Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4034 — Facility-Level Variation in Non-Pharmacologic Pain Care and Its Association with Opioid Medication Prescribing

Lead/Presenter: Charlotte Nolan, COIN - Seattle/Denver
All Authors: Nolan C (VA Eastern Colorado Health Care System, Denver, CO) Carey E (VA Eastern Colorado Health Care System, Denver, CO) Ho PM (VA Eastern Colorado Health Care System, Denver, CO) Kerns RD (Departments of Psychiatry, Neurology and Psychology, Yale University, New Haven, CT) Frank JW (VA Eastern Colorado Health Care System, Denver, CO)

Objectives:
Access to non-pharmacologic pain care varies by facility and may impact utilization of pharmacologic treatment such as opioid medications. We sought to examine the association between facility-level utilization of non-pharmacologic modalities and opioid medication prescribing.

Methods:
We identified Veterans receiving primary care from the VHA with incident chronic pain between 1/1/2010-9/30/2014 based on > = 1 of 3 criteria: (1) persistent moderate-severe pain ( > = 3 numeric pain ratings > = 4 within 365 days), (2) diagnosis codes "highly likely" to be related to chronic pain, and (3) receipt of long-term opioid therapy ( > = 90 days within 365 days). After linking Veterans to home primary care facilities, we used quasi-Poisson generalized linear models to estimate average facility-level utilization of 3 non-pharmacologic treatment modalities (physical therapy/occupational therapy (PT/OT), specialty pain clinic and psychosocial treatment) and facility-level opioid medication prescribing.

Results:
We identified 893,664 Veterans with incident chronic pain receiving primary care at 177 VHA medical centers. There was wide facility-level variation in utilization of PT/OT (mean, 40%; range, 11-63%), specialty pain care (mean, 12%, range, 3-50%) and psychosocial treatment (mean, 44%; range, 23-94%). Similarly, there was wide variation in opioid prescribing (mean, 43%; range 25-63%). Facility-level opioid prescribing was moderately negatively correlated with utilization of PT/OT (R = -0.37, P < .001) and weakly negatively correlated utilization of specialty pain care (R = -0.26, P < .001). Opioid prescribing was not correlated with psychosocial treatment (R = -0.10, P = 0.2).

Implications:
Non-pharmacologic pain care utilization varied substantially among VHA medical centers nationally. VHA medical centers with greater utilization of PT/OT and specialty pain care services prescribed relatively fewer opioid medications among Veterans with chronic pain.

Impacts:
Further study should examine the effectiveness of facility-level interventions to promote engagement with non-pharmacologic pain care and their impact on subsequent opioid medication use and patient outcomes.