Abstract
This study aimed to examine the degree to which facility- and clinician-level information accounts for nonpharmacological treatment (NPT) receipt early in a musculoskeletal pain treatment episode. We examined care provided within the US Military Health System (MHS) from 2016-2021, using a cross-sectional retrospective observational design with multivariable logistic regression analysis. The primary outcome was receipt of any nonpharmacological treatment, and the secondary outcome was receipt of nonpharmacological treatments before pharmacological treatment (opioid or muscle relaxant), in both cases measured over the first 60 days of a pain treatment episode. Key exposures included characteristics of the facilities and clinicians associated with the index visit. The study was a secondary analysis of 2016-2021 administrative records of members' demographic information, healthcare encounters, prescriptions filled, and facility and clinician characteristics. Subjects were military service members with at least 24 months of continuous eligibility who initiated care for musculoskeletal pain in a military treatment facility during 2016 to 2021. Forty percent of service members received NPT within 60 days of index pain diagnosis (39% in 2016, increasing to 46% in 2021). Both receipt of any NPT and receipt of NPT before pharmacological treatment were associated with facility-level NPT personnel availability in the year of the visit. For example, a facility with physical therapist availability 1 standard deviation above the mean had a 0.5% higher adjusted probability of each outcome). Modifiable barriers (e.g., NPT clinician availability) could be targeted in future interventions to encourage guideline-congruent NPT receipt. Perspective: This article examines the association of facility- and clinician-level factors with the receipt of nonpharmacological treatment (NPT) receipt early in a musculoskeletal pain treatment episode. The results could help to identify modifiable barriers (e.g., NPT clinician availability) to target in future interventions to encourage guideline-congruent receipt of NPT.