC, PhD, Michael Schneider, DC, PhD,
Paul Dougherty, DC, Brian J. Gleberzon, DC,
Lisa Z. Killinger, DC

Cleveland Chiropractic College,
Overland Park, KS 66210, USA.

OBJECTIVE: At this time, the scientific evidence base supporting the effectiveness of chiropractic care for musculoskeletal conditions has not yet definitively addressed its appropriateness for older adults. Expert consensus, as a form of evidence, must be considered when higher levels of evidence are lacking. The purpose of this project was to develop a document with evidence-based recommendations on the best practices for chiropractic care of older adults.

METHODS: A set of 50 seed statements was developed, based on the clinical experience of the multidisciplinary steering committee and the results of an extensive literature review. A formal Delphi process was conducted, following the rigorous RAND-UCLA (University of California, Los Angeles) methodology. The statements were circulated electronically to the Delphi panel until consensus was reached. Consensus was defined as agreement by at least 80% of the panelists. There were 28 panelists from 17 US states and Canada, including 24 doctors of chiropractic, 1 physical therapist, 1 nurse, 1 psychologist, and 1 acupuncturist.

RESULTS: The Delphi process was conducted in January-February 2010; all 28 panelists completed the process. Consensus was reached on all statements in 2 rounds. The resulting best practice document defined the parameters of an appropriate approach to chiropractic care for older adults, and is presented in this article.

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Chiropractic Use in the Medicare Population: Prevalence, Patterns, and Associations With 1-year Changes in Health and Satisfaction With Care

By Frank M. Painter|February 29, 2016|Medicare|

Chiropractic Use in the Medicare Population: Prevalence, Patterns, and Associations With 1-year Changes in Health and Satisfaction With Care

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2014 (Mar); 37 (8): 542-551

Paula A.M. Weigel, PhD, Jason M. Hockenberry, PhD, Fredric D. Wolinsky, PhD

Research Associate,
Department of Health Management and Policy,
College of Public Health,
The University of Iowa, Iowa City, IA

OBJECTIVE: The purpose of this study was to examine how chiropractic care compares to medical treatments on 1-year changes in self-reported function, health, and satisfaction with care measures in a representative sample of Medicare beneficiaries.

METHODS: Logistic regression using generalized estimating equations is used to model the effect of chiropractic relative to medical care on decline in 5 functional measures and 2 measures of self-rated health among 12170 person-year observations. The same method is used to estimate the comparative effect of chiropractic on 6 satisfaction with care measures. Two analytic approaches are used, the first assuming no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models.

RESULTS: The unadjusted models show that chiropractic is significantly protective against 1-year decline in activities of daily living, lifting, stooping, walking, self-rated health, and worsening health after 1 year. Persons using chiropractic are more satisfied with their follow-up care and with the information provided to them. In addition to the protective effects of chiropractic in the unadjusted model, the propensity score results indicate a significant protective effect of chiropractic against decline in reaching.

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