New Landmark Study Confirms Integrative Medicine IPA Reduces Clinical Utilization and Costs for Large Midwest Managed Care Plan
Results of a follow-up study released today from the Journal of Manipulative and Physiological Therapeutics (May 2007;00:1-7) reinforce and amplify the effectiveness of an integrative IPA management model vs. conventional strategies to decrease clinical utilization and costs over an extended period of time and in a safe and highly regulated large Chicago HMO environment. The unique feature of the care model was that doctors of chiropractic (DCs) represented two-thirds of the primary care providers involved.
In the report, "Clinical utilization and cost outcomes from an integrative medicine independent physician association: an additional 3-year update," authors Richard L. Sarnat, MD, James Winterstein, DC and Jerrilyn A. Cambron, DC, PhD analyze utilization data from the IPA and include first-time comparisons in data points among primary care physicians (PCPs) whose training backgrounds were in chiropractic, osteopathic and allopathic medicine.
Author Dr. James Winterstein says, "Health care delivery in the United States has become 'business centered' rather than 'patient centered. The AMI model, through the integration of allopathic, osteopathic, chiropractic and various forms of alternative and complementary medicine, has demonstrated the potential to revolutionize health care delivery by refocusing on the needs of the patient. This model eliminates the turf battles and in doing so, greatly diminishes costs while helping the patient optimize health with fewer high tech procedures and less hospitalization. These should be the intentions of all who function in health care delivery."
According to Mike Flynn, DC, board member and spokesperson for the Foundation for Chiropractic Progress (www.F4CP.org), "This continuing study clearly establishes the ability of the doctor of chiropractic to function effectively and efficiently as primary care gatekeepers in a managed care setting. Decreased utilization was uniformly achieved by all providers."
Results of the study demonstrate clinical and cost utilization decreases based on 70,274 member-months over a seven-year period. Differences in utilization include: 60.2 percent in-hospital admissions, 59.0 percent hospital days, 62.0 percent outpatient surgeries and procedures and 85 percent in pharmaceutical costs when compared with conventional medicine IPA performance for the same HMO product in the same geography and time frame. The IPA's current PCP 21-member physician panel includes a mix of 14 DCs, and seven MDs and DOs.
Dr. Flynn notes that the current study updates the authors' initial report (JMPT, 2004) and covers a larger population than originally reported. Methodology included demographic analysis and patient satisfaction surveys to determine clinical utilization and costs. Comparisons to the original publication's comparative blinded data, using non-random matched comparison groups, were also assessed for differences in age and disease profiles to compare outcomes.
HMO members are recruited to the IPA during an open enrollment period offered to the total plan population. Members obtain information about the IPA from the HMO's standard primary care and specialist physician directories or their companies' human resources personnel. No marketing incentives were used by the HMO to attract potential patient enrollees to the IPA study during any of the years of operation.
"This study gives credence to the perspective that the power to achieve reduced utilization results from the underlying philosophy of patient management and is not the result of differences in PCP education or licensure," says Dr. Flynn. "As our nation faces the acute challenges of rapid escalation of health care costs, and with conventional strategies for clinical improvement and cost containment failing to achieve targeted goals, all stakeholders can look to this study for evidence of an integrative model's ability to deliver tangible results."
Visit www.foundation4cp.com to access the calendar or call 916.359.0327.
About F4CP
The Foundation for Chiropractic Progress is a 501c6 corporation that represents a cross section of the chiropractic and vendor communities with the goal of increasing the public's awareness of the benefits of chiropractic. www.foundation4cp.org.
Saturday, May 26, 2007
Friday, May 25, 2007
Safe treatment for chronic back pain
New Treatment Offers Relief from Chronic Back Pain
Study Suggests Safe Treatment for a Variety of Conditions
Chronic back pain is a condition that affects a significant part of the population, with patients falling into three major groups; those with herniated discs, spinal stenosis (a nerve affecting narrowing of the spinal cord), and complications from failed back surgery. Radiofrequency thermolesioning is a widespread treatment for chronic back pain, but because of its neurodestructive nature, it is often considered an unsuitable treatment.
Building on earlier work, a new study led by Dr. David Abejón investigates the use of an alternative treatment known as pulsed radiofrequency (PRF) in treating chronic back pain. It finds that the treatment yields significant improvements for herniated disc patients and notable improvements for those with spinal stenosis. Since PRF does not involve drugs, it may be repeated multiple times. This study appears in the journal Pain Practice.
While the preexisting conditions that accompany chronic back pain, such as neurological lesions or neuropathic pain, make conventional radiofrequency a controversial treatment, Abejón notes “the use of PRF could reduce or potentially even eliminate these risks,” providing safe, effective pain relief for patients with a variety of lower back pain conditions.
Study Suggests Safe Treatment for a Variety of Conditions
Chronic back pain is a condition that affects a significant part of the population, with patients falling into three major groups; those with herniated discs, spinal stenosis (a nerve affecting narrowing of the spinal cord), and complications from failed back surgery. Radiofrequency thermolesioning is a widespread treatment for chronic back pain, but because of its neurodestructive nature, it is often considered an unsuitable treatment.
Building on earlier work, a new study led by Dr. David Abejón investigates the use of an alternative treatment known as pulsed radiofrequency (PRF) in treating chronic back pain. It finds that the treatment yields significant improvements for herniated disc patients and notable improvements for those with spinal stenosis. Since PRF does not involve drugs, it may be repeated multiple times. This study appears in the journal Pain Practice.
