Unraveling Disparities in Non-Pharmacologic Approaches for Medicaid Patients with Back Pain

Project Summary Many non-pharmacologic therapies (NPTs) such as massage, acupuncture, and chiropractic treatments are now covered for the treatment of back pain under Oregon Medicaid. However, racial and ethnic minorities access these treatments less often than white patients. The study includes two Specific Aims. In Aim 1, we will capture primary care NPT referral practices and other elements of the back pain visit through examination of 7 years of electronic health records (EHRs) from 8 primary care clinics, comparing NPT referral and other management practice differences across non-Hispanic white, non-Hispanic Black, and Hispanic Medicaid patients with back pain; we will also conduct brief interviews with medical directors to understand the context of care in each clinic. In Aim 2, we will explore barriers and facilitators of NPT through 1:1 in-depth interviews with Black and Hispanic patients with recent visits for back pain. Aim 2 will conclude with the integration of quantitative and qualitative data. This mixed methods study obtains information from the electronic health record (EHR) and directly from patient interviews across urban and rural primary care sites to explore factors that may influence uptake of NPT services differentially across racial and ethnic groups, including individual, clinic, and community factors.