Screening for Health-Related Social Needs: American College of Preventive Medicine's Practice Statement.

Interest is rapidly growing around screening for health-related social needs (HRSN) in direct patient care settings. The screening and provision of HRSN is often done in the context of trying to address social determinants of health (SDOH). While there is emerging evidence that screening and referral for HRSN can improve health outcomes, there are educational, operational, and systemic gaps that need to be filled in order for HRSN screening and referral to be implemented system-wide and result in meaningful improvement in population health outcomes.

Chronic Opioid Use After Implementation of Oregon's Medicaid Back Pain Policy.

Introduction: In 2016, Oregon developed an innovative policy to improve care for Medicaid patients with back pain. The objective of this study was to identify the factors associated with dose reduction and discontinuation among Medicaid patients using chronic opioid therapy after implementation of this policy.

Methods: Using Medicaid administrative claims data, this was a retrospective cohort of patients on chronic stable opioid therapy between July and December 2016.

Adaptive Approaches to Physical Pain Treatment Modalities During the COVID-19 Pandemic: A Qualitative Analysis.

Despite the lack of proven efficacy, opioids historically have been used for the treatment of noncancer back pain. A variety of other effective therapeutic options for pain management are becoming more available over time. In 2016, Oregon implemented a unique and novel policy to improve evidence-based back pain care and promote safer and more effective opioid prescribing through the state's Medicaid program, the Oregon Health Plan.

"It Has Improved My Practice to Be Able to Offer Alternative Treatments": A Longitudinal Qualitative Study of Oregon Medicaid Back Pain Providers.

This study aimed to understand health care providers' experiences implementing the Oregon Back Pain Policy (OBPP) over time. The Medicaid OBPP expanded coverage of evidence-based nonpharmacological therapy (NPT) for back pain and restricted access to opioid therapy and interventional approaches. The study included six online, asynchronous focus groups with providers in February 2020 (Time 1) and August 2022 (Time 2).

How Should Harm Reduction Be Included in Care Continua for Patients With Opioid Use Disorder?

Practices and interventions that aim to slow progression or reduce negative consequences of substance use are harm reduction strategies. Often described as a form of tertiary prevention, harm reduction is key to caring well for people who use drugs. Evidence-based harm reduction interventions include naloxone and syringe service programs.

Outcomes After a Statewide Policy to Improve Evidence-Based Treatment of Back Pain Among Medicaid Enrollees in Oregon.

Background: A novel Oregon Medicaid policy guiding back pain management combined opioid restrictions with emphasis on non-opioid and non-pharmacologic therapies.

Objective: To examine the effect of the policy on prescribing, health outcomes, and health service utilization.

Design: Using Medicaid enrollment, medical and prescription claims, prescription drug monitoring program, and vital statistics files, we analyzed the policy's association with selected outcomes using interrupted time series models.

A cross-sectional survey exploring clinician perceptions of a novel Medicaid back pain policy.

Objectives: Oregon Medicaid (Oregon Health Plan, or OHP) implemented an innovative policy in 2016 that increased coverage of evidence-based non-pharmacologic therapies (NPT, including physical therapy, massage, chiropractic, and acupuncture) while restricting opioids, epidural steroid injections, and surgeries. The objective of this study was to compare the perspectives of clinicians who see back pain patients and can prescribe pharmacologic therapies and/or refer to NPTs and clinicians who directly provide NPT therapies affected by the policy.

Methods: A cross-sectional online survey was administered to Oregon prescribing clinicians and NPT clinicians between December 2019 and February 2020.

Clinician Perspectives on Referring Medicaid Back Pain Patients to Integrative and Complementary Medicine: A Qualitative Study.

To increase understanding of referral processes from primary care to integrative and complementary medicine (ICM) under an Oregon Medicaid policy that restricted opioids and expanded access to ICM for back pain patients. Four asynchronous online focus groups with 48 medical clinicians were conducted. Themes were constructed using thematic analysis.

American College of Preventive Medicine: Addressing the Opioid Epidemic Through a Prevention Framework.

The opioid epidemic has resulted in significant morbidity and mortality in the U.S. Health systems, policymakers, payers, and public health have enacted numerous strategies to reduce the harms of opioids, including opioid use disorder (OUD).

Reduction of Long-Term Opioid Prescribing for Back Pain in Community Health Centers After a Medicaid Policy Change.

Introduction: Beginning around 2011, innumerable policies have aimed to improve pain treatment while minimizing harms from excessive use of opioids. It is not known whether changing insurance coverage for specific conditions is an effective strategy. We describe and assess the effect of an innovative Oregon Medicaid back/neck pain coverage policy on opioid prescribing patterns.

Experiences of Nonpharmacologic Providers Implementing the Oregon Back Pain Policy Expanding Services for Medicaid Recipients: A Focus Group Study.

