Serena Bezdjian, James M. Whedon, DC,
The purpose of this study was to examine experiences and attitudes toward care offered by chiropractors and prescription drug therapy offered by medical physicians for patients who have back pain.
Jim Whedon, Toler A, Bezdjian S, Goehl J, Russell R, Kazal L, Nagare M.
The objective of this investigation was to compare the value of primary spine care (PSC) with usual care for the management of patients with spine-related disorders (SRDs) within a primary care setting. Among patients with SRDs included in this study, implementation of the PSC model within a conventional primary care setting was associated with a trend toward reduced total expenditures for spine care compared with usual primary care. Implementation of PSC may lead to reduced costs and resource utilization but may be no more effective than usual care regarding clinical outcomes.
Jim Whedon
Chiropractic claims account for less than 1/10th of 1% of overall Medicare expenditures. Allowed services, allowed charges, and fee-for-service payments for chiropractic spinal manipulation under Medicare Part B generally increased from 2002, peaked in 2005 and 2006, and then declined through 2008. Per-user spending for chiropractic spinal manipulation also declined by 18% from 2006 to 2008, in contrast to 10% growth in total spending per beneficiary and 16% growth in overall Medicare spending.
Jim Whedon
To examine the relationship between regional chiropractic supply and both use and utilization intensity of chiropractic services among Medicare beneficiaries.
Jim Whedon
With the advent of new models for payment and delivery of healthcare services, the use of quality measures for continual improvement of clinical healthcare is now an integral feature of medical practice in the United States. However, quality measurement and quality improvement activities are not common practice among integrative health providers. This article discusses the import and application of quality measurement to the practice of integrative healthcare. It reviews developments in the healthcare quality improvement movement, explores the relevance of quality measures to integrative healthcare, describes examples of the current use of quality measures in integrative health practice, discusses discriminatory policies that may prevent participation in quality improvement by integrative health practitioners, and makes recommendations for practice and policy.
Jim Whedon
Private insurance plans typically reimburse doctors of chiropractic for a range of clinical services, but Medicare reimbursements are restricted to spinal manipulation procedures. Medicare pays for evaluations performed by medical and osteopathic physicians, nurse practitioners, physician assistants, podiatrists, physical therapists, and occupational therapists; however, it does not reimburse the same services provided by chiropractic physicians. Advocates for expanded coverage of chiropractic services under Medicare cite clinical effectiveness and patient satisfaction, whereas critics point to unnecessary services, inadequate clinical documentation, and projected cost increases. To further inform this debate, the purpose of this commentary is to address the following questions: (1) What are the barriers to expand coverage for chiropractic services? (2) What could potentially be done to address these issues? (3) Is there a rationale for Centers for Medicare and Medicaid Services to expand coverage for chiropractic services?
Jim Whedon
Pain relief resulting from services delivered by doctors of chiropractic may allow patients to use lower or less frequent doses of opioids, leading to reduced risk of adverse effects. The objective of this investigation was to evaluate the association between utilization of chiropractic services and the use of prescription opioid medications.
Jim Whedon
Utilization of nonpharmacological pain management may prevent unnecessary use of opioids. Our objective was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain.
Jim Whedon
Insurance reimbursement for clinical services provided by complementary healthcare professionals in the United States likely differs by provider specialty. It is hypothesized that a lower likelihood of insurance reimbursement demonstrates that complementary healthcare services are not utilized to an optimal level and are not financially accessible to all who may need or want these services. The purpose of this project was to evaluate the likelihood of insurance reimbursement for complementary healthcare services compared with other complementary services and with conventional primary care medical services in New Hampshire.
Jim Whedon
Posttraumatic stress disorder (PTSD) is an anxiety disorder often treated with antidepressant medication and/or psychotherapy. The long-term consequences of antidepressant drug use are not well understood, and patient dissatisfaction with antidepressant medication is common, either from ineffective symptom control and/or adverse effects. Discontinuation of antidepressants, however, can cause withdrawal symptoms. For individuals who are dissatisfied with anti-depressant medication and wish to discontinue long-term use, professional support, and information resources can be hard to come by. The effectiveness of integrative therapies for anxiety disorders including PTSD is mostly unknown. We present a case illustrative of the challenges of withdrawal from antidepressant drugs and discuss integrative therapies for the management of PTSD and support for medication withdrawal. We have presented the case of a courageous woman whose healing odyssey illuminates the limits of clinical knowledge about PTSD. The story is not yet over-since experiencing profound relief through soul retrieval, M.B. continues to harbor the hope of withdrawing permanently from psychotropic medication. Although the benefits and harms of long-term antidepressant use are unknown, pharmacotherapy remains the dominant model for the treatment of PTSD. However, for patients who want to discontinue long-term use of anti-depressant medication, insufficient professional expertise, support, and resources are available. More research is needed on the long-term effects of antidepressant use and withdrawal, and the integration of promising alternative models of treatment such as soul retrieval should be explored. At the deepest level, the dissociation of chronic posttraumatic stress may represent a fracture of the soul.
Jim Whedon
Racial and ethnic disparities in utilization of chiropractic services have been described at the state level, but little is known about such local disparities. We analyzed Medicare data for the year 2008 to evaluate by ZIP code for utilization of chiropractic services among older adults in Los Angeles County, California. We evaluated for availability and use of chiropractic services by racial/ethnic category, quantified geographic variations by coefficient of variation, and mapped utilization by selected racial/ethnic categories. Among 7502 beneficiaries who used chiropractic services, 72% were white, 12% Asian, 1% black, 1% Hispanic, and 14% other/unknown. Variation in the number of beneficiaries per ZIP code who used chiropractic services was highest among Hispanics, blacks, and Asians. We found evidence of racial disparities in use of chiropractic services at the local level in Los Angeles County. Older blacks and Hispanics in Los Angeles County may be underserved with regard to chiropractic care.
Jim Whedon
Mortality rates due to adverse drug events (ADEs) are escalating in the United States. Analgesics are among the drug classes most often associated with occurrence of an ADE. Utilization of nonpharmacologic chiropractic services for treatment of low back pain could lead to reduced risk of an ADE. The objective of this investigation was to evaluate the association between utilization of chiropractic services and likelihood of an ADE.
Jim Whedon
Deaths from injuries related to certain prescription medications, or adverse drug events (ADEs), are rising in the United States. Analgesics are one of the drug classes most often associated with an ADE. Treating low back pain with nonpharmacologic chiropractic services could lead to reduced risk of an ADE. This study observed the association between utilization of chiropractic services and likelihood of an ADE.