Influence of Initial Provider on Health Care Utilization in Patients Seeking Care for Neck Pain.
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To examine patients seeking care for neck pain to determine associations between the type of provider initially consulted and 1-year health care utilization.A retrospective cohort of 1702 patients (69.25% women, average age, 45.32±14.75 years) with a new episode of neck pain who consulted a primary care provider, physical therapist (PT), chiropractor (DC), or specialist from January 1, 2012, to June 30, 2013, was analyzed. Descriptive statistics were calculated for each group, and subsequent 1-year health care utilization of imaging, opioids, surgery, and injections was compared between groups.Compared with initial primary care provider consultation, patients consulting with a DC or PT had decreased odds of being prescribed opioids within 1 year from the index visit (DC: adjusted odds ratio [aOR], 0.54; 95% CI, 0.39-0.76; PT: aOR, 0.59; 95% CI, 0.44-0.78). Patients consulting with a DC additionally demonstrated decreased odds of advanced imaging (aOR, 0.43; 95% CI, 0.15-0.76) and injections (aOR, 0.34; 95% CI, 0.19-0.56). Initiating care with a specialist or PT increased the odds of advanced imaging (specialist: aOR, 2.96; 95% CI, 2.01-4.38; PT: aOR, 1.57; 95% CI, 1.01-2.46), but only initiating care with a specialist increased the odds of injections (aOR, 3.21; 95% CI, 2.31-4.47).Initially consulting with a nonpharmacological provider may decrease opioid exposure (PT and DC) over the next year and also decrease advanced imaging and injections (DC only). These data provide an initial indication of how following recent practice guidelines may influence health care utilization in patients with a new episode of neck pain.
SubjectACP, American College of Physicians
CDC, Centers for Disease Control and Prevention
ICD-9, International Classification of Diseases, Ninth Revision
IQR, interquartile range
MRI, magnetic resonance imaging
PCP, primary care provider
PT, physical therapist
UUHP, University of Utah Health Plans
aOR, adjusted odds ratio
Published Version (Please cite this version)10.1016/j.mayocpiqo.2017.09.001
Publication InfoGeorge, Steven; Horn, Maggie; & Fritz, Julie M (2017). Influence of Initial Provider on Health Care Utilization in Patients Seeking Care for Neck Pain. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 1(3). pp. 226-233. 10.1016/j.mayocpiqo.2017.09.001. Retrieved from https://hdl.handle.net/10161/18139.
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Professor of Orthopaedic Surgery
Dr. George’s primary interest is research involving biopsychosocial models for the prevention and treatment of chronic musculoskeletal pain disorders. His long term goals are to 1) improve accuracy for predicting who is going to develop chronic pain; and 2) identify non-pharmacological treatment options that limit the development of chronic pain conditions. Dr. George is an active member of the American Physical Therapy Association, American Pain Society, and International A
Assistant Professor of Orthopaedic Surgery
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