Implications of early and guideline adherent physical therapy for low back pain on utilization and costs
Implications of early and guideline adherent physical therapy for low back pain on utilization and costs
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DOI：
10.1186/s12913-015-0830-3
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发表时间：
2015-04-09
影响因子：
2.8
通讯作者：
George, Steven Z.
中科院分区：
文献类型：
--
作者：
Childs, John D.;Fritz, Julie M.;George, Steven Z.
背景资料：下腰痛（LBP）新发作后的初始管理决策被认为对医疗保健利用和成本有深远的影响。本研究的目的是评估的影响，早期和指导方针遵守物理治疗腰痛的军事卫生系统（MHS）内的利用率和成本。方法：患者提出的初级保健设置与新的投诉LBP从2007年1月1日至2009年12月31日确定从MHS管理分析和报告工具。描述性统计，利用率和成本进行了检查的基础上的时间转介到物理治疗和坚持实践指南超过2年的时间。利用结果（先进的成像，腰椎注射或手术，阿片类药物的使用）进行了比较，使用调整后的比值比与99%的置信区间。总LBP相关的医疗保健费用超过2年的后续行动进行了比较，使用线性回归models.Results：753,450符合条件的患者与LBP的初级保健访问之间的18-60岁被认为是。16.3%（n = 122，723）的患者使用物理治疗，其中24.0%（n = 17，175）的患者接受早期物理治疗，并遵守积极治疗的建议。早期转介到遵循指引的物理治疗与显著降低利用率的所有结果和60%降低总LBP相关costs.Conclusions：在MHS从早期遵循指引的物理治疗的成本节约的潜力可能是巨大的。这些结果也扩展了在平民环境中的类似研究的结果，通过证明早期指南依从性护理和利用率与单一支付者卫生系统中的成本之间的关联。未来的研究是必要的，以检查哪些患者LBP受益于早期物理治疗，并确定提供早期指南依从性护理的策略。
Background: Initial management decisions following a new episode of low back pain (LBP) are thought to have profound implications for health care utilization and costs. The purpose of this study was to evaluate the impact of early and guideline adherent physical therapy for low back pain on utilization and costs within the Military Health System (MHS).Methods: Patients presenting to a primary care setting with a new complaint of LBP from January 1, 2007 to December 31, 2009 were identified from the MHS Management Analysis and Reporting Tool. Descriptive statistics, utilization, and costs were examined on the basis of timing of referral to physical therapy and adherence to practice guidelines over a 2-year period. Utilization outcomes (advanced imaging, lumbar injections or surgery, and opioid use) were compared using adjusted odds ratios with 99% confidence intervals. Total LBP-related health care costs over the 2-year follow-up were compared using linear regression models.Results: 753,450 eligible patients with a primary care visit for LBP between 18-60 years of age were considered. Physical therapy was utilized by 16.3% (n = 122,723) of patients, with 24.0% (n = 17,175) of those receiving early physical therapy that was adherent to recommendations for active treatment. Early referral to guideline adherent physical therapy was associated with significantly lower utilization for all outcomes and 60% lower total LBP-related costs.Conclusions: The potential for cost savings in the MHS from early guideline adherent physical therapy may be substantial. These results also extend the findings from similar studies in civilian settings by demonstrating an association between early guideline adherent care and utilization and costs in a single payer health system. Future research is necessary to examine which patients with LBP benefit early physical therapy and determine strategies for providing early guideline adherent care.