The Effect of Including Benchmark Prevalence Data of Common Imaging Findings in Spine Image Reports on Health Care Utilization Among Adults Undergoing Spine Imaging

Jarvik, Jeffrey G.; Meier, Eric N.; James, Kathryn; Gold, Laura S.; Tan, Katherine; Kessler, Larry G.; Suri, Pradeep; Kallmes, David F.; Cherkin, Daniel C.; Deyo, Richard A.; Sherman, Karen J.; Halabi, Safwan; Comstock, Bryan A.; Luetmer, Patrick H.; Avins, Andrew L.; Rundell, Sean D.; Griffith, Brent; Friedly, Janna; Lavallee, Danielle C.; Stephens, Kari A.; Turner, Judith A.; Bresnahan, Brian W.; Heagerty, Patrick J.

doi:10.1001/jamanetworkopen.2020.15713

Cited by 35 publications

(39 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, consistent with prior research, we found that patients identified as Black/African American, 12,34 identified as Hispanic, 12,34 of higher SES, 14 with no comorbidities, 35 or who received low back imaging in more recent years 7,8 had reduced odds of receiving immediate prescriptions for opioids. Likely, the reduction in opioid prescriptions in the later years of our study was influenced both by the increasing proportion of patients whose images contained the benchmark text for the LIRE study, which was associated with small but significant decreases in the likelihood of subsequent opioid prescriptions, 23 as well as by increasingly broad societal concern about the harms associated with opioid prescriptions. These concerns were summarized in the 2016 Centers for Disease Control and Prevention (CDC) opioid prescribing guidelines, 9 which called attention to the lack of evidence supporting the efficacy of long-term opioid therapy and its potential harms.…”

Section: Discussionmentioning

confidence: 78%

“…However, patients whose images contained the intervention text had a small but statistically significant decrease in the likelihood of receiving prescriptions for opioids within a year of their index images. 23 For this secondary analysis, all participating institutional review boards determined that the study was minimal risk and granted waivers of consent and Health Insurance Portability and Accountability Act (HIPAA) authorization.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Patient, Provider, and Clinic Characteristics Associated with Opioid and Non-Opioid Pain Prescriptions for Patients Receiving Low Back Imaging in Primary Care

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background: To describe characteristics of patients, providers, and clinics associated with opioid or non-opioid pain medication prescribing patterns for patients who received lower spine imaging in primary care clinics.Methods: In these secondary analyses of the Lumbar Imaging with Reporting of Epidemiology (LIRE) study, a randomized controlled trial conducted in 4 health systems in the United States, we evaluated characteristics associated with receipt of pain medication prescriptions. The outcomes were receipt of prescriptions for opioid or, separately, non-opioid pain medications within 90 days after imaging. Among patients who received opioid or non-opioid prescriptions, we evaluated receipt of multiple prescriptions in the year following imaging. Mixed models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).Results: Compared with whites, patients identified as Asian (OR, 0.53; 95% CI, 0.51-0.56), Native Hawaiian/ Pacific Islander (OR, 0.73; 95% CI, 0.64-0.83), multiracial (OR, 0.84; 95% CI, 0.71-0.98) or Black (OR, 0.92; 95% CI, 0.89-0.96) had significantly reduced odds for receiving prescriptions for opioids within 90 days. Patients identified as Native American/Alaska Native had greater odds for receiving prescriptions for non-opioid pain medications within 90 days (OR, 1.12; 95% CI, 1.01-1.24). Receipt of pain prescriptions 120 days before imaging was strongly predictive of subsequent receipt of pain prescriptions across all categories.Conclusions: After adjusting for factors that could affect prescribing, the strongest differences observed in pain-medication prescribing were across racial categories and for patients with previous pain prescriptions. Further research is needed to understand these differences and to optimize prescribing. ( J Am Board Fam Med 2021;34:950-963.

show abstract

Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Patient, Provider, and Clinic Characteristics Associated with Opioid and Non-Opioid Pain Prescriptions for Patients Receiving Low Back Imaging in Primary Care

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…Furthermore, professional opportunities to manage pain are not always the focus of some disciplines and some disciplines may play a larger role in the care pathway than others and thus arguably may need higher levels of knowledge and attitudes relative to other disciplines. However, each discipline involved in this study may encounter people with pain directly and as such it is important that they all have appropriate knowledge and attitudes to provide patients with clear and consistent high quality basic pain management advice For example, in diagnostic radiography patient interaction may be limited, nevertheless, even if interactions are brief, correct communication is critical [67,68]. Kyei et al (2014) [69] observe the need for good radiographer communication skills because there is only a short time frame available to establish a relationship with patients.…”

