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Influence of Initial Provider on Health Care Utilization in Patients Seeking Care for Neck Pain.

dc.contributor.author George, Steven
dc.contributor.author Horn, Maggie
dc.contributor.author Fritz, Julie M
dc.date.accessioned 2019-03-07T15:33:49Z
dc.date.available 2019-03-07T15:33:49Z
dc.date.issued 2017-12
dc.identifier S2542-4548(17)30057-7
dc.identifier.issn 2542-4548
dc.identifier.issn 2542-4548
dc.identifier.uri https://hdl.handle.net/10161/18139
dc.description.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.
dc.language eng
dc.publisher Elsevier BV
dc.relation.ispartof Mayo Clinic Proceedings: Innovations, Quality & Outcomes
dc.relation.isversionof 10.1016/j.mayocpiqo.2017.09.001
dc.subject ACP, American College of Physicians
dc.subject CDC, Centers for Disease Control and Prevention
dc.subject DC, chiropractor
dc.subject ICD-9, International Classification of Diseases, Ninth Revision
dc.subject IQR, interquartile range
dc.subject MRI, magnetic resonance imaging
dc.subject PCP, primary care provider
dc.subject PT, physical therapist
dc.subject UUHP, University of Utah Health Plans
dc.subject aOR, adjusted odds ratio
dc.title Influence of Initial Provider on Health Care Utilization in Patients Seeking Care for Neck Pain.
dc.type Journal article
dc.date.updated 2019-03-07T15:33:47Z
pubs.begin-page 226
pubs.end-page 233
pubs.issue 3
pubs.organisational-group School of Medicine
pubs.organisational-group Duke
pubs.organisational-group Duke Clinical Research Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group Orthopaedics
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Population Health Sciences
pubs.organisational-group Basic Science Departments
pubs.organisational-group Orthopaedics, Physical Therapy
pubs.publication-status Published
pubs.volume 1


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