ingest cdrApp 2018-08-23T19:27:55.868Z d39a25df-af15-48e9-aec2-c9af81a997a2 modifyDatastreamByValue RELS-EXT fedoraAdmin 2018-08-23T19:28:47.743Z Setting exclusive relation addDatastream MD_TECHNICAL fedoraAdmin 2018-08-23T19:28:58.943Z Adding technical metadata derived by FITS addDatastream MD_FULL_TEXT fedoraAdmin 2018-08-23T19:29:22.058Z Adding full text metadata extracted by Apache Tika modifyDatastreamByValue RELS-EXT fedoraAdmin 2018-08-23T19:29:44.041Z Setting exclusive relation modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-09-26T21:40:00.671Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2019-03-20T15:41:58.266Z Ruchir Karmali Author Department of Health Policy and Management Gillings School of Global Public Health RUNNING OUT OF OPTIONS: IS ACCESS TO NON-PHARMACOLOGIC PAIN MANAGEMENT TREATMENTS LINKED TO OPIOID PRESCRIPTIONS? The high prevalence of chronic pain and the rising opioid prescription rate impact the quality of life of older adults. Clinical guidelines recommend non-pharmacologic treatments over opioids for chronic pain. Evidence shows that opioids are used more than non-pharmacologic treatments, and opioid prescription practices differ geographically. Healthcare system characteristics can encourage or deter pain management practices. Therefore, the research objective was to understand if and how access to non-pharmacologic pain treatments is associated with opioid prescriptions patterns for older adults with a new episode of persistent musculoskeletal pain (lasting > three months). From a 5% sample of fee-for-service Medicare beneficiaries enrolled from 2007-2014, we constructed a cohort of beneficiaries over 65 with a new episode of persistent musculoskeletal pain and no opioid prescriptions within the prior six months. Using claims data and the Area Health Resource File, we defined access as the provider supply and service use for two common non-pharmacologic services, physical therapy (PT) and mental health (MH). In Aim 1, greater supply of non-pharmacologic providers was associated with lower odds of an opioid prescription in the first three months of an episode. PT during the first three months of an episode was associated with lower odds of an opioid prescription in following three months. In Aim 2, greater supply of MH providers was associated with lower odds of long-term prescriptions (≥90 days’ supply) and high-dose prescriptions (≥50 Milligrams Morphine Equivalent). In Aim 3, we explored how primary care providers in North Carolina operationalize caring for chronic pain patients as discrete responsibilities and the needs, supports, barriers, and priorities for change associated with each responsibility. Provider reported struggling to avoid prescribing opioids while trying to recommend non-pharmacologic treatments and discuss the relationship between pain and MH. Common supports included published literature, patient education, allied health professionals, electronic health records, and prescribing policies. Key barriers included poor insurance coverage and limited time. Priorities to improve chronic pain care were better patient education materials and more MH professionals. Taken together, the findings support polices that reduce shortages and engage patients in non-pharmacologic services to improve opioid prescribing practices for chronic pain. Summer 2018 2018 Public health Chronic Pain, Healthcare Access, Musculoskeletal Pain, Older Adults, Opioids eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Policy and Management Kristen Hassmiller Lich Thesis advisor Steven George Thesis advisor Asheley Skinner Thesis advisor Justin Trogdon Thesis advisor Morris Weinberger Thesis advisor text Ruchir Karmali Creator Department of Health Policy and Management Gillings School of Global Public Health RUNNING OUT OF OPTIONS: IS ACCESS TO NON-PHARMACOLOGIC PAIN MANAGEMENT TREATMENTS LINKED TO OPIOID PRESCRIPTIONS? The high prevalence of chronic pain and the rising opioid prescription rate impact the quality of life of older adults. Clinical guidelines recommend non-pharmacologic treatments over opioids for chronic pain. Evidence shows that opioids are used more than non-pharmacologic treatments, and opioid prescription practices differ geographically. Healthcare system characteristics can encourage or deter pain management practices. Therefore, the research objective was to understand if and how access to non-pharmacologic pain treatments is associated with opioid prescriptions patterns for older adults with a new episode of persistent musculoskeletal pain (lasting > three months). From a 5% sample of fee-for-service Medicare beneficiaries enrolled from 2007-2014, we constructed a cohort of beneficiaries over 65 with a new episode of persistent musculoskeletal pain and no opioid prescriptions within the prior six months. Using claims data and the Area Health Resource File, we defined access as the provider supply and service use for two common