Healthcare Utilization and Referral Patterns in the Initial Management of New-Onset, Uncomplicated, Low Back Workers' Compensation Disability Claims

ObjectivesThe objective of this historical cohort study was to determine the claimant and prescriber factors associated with receiving opioids at first postinjury dispense compared with non-steroidal anti-inflammatory drugs (NSAIDs) and skeletal muscle relaxants (SMRs) in a sample of workers’ compensation claimants with low back pain (LBP) claims between 1998 and 2009 in British Columbia, Canada.MethodsAdministrative workers’ compensation, prescription and healthcare data were linked. The association between claimant factors (sociodemographics, occupation, diagnosis, comorbidities, pre-injury prescriptions and healthcare) and prescriber factors (sex, birth year, specialty) with drug class(es) at first dispense (opioids vs NSAIDs/SMRs) was examined with multilevel multinomial logistic regression.ResultsIncreasing days supplied with opioids in the previous year was associated with increased odds of receiving opioids only (1–14 days OR 1.62, 95% CI 1.51 to 1.75; ≥15 days OR 5.12, 95% CI 4.65 to 5.64) and opioids with NSAIDs/SMRs (1–14 days OR 1.49, 95% CI 1.39 to 1.60; ≥15 days OR 2.82, 95% CI 2.56 to 3.12). Other significant claimant factors included: pre-injury dispenses for NSAIDs, SMRs, antidepressants, anticonvulsants and sedative-hypnotics/anxiolytics; International Statistical Classification of Diseases and Related Health Problems, 9th Revision diagnosis; various pre-existing comorbidities; prior physician visits and hospitalisations; and year of injury, age, sex, health authority and occupation. Prescribers accounted for 25%–36% of the variability in the drug class(es) received, but prescriber sex, specialty and birth year did not explain observed between-prescriber variation.ConclusionsDuring this period in the opioid crisis, early postinjury dispensing was multifactorial, with several claimant factors associated with receiving opioids at first prescription. Prescriber variation in drug class choice appears particularly important, but was not explained by basic prescriber characteristics.

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Musculoskeletal pain and new-onset poor physical function in elderly survivors of a natural disaster: a longitudinal study after the great East Japan earthquake

BMC Geriatrics ◽

10.1186/s12877-019-1283-z ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Yutaka Yabe ◽

Yoshihiro Hagiwara ◽

Takuya Sekiguchi ◽

Yumi Sugawara ◽

Masahiro Tsuchiya ◽

...

Keyword(s):

Longitudinal Study ◽

Natural Disasters ◽

Physical Function ◽

Musculoskeletal Pain ◽

Functional Disability ◽

Functional Decline ◽

Great East Japan Earthquake ◽

Low Back ◽

Shoulder And Neck Pain ◽

New Onset

Abstract Background Functional disability is a significant problem after natural disasters. Musculoskeletal pain is reported to increase after disasters, which can cause functional disability among survivors. However, the effects of musculoskeletal pain on functional decline after natural disasters are unclear. The present study aimed to examine the association between musculoskeletal pain and new-onset poor physical function among elderly survivors after the Great East Japan Earthquake. Methods A longitudinal study was conducted on survivors aged ≥65 years at three and 4 years after the Great East Japan Earthquake. A total of 747 persons were included in this study. Physical function was assessed using the Kihon Checklist. New-onset poor physical function was defined as low physical function not present at 3 years but present at 4 years after the disaster. Knee, hand or foot, low back, shoulder, and neck pain was assessed using a self-reported questionnaire and was defined as musculoskeletal pain. Musculoskeletal pain at 3 years after the disaster was categorized according to the number of pain regions (0, 1, ≥ 2). Multiple logistic regression analyses were performed to calculate the odds ratio (OR) and 95% confidence interval (95% CI) for new-onset poor physical function due to musculoskeletal pain. Results The incidence of new-onset poor physical function was 14.9%. New-onset poor physical function was significantly associated with musculoskeletal pain. Compared with “0” musculoskeletal pain region, the adjusted ORs (95% CI) were 1.39 (0.75–2.58) and 2.69 (1.52–4.77) in “1” and “≥ 2” musculoskeletal pain regions, respectively (p for trend = 0.003). Conclusions Musculoskeletal pain is associated with new-onset poor physical function among elderly survivors after the Great East Japan Earthquake. Monitoring musculoskeletal pain is important to prevent physical function decline after natural disasters.

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