scholarly journals Association of patient engagement strategies with utilisation and spending for musculoskeletal problems in the USA: a cross-sectional analysis of Medicare patients and physician practices

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e053121
Author(s):  
Timothy T Brown ◽  
Vanessa B Hurley ◽  
Hector P Rodriguez
Keyword(s):  
Patient Engagement ◽  
Lumbar Fusion ◽  
Secondary Outcome ◽  
Low Back ◽  
Cross Sectional ◽  
Physician Practices ◽  
Practice Level ◽  
Total Spending ◽  
Engagement Strategies ◽  
Musculoskeletal Problems

ObjectiveMusculoskeletal problems like hip and knee osteoarthritis and low-back pain are preference sensitive conditions. Patient engagement strategies (PES), such as shared decision-making and motivational interviewing, can help align patients’ preferences with treatment options and potentially reduce spending. We assess the association of physician practice-level adoption of PES with utilisation and spending.DesignCross-sectional study in which patients were matched across low, moderate and high levels of PES via coarsened exact matching.SettingPrimary and secondary care in 2190 physician practices.Participants39 336 hip, 48 362 knee and 67 940 low-back patients who were Medicare beneficiaries were matched to the 2017–2018 National Survey of Healthcare Organizations and Systems.Primary and secondary outcome measuresTotal hip replacement (THR), total knee replacement (TKR), 1–2 level posterior lumbar fusion (LF), total annual spending, components of total annual spending.ResultsTotal annual spending for patients with musculoskeletal problems did not differ for practices with low versus moderate PES, low versus high PES or moderate versus high PES, but spending was significantly lower in some categories for practices with relatively higher PES adoption. For hospital-owned and health system-owned practices, the ORs of receiving LF were 0.632 (95% CI 0.396 to 1.009) for patients attributed to practices with high PES compared with patients attributed to practices with moderate PES. For independent practices, the odds of receiving THR were 1.403 (95% CI 1.035 to 1.902) for patients attributed to practices with moderate PES compared with patients attributed to practices with low PES.ConclusionsPractice-level adoption of PES for patients with musculoskeletal problems was generally not associated with total spending. PES, however, may steer patients toward evidence-based treatments. Opportunities for overall spending reduction exist as indicated by the variation in the subcomponents of total spending by PES adoption.

scholarly journals Knowledge, attitude and practice of Lebanese community pharmacists with regard to self-management of low back pain

2020 ◽  
Vol 19 (4) ◽  
pp. 873-878
Author(s):  
Mariam K. Dabbous ◽  
Sara M. Moustafa ◽  
Fouad R. Sakr ◽  
Marwan G. Akel ◽  
Jihan H. Safwan ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Community Pharmacists ◽  
Cross Sectional Study ◽  
Oral Dosage ◽  
Secondary Outcome ◽  
Low Back ◽  
Cross Sectional ◽  
Local Patch

Purpose: To determine the knowledge, attitude and reported practice of Lebanese community pharmacists who advise persons who present with low back pain.Methods: This was a multi-center cross-sectional study conducted in over 300 community pharmacies across Lebanon from December 2017 to May 2018. Pharmacists working at a community pharmacy were considered eligible, and those who volunteered to participate completed the questionnaire. The questionnaire was designed for self-completion by the pharmacist and included demographic questions about the respondent, questions that assessed knowledge and attitude toward low back pain, and questions about treatment to reflect and characterize the nature of practice. The primary outcome was to determine the knowledge, attitude and reported practice of the Lebanese pharmacists advising people who presented with low back pain. The secondary outcome was to assess factors that affect knowledge, attitude, and practice.Results: The response of 320 community pharmacists was analysed. The proportion of pharmacists with good knowledge about low back pain (51. 7 %) was slightly higher than those with poor knowledge (48. 3 %). Oral therapy was the most prescribed dosage form for back pain compared to local patch and cream. Among oral dosage forms, non-steroidal anti-inflammatory drugs were the most prescribed medications (42 %). Of the patients’ referral to the physician if necessary, 73.1 % of the referrals were by pharmacists.Conclusion: Community pharmacists in Lebanon demonstrate an acceptable level of knowledge of back pain, yet major gaps still exist, particularly in terms of the quality of advice. Hence, more education is needed to provide better quality of advice. Keywords: Attitude, Knowledge, Low back pain, Reported practice, Quality of advice

scholarly journals Analysing actual prices of medical products: a cross-sectional survey of Dutch hospitals