non-pharmacologic services, physical therapy (PT) and mental health (MH). In Aim 1, greater supply of non-pharmacologic providers was associated with lower odds of an opioid prescription in the first three months of an episode. PT during the first three months of an episode was associated with lower odds of an opioid prescription in following three months. In Aim 2, greater supply of MH providers was associated with lower odds of long-term prescriptions (≥90 days’ supply) and high-dose prescriptions (≥50 Milligrams Morphine Equivalent). In Aim 3, we explored how primary care providers in North Carolina operationalize caring for chronic pain patients as discrete responsibilities and the needs, supports, barriers, and priorities for change associated with each responsibility. Provider reported struggling to avoid prescribing opioids while trying to recommend non-pharmacologic treatments and discuss the relationship between pain and MH. Common supports included published literature, patient education, allied health professionals, electronic health records, and prescribing policies. Key barriers included poor insurance coverage and limited time. Priorities to improve chronic pain care were better patient education materials and more MH professionals. Taken together, the findings support polices that reduce shortages and engage patients in non-pharmacologic services to improve opioid prescribing practices for chronic pain. Public health Chronic Pain; Healthcare Access; Musculoskeletal Pain; Older Adults; Opioids Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Policy and Management Kristen Hassmiller Lich Thesis advisor Steven George Thesis advisor Asheley Skinner Thesis advisor Justin Trogdon Thesis advisor Morris Weinberger Thesis advisor 2018 2018-08 eng text Ruchir Karmali Creator Department of Health Policy and Management Gillings School of Global Public Health RUNNING OUT OF OPTIONS: IS ACCESS TO NON-PHARMACOLOGIC PAIN MANAGEMENT TREATMENTS LINKED TO OPIOID PRESCRIPTIONS? The high prevalence of chronic pain and the rising opioid prescription rate impact the quality of life of older adults. Clinical guidelines recommend non-pharmacologic treatments over opioids for chronic pain. Evidence shows that opioids are used more than non-pharmacologic treatments, and opioid prescription practices differ geographically. Healthcare system characteristics can encourage or deter pain management practices. Therefore, the research objective was to understand if and how access to non-pharmacologic pain treatments is associated with opioid prescriptions patterns for older adults with a new episode of persistent musculoskeletal pain (lasting > three months). From a 5% sample of fee-for-service Medicare beneficiaries enrolled from 2007-2014, we constructed a cohort of beneficiaries over 65 with a new episode of persistent musculoskeletal pain and no opioid prescriptions within the prior six months. Using claims data and the Area Health Resource File, we defined access as the provider supply and service use for two common non-pharmacologic services, physical therapy (PT) and mental health (MH). In Aim 1, greater supply of non-pharmacologic providers was associated with lower odds of an opioid prescription in the first three months of an episode. PT during the first three months of an episode was associated with lower odds of an opioid prescription in following three months. In Aim 2, greater supply of MH providers was associated with lower odds of long-term prescriptions (≥90 days’ supply) and high-dose prescriptions (≥50 Milligrams Morphine Equivalent). In Aim 3, we explored how primary care providers in North Carolina operationalize caring for chronic pain patients as discrete responsibilities and the needs, supports, barriers, and priorities for change associated with each responsibility. Provider reported struggling to avoid prescribing opioids while trying to recommend non-pharmacologic treatments and discuss the relationship between pain and MH. Common supports included published literature, patient education, allied health professionals, electronic health records, and prescribing policies. Key barriers included poor insurance coverage and limited time. Priorities to improve chronic pain care were better patient education materials and more MH professionals. Taken together, the findings support polices that reduce shortages and engage patients in non-pharmacologic services to improve opioid prescribing practices for chronic pain. Public health Chronic Pain; Healthcare Access; Musculoskeletal Pain; Older Adults; Opioids Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Kristen Hassmiller Lich Thesis advisor Steven George Thesis advisor Asheley Skinner Thesis advisor Justin Trogdon Thesis advisor Morris Weinberger Thesis advisor 2018 2018-08 eng text Karmali_unc_0153D_18064.pdf uuid:0603ff27-8907-427d-a552-e578fb7bcb81 2020-08-23T00:00:00 2018-07-23T15:15:42Z proquest application/pdf 3523164