The use of risk sharing tools for post adoption surveillance of a non pharmacological technology in routine practice: results after one year

Abstract

BackgroundTo report results obtained by combining risk sharing tools with post-adoption surveillance mechanisms in order to control quality of care and implement a value-based reimbursement scheme for Neuro-reflexotherapy (NRT), a non-pharmacological treatment proven effective for neck pain (NP), thoracic pain (TP) and low back pain (LBP).MethodsPre-post prospective cohort study in routine clinical practice, carried out in primary care centers in the Spanish National Health Service in the Balearic Islands (Ib-Salut). Eight-hundred and seventy-one subacute and chronic NP, TP and LBP patients treated in Ib-Salut, who underwent NRT during 2011. A shared risk contract (SRC) was developed, where payments for NRT were linked to results on patients’ clinical evolution, reduction in medication and proportion of patients undergoing spinal surgery. Main outcome measures were local pain (NP, TP or LBP), referred pain, LBP-related disability and NP-related disability, measured using previously validated instruments at referral and 3 months later, use of medication assessed at referral and discharge, and rates of spinal surgery prescription after undergoing NRT.ResultsMedian improvements at discharge corresponded to 57.1% of baseline value for local pain, 75.0% for referred pain, 53.8% for LBP-related disability and 45.0% for NP-related disability. Patients taking medication at discharge represented 29.0% of those taking it at referral. The proportion of patients in whom spinal surgery was prescribed after undergoing NRT was 0%. These results were consistent with those from previous randomised controlled trials (RCTs) and studies in routine practice, and complied with the standards set in the SRC.ConclusionsIt is feasible and effective to enhance post adoption surveillance methods with risk sharing tools to improve quality control and support value-based reimbursement decisions for NRT. The feasibility of generalising this approach to other settings and to other non-pharmacological treatments should be explored.

Post-Implementation Surveillance of a Non-Pharmacological Health Technology Within a National Health Service

“…These results are consistent with existing RCTs (10-13), systematic reviews (9;13), studies in routine practice (14)(15)(16)(17)(18)(19), and reviews supporting major evidence-based clinical practice guidelines (8;9). These results are consistent with existing RCTs (10-13), systematic reviews (9;13), studies in routine practice (14)(15)(16)(17)(18)(19), and reviews supporting major evidence-based clinical practice guidelines (8;9).…”

“…Results from this model make it possible to calculate the risk of requiring more than one NRT procedure for each individual patient, which is valuable for shared decision making ( Table 3). NRT is indicated for treating an ongoing pain episode, and not for preventing relapse (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Only a minority of patients (usually in the upper economic class) seek care exclusively through private health care, but patients who are covered by both the SNHS and a private insurance, may use the latter to undergo diagnostic procedures (and, especially, MRIs) prescribed in the SNHS, since waiting time in private practice is seven times shorter than in the SNHS (32).…”

“…Post-implementation surveillance methods were put in place since inception (14)(15)(16)(17)(18)(19). Post-implementation surveillance methods were put in place since inception (14)(15)(16)(17)(18)(19).…”

Predicting the evolution of neck pain episodes in routine clinical practice

“…The registry included all patients seeking care for NP in the participating centers, where they were treated following standard practice in routine clinical practice. Clinically relevant data were gathered using previously validated methods [14, 16, 18, 24–26], and the proportion of losses to follow-up was below 7%. Data from this registry make it possible to develop predictive models which are valid to determine the likelihood of improvement, factoring in patients’ characteristics and clinical decisions, and nomograms to facilitate the use of these models in routine practice (Table 3, Figs.…”

“…This registry used the same variables and measuring instruments as the only registry of neck and back pain patients available in Spain. The latter was originally developed for post-marketing surveillance of a minimally invasive technology (“neuro-reflexotherapy”), and has shown to be reliable and lead to low proportions of missing data and losses to follow-up [14, 16, 24].…”