Section: Discussionmentioning

confidence: 99%

International, multi-disciplinary, cross-section study of pain knowledge and attitudes in nursing, midwifery and allied health professions students

et al. 2022

View full text Add to dashboard Cite

Background Persistent pain is a highly prevalent, global cause of disability. Research suggests that many healthcare professionals are not well equipped to manage pain, and this may be attributable at least in part to undergraduate education. The primary aim of this study was to quantify and compare first and final year nursing, midwifery and allied health professional (NMAHP) students’ pain related knowledge and attitudes. The secondary aim was to explore what factors influence students’ pain related knowledge and attitudes. Methods In this cross-sectional study, 1154 first and final year healthcare students, from 12 universities in five different countries completed the Revised Neurophysiology of Pain Quiz (RNPQ) [knowledge] and the Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS) [attitudes]. Results Physiotherapy was the only student group with statistically and clinically improved pain related knowledge [mean difference, 95% CI] (3.4, 3.0 to 3.9, p = 0.01) and attitudes (-17.2, -19.2 to 15.2, p = 0.01) between first and final year. Pain education teaching varied considerably from course to course (0 to 40 h), with greater levels of pain related knowledge and attitudes associated with higher volumes of pain specific teaching. Conclusions There was little difference in pain knowledge and attitudes between all first and final year NMAHP students other than physiotherapy. This suggests that for most NMAHP disciplines, undergraduate teaching has little or no impact on students’ understanding of pain. There is an urgent need to enhance pain education provision at the undergraduate level in NMAHPs. Trial Registration The study protocol was prospectively registered at ClinicalTrials.Gov NCT03522857.

show abstract

“…To our knowledge, the effectiveness of an intervention developed to address both physician- and patient-related barriers to reducing the use of imaging has not previously been tested. Previous studies have demonstrated reduced imaging examinations with the inclusion of epidemiologic data in lumbar spine MRI reports [ 25 – 27 ]. In our study, information on the usefulness of imaging was provided to all the patients and professionals, regardless of whether or not imaging was undertaken.…”

Section: Discussionmentioning

confidence: 99%

Patient education booklet to support evidence-based low back pain care in primary care – a cluster randomized controlled trial

et al. 2021

View full text Add to dashboard Cite

Background Inappropriate imaging and low-value care for low back pain (LBP) are common. A new patient-education booklet was created to overcome identified barriers to the delivery of recommended care, including the use of inappropriate imaging. Our aim was to assess the effectiveness of this booklet as part of primary care for LBP patients in comparison to usual care. Methods A cluster-randomized trial was performed. The intervention involved providing practitioners with the new patient-education booklet and a 30-min training session on its use. The booklet was provided during the clinical consult to all consenting LBP patients in the intervention group. Primary outcomes were the proportion of patients presenting with LBP who underwent imaging examinations during the first three months of follow-up and PROMIS PF-20 (Patient-Reported Outcomes Measurement Information System, 20-item physical functioning short form) change between baseline and three-month follow-up. Secondary outcomes, including sick leave and imaging examinations at 12 months, were investigated. Logistic regression using GEE-estimation was used for dichotomous outcomes, Poisson regression using GEE-estimation for count outcomes, and linear mixed models for continuous outcomes. Results Using the patient education booklet appeared to substantially reduce the proportion of LBP patients who underwent an imaging examination at three months, but the result was not statistically significant (OR 0.57, 95% confidence interval (Cl) 0.27 to 1.22). At 12 months, the effect was slightly larger and statistically significant (OR 0.50, 95%Cl 0.30 to 0.83, p = 0.008). No difference was observed in the PROMIS PF-20 T-score change between baseline and 3 months or 12 months (p = 0.365 and p = 0.923, respectively). The number of sick leave days in the intervention group was less than that in the control group at 3 months (RR 0.47, 95%Cl 0.26 to 0.83, p = 0.010) and at 12 months (RR 0.36, 95%Cl 0.18 to 0.72, p = 0.004). Conclusions The booklet appeared to be effective in reducing the proportion of LBP patients who underwent imaging examinations over 12 months. The intervention had no discernible effect on the PROMIS PF20 T-score change. The number of sick leave days was substantially lower in the intervention group. Trial registration ISRCTN, ISRCTN14389368, Registered 4 April 2019—Retrospectively registered.

show abstract

The Effect of Including Benchmark Prevalence Data of Common Imaging Findings in Spine Image Reports on Health Care Utilization Among Adults Undergoing Spine Imaging

Cited by 35 publications

References 29 publications

Patient, Provider, and Clinic Characteristics Associated with Opioid and Non-Opioid Pain Prescriptions for Patients Receiving Low Back Imaging in Primary Care

Patient, Provider, and Clinic Characteristics Associated with Opioid and Non-Opioid Pain Prescriptions for Patients Receiving Low Back Imaging in Primary Care

International, multi-disciplinary, cross-section study of pain knowledge and attitudes in nursing, midwifery and allied health professions students

Patient education booklet to support evidence-based low back pain care in primary care – a cluster randomized controlled trial

Contact Info

Product

Resources

About