The objective of this study was to understand the experiences of nonpharmacologic therapy (NPT) providers implementing the Oregon Back Pain Policy (OBPP). The Medicaid OBPP expanded coverage of evidence-based NPTs for back pain and simultaneously restricted access to acute and chronic opioid therapy and some interventional approaches for chronic back pain. This study uses a cross-sectional, observational design.

Increased Use of Complementary and Alternative Therapies for Back Pain Following Statewide Medicaid Coverage Changes in Oregon.

Background: In 2016, Oregon introduced a policy to improve back pain treatment among Medicaid enrollees by expanding benefits for evidence-based complementary and alternative medical (CAM) services and establishing opioid prescribing restrictions.

Objective: To examine changes in CAM utilization following the policy and variations in utilization across patient populations.

Design: A retrospective study of Oregon Medicaid claims data, examining CAM therapy utilization by back pain patients pre- vs post-policy.

Reducing Tobacco Use in Oregon Through Multisector Collaboration: Aligning Medicaid and Public Health Programs.

Introduction: Tobacco use is the leading cause of preventable death and disease in the United States. Oregon's coordinated care model for Medicaid provides an opportunity to consider novel ways to reduce tobacco use.

Purpose And Objectives: We sought to evaluate the changes in tobacco cessation benefits, patient access to cessation interventions, and cigarette smoking prevalence before and after introduction of the statewide Coordinated Care Organization (CCO) cigarette smoking incentive metric for Medicaid members.

Medical Reversals in Family Practice: A Review.

Background: Primary care physicians are challenged by the need to stay abreast of current research on a wide variety of topics in an environment of time constraints, evolving literature, and misinformation on health topics that are sometimes promulgated to the public.

Objective: We sought to identify and discuss common clinical situations encountered in primary care for which medical reversals have occurred.

Methods: We recently identified almost 400 medical practices that were used in clinical care before they were tested in well-done randomized controlled trials and subsequently were found to be ineffective or harmful.

Medical reversals in low- and middle-income countries.

Background: Low- to middle-income countries (LMICs) often have limited budgets for health care, and as such, they need to prioritize health care interventions that are evidence based. However, sometimes, interventions are implemented despite a lack of supporting evidence because of a perceived biologic plausibility or because they have worked in other populations. Later, some of these interventions are shown to either lack benefit or are harmful in randomized studies, which we call a medical reversal.

A comprehensive review of randomized clinical trials in three medical journals reveals 396 medical reversals.

The ability to identify medical reversals and other low-value medical practices is an essential prerequisite for efforts to reduce spending on such practices. Through an analysis of more than 3000 randomized controlled trials (RCTs) published in three leading medical journals (the Journal of the American Medical Association, the Lancet, and the New England Journal of Medicine), we have identified 396 medical reversals. Most of the studies (92%) were conducted on populations in high-income counties, cardiovascular disease was the most common medical category (20%), and medication was the most common type of intervention (33%).

Electronic Nicotine Delivery Systems or E-cigarettes: American College of Preventive Medicine's Practice Statement.

Introduction: E-cigarettes or or electronic nicotine delivery systems (ENDS) have rapidly gained popularity in the U.S. Controversy exists about the safety and efficacy of ENDS.

Integrating Public Health and Health Care Strategies to Address the Opioid Epidemic: The Oregon Health Authority's Opioid Initiative.

Context: Oregon is experiencing an opioid overdose epidemic, similar to the United States as a whole. To address this crisis, the Oregon Health Authority (OHA) implemented a strategic Opioid Initiative, convening stakeholders and integrating public health and health care system activities across sectors. Recent data indicate progress: from 2015 to 2016, Oregon had the sharpest decline in prescription opioid overdose deaths of any state.

Choosing Wisely® in Preventive Medicine: The American College of Preventive Medicine's Top 5 List of Recommendations.

The Choosing Wisely(®) initiative is a national campaign led by the American Board of Internal Medicine Foundation, focused on quality improvement and advancing a dialogue on avoiding wasteful or unnecessary medical tests, procedures, and treatments. The American College of Preventive Medicine (ACPM) Prevention Practice Committee is an active participant in the Choosing Wisely project. The committee created the ACPM Choosing Wisely Task Force to lead the development of ACPM's recommendations with the intention of facilitating wise decisions about the appropriate use of preventive care.

The American College of Preventive Medicine Position Statement on Hepatitis C Virus Infection.

The American College of Preventive Medicine Prevention Practice Committee contributes to policy guidelines and recommendations on preventive health topics for clinicians and public health decision makers. After review of the currently available evidence, the College is providing a consensus-based set of recommendations designed to increase screening for and prevention of hepatitis C virus infection, increase linkage to care, improve access to treatment, and encourage development of hepatitis C virus-related quality measures.