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e035174 ◽  
Author(s):  
Anouk den Ambtman ◽  
Joris Knoben ◽  
Dana van den Hurk ◽  
Mark Van Houdenhoven
Keyword(s):  
Value Added ◽  
Secondary Outcome ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Electronic Survey ◽  
Medical Products ◽  
Total Spending ◽  
Academic Hospitals ◽  
Average Coefficient ◽  
Actual Price

ObjectivesTo assess whether there is a difference between the net prices of medical products used by Dutch hospitals and, if there is, how this difference can be explained.DesignCross-sectional self-administered electronic survey.SettingWe surveyed the prices paid for 17 commonly used medical products, such as pacemakers, gloves and stents in 38 Dutch hospitals (including general, specialised and academic hospitals) in 2017. Hospitals voluntarily and anonymously provided these data and received a personalised free benchmark tool in return. This tool provides information about the variance in prices of the medical products they buy.Participants38 out of 79 hospitals entered and completed the study.Primary and secondary outcome measuresActual price paid excluding Value Added Tax (VAT) per item, the order size per year, total spending for an assortment group and total spending for all products purchased from a specific supplier were measured.ResultsWe found large price variations for the medical products surveyed (average coefficient of variation of 71%). In general, these differences were hard to explain (average R2of 26%). Only purchasing volume (for 8 out of 17 products) was significantly associated with the net price paid by a hospital. Total spending for an assortment group (in euros with a specific supplier) and total spending (for all products in euros with a specific supplier) were not related to the net price paid.ConclusionsWe conclude that only purchasing volume is associated with lower prices paid. Total spending for an assortment group and total spending for all products purchased from a specific supplier are not. These results are in stark contrast to expectations based on economic theory. Other sources of differences in bargaining power might explain these findings. Further research might involve comparing prices across countries.

Poster 183: What is the Etiology of Low Back Pain in Patients Having Undergone Lumbar Fusion? An Interim Analysis of a Cross-Sectional Analytic Study

PM&R ◽  
2009 ◽  
Vol 1 ◽  
pp. S183-S184
Author(s):  
Michael J. DePalma ◽  
Jessica M. Ketchum ◽  
Amr Kouchouk ◽  
David Powell ◽  
Evan D. Queler ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Interim Analysis ◽  
Lumbar Fusion ◽  
Analytic Study ◽  
Low Back ◽  
Cross Sectional

scholarly journals Prevalence of musculoskeletal problems in caregivers handling non-ambulatory spinal cord injury patients

2021 ◽  
Vol 7 (9) ◽  
pp. 454
Author(s):  
Pranjali Kulkarni ◽  
Manish Ray ◽  
Ashok Shyam ◽  
Parag Sancheti
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Low Back Pain ◽  
Back Pain ◽  
Cross Sectional Study ◽  
Low Back ◽  
Cross Sectional ◽  
Validated Questionnaire ◽  
Cord Injury ◽  
Musculoskeletal Problems

<p class="abstract"><strong>Background:</strong> Spinal cord injury (SCI) is a distressing disorder that can cause of loss of physical, psychological and social functioning, that can cause high level of disability in patients. Due to disability, they are dependent on caregivers for their daily activities. Caregivers of SCI can be family or professional caregivers. Due to lack of training and awkward posture, caring for SCI patients may be burdensome which results in musculoskeletal problems in caregivers so it is important to find out the prevalence of musculoskeletal problems. The objectives were to find out the prevalence of musculoskeletal problems in caregivers handling non-ambulatory SCI patients and most common site of injury.</p><p class="abstract"><strong>Methods:</strong> A cross sectional study was carried out on 80 caregivers including both professional and family caregivers. Self-structured validated questionnaire used to interview the caregivers based on convenient sampling. The data was analysed by descriptive statistics.</p><p class="abstract"><strong>Results:</strong> The prevalence of musculoskeletal problems is 95% in caregivers including both family and professional caregivers. Low back pain was the commonest site of symptoms (53%) followed by 15% neck, 12% upper back pain, right shoulder (10%), right wrist (5%) and no pain (5%).</p><p class="abstract"><strong>Conclusions:</strong> The prevalence of musculoskeletal problems in caregivers handling non ambulatory SCI is high. Most affected area is low back pain and neck pain. The findings of the study indicated that proper training and exercise are required, on means of preventing musculoskeletal problems.</p><p> </p>

scholarly journals Determinants of inter-practice variation in childhood asthma and respiratory infections: cross-sectional study of a national sentinel network

