Opposite drug prescription and cost trajectories following integrative and conventional care for pain--a case-control study.
OBJECTIVE
Pharmacotherapy may have a limited role in long-term pain management. Comparative trajectories of drug prescriptions and costs, two quality-of-care indicators for pain conditions, are largely unknown subsequent to conventional or integrative care (IC) management. The objectives of this study were to compare prescribed defined daily doses (DDD) and cost of first line drugs for pain patients referred to conventional or anthroposophic IC in Stockholm County, Sweden.


METHODS
In this retrospective high quality registry case-control study, IC and conventional care patients were identified through inpatient care registries and matched on pain diagnosis (ICD-10: M79), age, gender and socio-demographics. National drug registry data was used to investigate changes in DDD and costs from 90/180 days before, to 90/180 days after, index visits to IC and conventional care. The primary selected drug category was analgesics, complemented by musculo-skeletal system drugs (e.g. anti-inflammatories, muscle relaxants) and psycholeptics (e.g. hypnotics, sedatives).


RESULTS
After index care visits, conventional care pain patients (n = 1050) compared to IC patients (n = 213), were prescribed significantly more analgesics. The average (95% CI) group difference was 15.2 (6.0 to 24.3), p = 0.001, DDD/patient after 90 days; and 21.5 (7.4 to 35.6), p = 0.003, DDD/patient after 180 days. The cost of the prescribed and sold analgesics was significantly higher for conventional care after 90 days: euro/patient 10.7 (1.3 to 20.0), p = 0.025. Changes in drug prescription and costs for the other drug categories were not significantly different between groups.


CONCLUSIONS
Drug prescriptions and costs of analgesics increased following conventional care and decreased following IC, indicating potentially fewer adverse drug events and beneficial societal cost savings with IC.
Karolinska Institutet, Department of Neurobiology Care Sciences and Society, Division of Nursing, Research Group Integrative Care, Huddinge, Sweden; I C - The Integrative Care Science Center, Järna, Sweden.
Tobias
T
Sundberg
Centre for Applied Biostatistics, Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden.
Max
M
Petzold
Division Integrative Health Promotion, University of Applied Sciences and Arts, Coburg, Germany; Generation Research Program, Ludwig-Maximilians-University, Bad Tölz, Germany; Brain, Mind & Healing Program, Samueli Institute, Alexandria, Virginia, United States of America.
Niko
N
Kohls
Karolinska Institutet, Department of Neurobiology Care Sciences and Society, Division of Nursing, Research Group Integrative Care, Huddinge, Sweden; I C - The Integrative Care Science Center, Järna, Sweden.
Torkel
T
Falkenberg
D000293:Adolescent; D000328:Adult; D000700:Analgesics / Q000191:economics / Q000627:therapeutic use; D000887:Anthroposophy / Q000523:psychology; D000893:Anti-Inflammatory Agents / Q000191:economics / Q000627:therapeutic use; D016022:Case-Control Studies; D017046:Cost Savings / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000191:economics / Q000627:therapeutic use; D055048:Integrative Medicine / Q000191:economics*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000191:economics* / Q000503:physiopathology / Q000523:psychology; D005791:Patient Care / Q000379:methods; D019984:Quality Indicators, Health Care / Q000191:economics*; D012042:Registries; D012189:Retrospective Studies; D013548:Sweden
D000700:Analgesics; D000893:Anti-Inflammatory Agents; D006993:Hypnotics and Sedatives