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Livingston CJ, Gray M, LaForge K, Choo EK. A cross-sectional survey exploring clinician perceptions of a novel Medicaid back pain policy. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2023; 20:438-446. [PMID: 36306465 DOI: 10.1515/jcim-2022-0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Oregon Medicaid (Oregon Health Plan, or OHP) implemented an innovative policy in 2016 that increased coverage of evidence-based non-pharmacologic therapies (NPT, including physical therapy, massage, chiropractic, and acupuncture) while restricting opioids, epidural steroid injections, and surgeries. The objective of this study was to compare the perspectives of clinicians who see back pain patients and can prescribe pharmacologic therapies and/or refer to NPTs and clinicians who directly provide NPT therapies affected by the policy. METHODS A cross-sectional online survey was administered to Oregon prescribing clinicians and NPT clinicians between December 2019 and February 2020. The survey was completed by 107 prescribing clinicians and 83 NPT clinicians. RESULTS Prescribing clinicians and NPT clinicians had only moderate levels of familiarity with core elements of the policy. Prescribing clinicians had higher levels of frustration caring for OHP patients with back pain than NPT clinicians (83 vs. 34%, p<0.001) and were less confident in their ability to provide effective care (73 vs. 85%, p = .025). Eighty-six percent of prescribing clinicians and 83% of NPT clinicians thought active NPT treatments were effective; 74 and 70% thought passive NPT treatments were effective. Forty percent of prescribing clinicians and 25% of NPT clinicians (p<0.001) thought medically-light therapies were effective, while 29% of prescribing clinicians and 10% of NPT clinicians thought medically-intensive treatments were effective (p=0.001). Prescribing clinicians thought increased access to NPTs improved outcomes, while opinions were less consistent on the impact of restricting opioid prescribing. CONCLUSIONS Prescribing clinicians and NPT clinicians had varying perspectives of a Medicaid coverage policy to increase evidence-based back pain care. Understanding these perspectives is important for contextualizing policy effectiveness.
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Affiliation(s)
| | | | | | - Esther K Choo
- Department of Emergency Medicine, Oregon Health & Science University, OR, USA
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Hwang JH, Cho HJ, Im HB, Jung YS, Choi SJ, Han D. Complementary and alternative medicine use among outpatients during the 2015 MERS outbreak in South Korea: a cross-sectional study. BMC Complement Med Ther 2020; 20:147. [PMID: 32404092 PMCID: PMC7220580 DOI: 10.1186/s12906-020-02945-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 05/07/2020] [Indexed: 12/13/2022] Open
Abstract
Background The 2015 MERS outbreak in South Korea was the largest event outside of the Middle East. Under such circumstances, individuals tend to resort to non-conventional solutions such as complementary and alternative medicine (CAM) to manage health. Thus, this study aims to examine characteristics of CAM use among outpatients in a community hospital setting during the 2015 MERS outbreak and to assess potential predictors of CAM use during the epidemic. Methods A cross-sectional study was conducted among 331 patients (response rate: 82.75%) at a community hospital located in Seoul, South Korea. The survey instrument included 36 questions on the use of CAM, demographic characteristics, health status, and respondents’ perceptions and concerns about MERS infection. Chi-square test and logistic regression were conducted for data analysis using SPSS ver. 21.0., and a p-value of less than 0.05 was considered statistically significant for all analyses. Results 76.1% of respondents used one or more types of CAM modalities during the MERS outbreak. Consumption of easily accessible modalities such as multivitamin (51.2%) and food products (32.1%) was most popular, and the majority of CAM users relied on mass media (52.4%) and the internet (27.4%) to obtain information on CAM. The use of CAM was associated with age between 40 and 49, age over 50, prior CAM use, and dissatisfaction with the government response to the MERS outbreak. Conclusions CAM was commonly used by outpatients during the 2015 MERS outbreak in Korea, and mass media was the main source of information. Establishing a media platform is of paramount importance to provide reliable information and ensure the safety of its use.
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Affiliation(s)
- Jung Hye Hwang
- Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, South Korea.,Department of Global Health and Development, Graduate School, Hanyang University, Seoul, South Korea.,Institute of Health Services Management, Hanyang University, Seoul, South Korea
| | - Hyun Jeong Cho
- Graduate School of Public Policy, Hanyang University, Seoul, South Korea
| | - Hyea Bin Im
- Department of Global Health and Development, Graduate School, Hanyang University, Seoul, South Korea.,Institute of Health Services Management, Hanyang University, Seoul, South Korea
| | - Young Sun Jung
- Department of Global Health and Development, Graduate School, Hanyang University, Seoul, South Korea.,Institute of Health Services Management, Hanyang University, Seoul, South Korea
| | - Soo Jeung Choi
- Department of Global Health and Development, Graduate School, Hanyang University, Seoul, South Korea.,Institute of Health Services Management, Hanyang University, Seoul, South Korea
| | - Dongwoon Han
- Department of Global Health and Development, Graduate School, Hanyang University, Seoul, South Korea. .,Institute of Health Services Management, Hanyang University, Seoul, South Korea. .,Graduate School of Public Policy, Hanyang University, Seoul, South Korea. .,Department of Preventive Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea. .,, Seoul, South Korea.
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