New Prescription Opioids Findings from Marymount University Described (Where to start? A two stage residual inclusion approach to estimating influence of the initial provider on health care utilization and costs for low back pain in the US): Opioids – Prescription Opioids

2022 JUN 09 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Fresh data on prescription opioids are presented in a new report. According to news reporting from Marymount University by NewsRx journalists, research stated, “Diagnostic testing and treatment recommendations can vary when medical care is sought by individuals for low back pain (LBP), leading to variation in quality and costs of care. We examine how the first provider seen by an individual at initial diagnosis of LBP influences downstream utilization and costs.”

The news journalists obtained a quote from the research from Marymount University: “Using national private health insurance claims data, individuals age 18 or older were retrospectively assigned to cohorts based on the first provider seen at the index date of LBP diagnosis. Exclusion criteria included individuals with a diagnosis of LBP or any serious medical conditions or an opioid prescription recorded in the 6 months prior to the index date. Outcome measures included use of imaging, back surgery rates, hospitalization rates, emergency department visits, early- and long-term opioid use, and costs (out-of-pocket and total costs of care) twelve months post-index date. We used a two-stage residual inclusion (2SRI) estimation approach comparing copay for the initial provider visit and differential distance as the instrumental variable to reduce selection bias in the choice of first provider, controlling for demographics. Among 3,799,593 individuals, cost and utilization varied considerably based on the first provider seen by the patient. Copay and differential distance provided similar results, with copay preserving a greater sample size. The frequency of early opioid prescription was significantly lower when care began with an acupuncturist or chiropractor, and highest for those who began with an emergency medicine physician or advanced practice registered nurse (APRN). Long-term opioid prescriptions were low across most providers except physical medicine and rehabilitation physicians and APRNs. The frequency and time to serious illness varied little across providers. Total cost of care was lowest when starting with a chiropractor ($5093) or primary care physician ($5660), and highest when starting with an orthopedist ($9434) or acupuncturist ($9205).”

According to the news reporters, the research concluded: “The first provider seen by individuals with LBP was associated with large differences in health care utilization, opioid prescriptions, and cost while there were no differences in delays in diagnosis of serious illness.”

For more information on this research see: Where to start? A two stage residual inclusion approach to estimating influence of the initial provider on health care utilization and costs for low back pain in the US. BMC Health Services Research, 2022,22(1):1-12. (BMC Health Services Research - http://bmchealthservres.biomedcentral.com). The publisher for BMC Health Services Research is BMC.

A free version of this journal article is available at https://doi.org/10.1186/s12913-022-08092-1.

Our news editors report that additional information may be obtained by contacting Kenneth J. Harwood, College of Health and Education, Marymount University. Additional authors for this research include Jesse M. Pines, C. Holly A. Andrilla, Bianca K. Frogner.

(Our reports deliver fact-based news of research and discoveries from around the world.)