The epidemiology and medical management of low back pain during ambulatory medical care visits in the United States.
The epidemiology and medical management of low back pain during ambulatory medical care visits in the United States.
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DOI：
10.1186/1750-4732-2-11
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发表时间：
2008-11-24
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影响因子：
--
通讯作者：
Licciardone JC
中科院分区：
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作者：
Licciardone JC
下背痛（LBP）是一种常见的症状。在2003-2004年期间，国家门诊医疗调查（NAMCS）中归因于LBP的患者就诊作为流行病学分析的基础（n = 1539）。LBP是寻求治疗的主要原因的患者就诊子集（原发性LBP患者就诊）作为医疗管理分析的基础（n = 1042）。国家人口估计数是使用统计加权技术得出的。有6170万（SE，400万）LBP患者就诊，4240万（SE，310万）原发性LBP患者就诊。只有55%的LBP患者就诊由初级保健医生提供。年龄，地理区域，慢性症状，损伤，医生提供者的类型和医生的专业与LBP患者的访问。年龄，受伤，初级保健医生的地位，类型的医生提供者，和共享的医生护理与LBP护理的慢性化。骨科医生比对抗疗法医生更有可能在LBP患者访视（比值比[OR]，2.61; 95%置信区间[CI]，1.75-3.92）和慢性LBP患者访视（OR，4.39; 95% CI，2.47-7.80）期间提供医疗护理。在1420万例（SE，120万）和1050万例（SE，110万）原发性LBP患者就诊期间，分别订购了非甾体抗炎药（NSAID）和麻醉性镇痛药。与急性LBP患者访视相比，慢性LBP患者访视期间订购药物（OR，0.29; 95% CI，0.13-0.62），特别是NSAID（OR，0.40; 95% CI，0.25-0.64）的频率较低。总体而言，骨科医生比对抗疗法医生更不可能为LBP订购NSAID（OR，0.43; 95%CI，0.24-0.76）。在初次LBP患者就诊期间，订购、安排或进行了近200万例外科手术。在美国，初级保健医生提供的LBP就诊比例仍然不理想。LBP的医疗管理，特别是慢性LBP，似乎过度使用手术相对于更保守的措施，如病人咨询，非麻醉性镇痛药，和其他药物治疗。骨科医生更有可能提供腰痛护理，而不太可能使用非甾体抗炎药在这样的访问，比他们的对抗疗法同行。一般来说，腰痛的医疗管理似乎并不符合雅阁指南。
Low back pain (LBP) is a common symptom. Patient visits attributed to LBP in the National Ambulatory Medical Care Survey (NAMCS) during 2003–2004 served as the basis for epidemiological analyses (n = 1539). The subset of patient visits in which LBP was the primary reason for seeking care (primary LBP patient visits) served as the basis for medical management analyses (n = 1042). National population estimates were derived using statistical weighting techniques. There were 61.7 million (SE, 4.0 million) LBP patient visits and 42.4 million (SE, 3.1 million) primary LBP patient visits. Only 55% of LBP patient visits were provided by primary care physicians. Age, geographic region, chronicity of symptoms, injury, type of physician provider, and physician specialty were associated with LBP patient visits. Age, injury, primary care physician status, type of physician provider, and shared physician care were associated with chronicity of LBP care. Osteopathic physicians were more likely than allopathic physicians to provide medical care during LBP patient visits (odds ratio [OR], 2.61; 95% confidence interval [CI], 1.75–3.92) and chronic LBP patient visits (OR, 4.39; 95% CI, 2.47–7.80). Nonsteroidal anti-inflammatory drugs (NSAIDs) and narcotic analgesics were ordered during 14.2 million (SE, 1.2 million) and 10.5 million (SE, 1.1 million) primary LBP patient visits, respectively. Drugs (OR, 0.29; 95% CI, 0.13–0.62) and, specifically, NSAIDs (OR, 0.40; 95% CI, 0.25–0.64) were ordered less often during chronic LBP patient visits compared with acute LBP patient visits. Overall, osteopathic physicians were less likely than allopathic physicians to order NSAIDs for LBP (OR, 0.43; 95% CI, 0.24–0.76). Almost two million surgical procedures were ordered, scheduled, or performed during primary LBP patient visits. The percentage of LBP visits provided by primary care physicians in the United States remains suboptimal. Medical management of LBP, particularly chronic LBP, appears to over-utilize surgery relative to more conservative measures such as patient counseling, non-narcotic analgesics, and other drug therapies. Osteopathic physicians are more likely to provide LBP care, and less likely to use NSAIDs during such visits, than their allopathic counterparts. In general, LBP medical management does not appear to be in accord with evidence-based guidelines.