While the preexisting conditions that accompany chronic back pain, such as neurological lesions or neuropathic pain, make conventional radiofrequency a controversial treatment, Abejón notes “the use of PRF could reduce or potentially even eliminate these risks,” providing safe, effective pain relief for patients with a variety of lower back pain conditions.
Aggressive treatment for whiplash?
Aggressive treatment for whiplash does not promote faster recovery
Whiplash, the most common traffic injury, leads to neck pain, headache and other symptoms, resulting in a significant burden of disability and health care utilization. Although there are few effective treatments for whiplash, a growing body of evidence suggests that the type and intensity of treatment received shortly after the injury have a long-lasting influence on the prognosis. A new study published in the June 2007 issue of Arthritis Care & Research (http://www.interscience.wiley.com/journal/arthritiscare) examined whether the association between early types of care and recovery time shown in an earlier study was reproducible with whiplash compensated under tort insurance.
A previous study led by Pierre Côté, of the University of Toronto in Toronto, Canada, found that patients compensated under no-fault insurance had a longer recovery if they visited general practitioners numerous times and/or consulted chiropractors or specialists than if they just visited general practitioners once or twice. In the current study, the authors examined patterns of care for 1,693 patients with whiplash injuries who were compensated under tort insurance.
The results showed that increasing the intensity of care to more than 2 visits to a general practitioner, 6 visits to a chiropractor, or adding chiropractic care to general practitioner care was associated with slower recovery. "The results agree with our previous analysis in a cohort of patients compensated under a no-fault insurance scheme and support the hypothesis that the prognosis of whiplash injuries is influenced by the type and intensity of care received within the first month after injury," the authors state.
They note that effective care, if medically needed, improves the prognosis of patients and that practice guidelines recommend treatment shortly after the injury. However, it may be that doctors responding to pressure from patients use treatments, schedule follow-up visits and refer patients to specialists when not medically needed. "This in turn may lead to adverse outcomes and even prolong recovery by legitimizing patients’ fears and creating unnecessary anxiety," according to the authors. It is also possible that early aggressive treatment delays recovery by encouraging the use of passive coping strategies. "Reliance on frequent clinical care, a form of passive coping strategy, may have a negative effect on recovery by reinforcing the patients’ belief that whiplash injuries often lead to disability," the authors state. They cite another study that showed that whiplash patients who used coping strategies such as wishing for pain medication or believing that they couldn’t do anything to lessen the pain had a slower recover than those who did not use such strategies.
Unlike the previous study, the current one did not show a slower recovery for patients who consulted a general practitioner and a specialist. This suggests that the insurance system (tort versus no-fault) can affect the association between certain patterns of care and recovery because it may influence how patients perceive their medical needs, the pressure they put on clinicians to be referred, and how insurers require them to legitimize their injury. The authors conclude that further trials "are essential to understand the influence of health care provision in preventing or facilitating disability."
Whiplash, the most common traffic injury, leads to neck pain, headache and other symptoms, resulting in a significant burden of disability and health care utilization. Although there are few effective treatments for whiplash, a growing body of evidence suggests that the type and intensity of treatment received shortly after the injury have a long-lasting influence on the prognosis. A new study published in the June 2007 issue of Arthritis Care & Research (http://www.interscience.wiley.com/journal/arthritiscare) examined whether the association between early types of care and recovery time shown in an earlier study was reproducible with whiplash compensated under tort insurance.
A previous study led by Pierre Côté, of the University of Toronto in Toronto, Canada, found that patients compensated under no-fault insurance had a longer recovery if they visited general practitioners numerous times and/or consulted chiropractors or specialists than if they just visited general practitioners once or twice. In the current study, the authors examined patterns of care for 1,693 patients with whiplash injuries who were compensated under tort insurance.
The results showed that increasing the intensity of care to more than 2 visits to a general practitioner, 6 visits to a chiropractor, or adding chiropractic care to general practitioner care was associated with slower recovery. "The results agree with our previous analysis in a cohort of patients compensated under a no-fault insurance scheme and support the hypothesis that the prognosis of whiplash injuries is influenced by the type and intensity of care received within the first month after injury," the authors state.
They note that effective care, if medically needed, improves the prognosis of patients and that practice guidelines recommend treatment shortly after the injury. However, it may be that doctors responding to pressure from patients use treatments, schedule follow-up visits and refer patients to specialists when not medically needed. "This in turn may lead to adverse outcomes and even prolong recovery by legitimizing patients’ fears and creating unnecessary anxiety," according to the authors. It is also possible that early aggressive treatment delays recovery by encouraging the use of passive coping strategies. "Reliance on frequent clinical care, a form of passive coping strategy, may have a negative effect on recovery by reinforcing the patients’ belief that whiplash injuries often lead to disability," the authors state. They cite another study that showed that whiplash patients who used coping strategies such as wishing for pain medication or believing that they couldn’t do anything to lessen the pain had a slower recover than those who did not use such strategies.
Unlike the previous study, the current one did not show a slower recovery for patients who consulted a general practitioner and a specialist. This suggests that the insurance system (tort versus no-fault) can affect the association between certain patterns of care and recovery because it may influence how patients perceive their medical needs, the pressure they put on clinicians to be referred, and how insurers require them to legitimize their injury. The authors conclude that further trials "are essential to understand the influence of health care provision in preventing or facilitating disability."
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