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e024372
Author(s):  
Uy Hoang ◽  
Harshana Liyanage ◽  
Rachel Coyle ◽  
Charles Godden ◽  
Simon Jones ◽  
...  
Keyword(s):  
Childhood Asthma ◽  
Respiratory Infections ◽  
Cross Sectional Study ◽  
Secondary Outcome ◽  
Sectional Study ◽  
Cross Sectional ◽  
Practice Level ◽  
Children With Asthma ◽  
The Mean ◽  
Tract Infections

ObjectivesRespiratory infections are associated with acute exacerbations of asthma and accompanying morbidity and mortality. In this study we explore inter-practice variations in respiratory infections in children with asthma and study the effect of practice-level factors on these variations.DesignCross-sectional study.SettingWe analysed data from 164 general practices in the Royal College of General PractitionersResearch and Surveillance Centresentinel network in England.ParticipantsChildren 5–12 years.InterventionsNone. In this observational study, we used regression analysis to explore the impact of practice-level determinants on the number of respiratory infections in children with asthma.Primary and secondary outcome measuresWe describe the distribution of childhood asthma and the determinants of upper/lower respiratory tract infections in these children.Results83.5% (137/164) practices were in urban locations; the mean number of general practitioners per practice was 7; and the mean duration since qualification 19.7 years. We found almost 10-fold difference in the rate of asthma (1.5–11.8 per 100 children) and 50-fold variation in respiratory infection rates between practices. Larger practices with larger lists of asthmatic children had greater rates of respiratory infections among these children.ConclusionWe showed that structural/environmental variables are consistent predictors of a range of respiratory infections among children with asthma. However, contradictory results between measures of practice clinical care show that a purely structural explanation for variability in respiratory infections is limited. Further research is needed to understand how the practice factors influence individual risk behaviours relevant to respiratory infections.

scholarly journals Patient and practice characteristics predicting attendance and completion at a specialist weight management service in the UK: a cross-sectional study

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e018286 ◽  
Author(s):  
David N Blane ◽  
Philip McLoone ◽  
David Morrison ◽  
Sara Macdonald ◽  
Catherine A O’Donnell
Keyword(s):  
Weight Management ◽  
Cross Sectional Study ◽  
Secondary Outcome ◽  
Management Service ◽  
Sectional Study ◽  
Cross Sectional ◽  
Practice Level ◽  
Practice Characteristics ◽  
Weight Management Service ◽  
Deprived Areas

ObjectiveTo determine the association between patient and referring practice characteristics and attendance and completion at a specialist health service weight management service (WMS).DesignCross-sectional study.SettingRegional specialist WMS located in the West of Scotland.Participants9677 adults with obesity referred between 2012 and 2014; 3250 attending service and 2252 completing.Primary and secondary outcome measuresPrimary outcome measure was attendance at the WMS; secondary outcome was completion, defined as attending four or more sessions.AnalysisMultilevel binary logistic regression models constructed to determine the association between patient and practice characteristics and attendance and completion.ResultsApproximately one-third of the 9677 obese adults referred attended at least one session (n=3250, 33.6%); only 2252 (23%) completed by attending four or more sessions. Practice referrals ranged from 1 to 257. Patient-level characteristics were strongest predictors of attendance; odds of attendance increased with age (OR 4.14, 95% CI 3.27 to 5.26 for adults aged 65+ compared with those aged 18–24), body mass index (BMI) category (OR 1.83, 95% CI 1.56 to 2.15 for BMI 45+ compared with BMI 30–35) and increasing affluence (OR 1.96, 95% CI 1.17 to 3.28). Practice-level characteristics most strongly associated with attendance were being a non-training practice, having a larger list size and not being located in the most deprived areas.ConclusionsThere was wide variation in referral rates across general practice, suggesting that there is still much to do to improve engagement with weight management by primary care practitioners. The high attrition rate from referral to attendance and from attendance to completion suggests ongoing barriers for patients, particularly those from the most socioeconomically deprived areas. Patient and practice-level characteristics can help us understand the observed variation in attendance at specialist WMS following general practitioner (GP) referral and the underlying explanations for these differences merit further investigation.

scholarly journals Postural indices and limits of stability in subjects having chronic low back pain versus healthy control: A cross-sectional comparative study

2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Hisham M. Hussein
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Postural Stability ◽  
Low Back ◽  
Cross Sectional ◽  
Limits Of Stability ◽  
Musculoskeletal Problems ◽  
Healthy Control ◽  
Postural Performance

Introduction: Balance and postural performance measures are quite variable. These measures could be influenced by chronic musculoskeletal problems. Literature contains contradicting results regarding the affection of postural stability indices and limits of stability measures in subjects having chronic low back pain. Additionally, the available work in this topic is still scarce.

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