Table 2.
Associations between utilization and ≥2 opioid prescriptions.
| No Early Opioid Rx (n=200) |
≥2 Early Opioid Rx’s (n=200) |
Generalized Linear Regression Estimate (95% CI)a |
p-value | |
|---|---|---|---|---|
| 24-month RVUs, mean, median (IQR) | ||||
| Overall | 130, 55 (31–140) | 170, 81 (39–170) | 38 (−5.4, 82) | 0.09 |
| Overall Spine | 24, 3.3 (1.5–13) | 51, 3.7 (1.7–18) | 25 (−4.4, 55) | 0.90b |
| Spine Injections | 0.8, 0 (0); (n=16)c | 2.9, 0 (0); (n=45)c | 2.0 (0.8, 3.3) | 0.05b |
| Spine Imaging | 5.0, 1.0 (0–11); (n=105)c | 7.2, 1.2 (0–12); (n=139)c | 2.3 (0.5, 4.0) | 0.16b |
| Spine Surgery | 14, 0 (0); (n=5) | 35, 0 (0); (n=10)c | 19 (−7.7, 45) | 0.90b |
| Physical Therapy-Any | 4.4, 2.2 (0–5.8); (n=114)c | 4.6, 3.1 (0–7.1); (n=116)c | 0.2 (−1.1, 1.5) | 0.90b |
| # ED Visits among patients with ≥1 ED visit, mean, median (IQR) | 2.6, 2 (1–3) | 2.5, 2 (1–3) | 0.03 (−0.2, 0.3) | 0.81 |
| # Hospitalizations among patients with ≥1, mean, median (IQR) | 1.6, 1 (1–2) | 1.4, 1 (1–2) | −0.2 (−0.3, −0.004) | 0.05 |
| # of Opioid Prescriptions between months >3–24, mean, median (IQR) | 1.2, 0 (0–2) | 4.5, 1.5 (0–7) | 3.3 (2.3, 4.4) | <0.0001 |
|
| ||||
|
No Early Opioid Rx (n=200) |
≥2 Early Opioid Rx’s (n=200) |
Odds Ratio Estimate (95% CI)a | p-value | |
|
| ||||
| ≥1 ED Visit in 24 mo. after index visit | 78 (39%) | 95 (47%) | 1.6 (1.0–2.5) | 0.04 |
| ≥1 Hospitalization in 24 mo. after index visit | 44 (22%) | 44 (22%) | 1.1 (0.6, 1.9) | 0.75 |
| RDQ Improved ≥30% between baseline and 24 months, n (%) | 70 (40%) | 71 (41%) | 1.2 (0.6, 2.1) | 0.63 |
| ≥1 opioid Rx 3-<6 months after index visit, n (%) | 35 (18%) | 85 (43%) | 3.0 (1.8, 5.0) | <0.0001 |
| ≥1 opioid Rx 6-<12 months after index visit, n (%) | 37 (19%) | 93 (47%) | 3.8 (2.2, 6.6) | <0.0001 |
| ≥1 opioid Rx 12-<18 months after index visit, n (%) | 39 (20%) | 90 (45%) | 4.0 (2.2, 7.3) | <0.0001 |
| ≥1 opioid Rx 18-<24 months after index | 36 (18%) | 81 (41%) | 3.0 (1.7, 5.1) | <0.0001 |
a
Adjusted for sex, age, diagnosis (non-specific, back and leg, or other), back pain duration, and total RVUs in the year prior to the index visit.
b
p-values adjusted using the stepdown Bonferroni method
c
Number of people who had >0 RVUs in that category
Abbreviations: Rx=Prescription; CI=Confidence interval; RVUs=Relative value units; IQR=Interquartile Range (quartile 1 to quartile 3); RDQ=Roland Morris Disability Questionnaire (scale 0–24); higher=worse function