Influence of Initial Provider on Health Care Utilization in Patients Seeking Care for Neck Pain.
Abstract
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.
Type
Journal articleSubject
ACP, American College of PhysiciansCDC, Centers for Disease Control and Prevention
DC, chiropractor
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
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https://hdl.handle.net/10161/18139Published Version (Please cite this version)
10.1016/j.mayocpiqo.2017.09.001Publication Info
Horn, Maggie E; George, Steven Z; & 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.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Steven Zachary George
Laszlo Ormandy Distinguished 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, United States Association of the Study of
Maggie Elizabeth Horn
Assistant Professor in Orthopaedic Surgery
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