Evaluation and Treatment Patterns of New Low Back Pain Episodes for Elderly Adults in the United States, 2011-2014.
Evaluation and Treatment Patterns of New Low Back Pain Episodes for Elderly Adults in the United States, 2011-2014.
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DOI：
10.1097/mlr.0000000000001244
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发表时间：
2020-02
期刊：
影响因子：
3
通讯作者：
Ly DP
中科院分区：
文献类型：
--
作者：
Ly DP
新发腰痛 (LBP) 是门诊常见的主诉。对于如何在一年内向出现新腰痛的患者提供护理以及这种护理模式是否符合指南，人们知之甚少。这项回顾性分析包括 2011 年 1 月 1 日至 2014 年 12 月 31 日期间 162,238 名未使用过阿片类药物且新出现 LBP 的受益人的医疗保险索赔。简单模式使用率（计算机断层扫描 [CT] 和磁共振成像 [MRI] [“高级成像”]、物理治疗 [PT]、阿片类药物和非阿片类药物）和百分位数（第 5 个百分位数，报告了第 25 个百分位、中位数、75 个百分位和第 95 个百分位。在第一年内，两次或多次就诊新腰痛的患者中有 29.4%（95% 置信区间 [CI] 29.1-29.8）接受了高级影像学检查，其中 48.4%（95% CI 47.7-49.0）在首次就诊后 6 周内接受了高级影像学检查。两次或多次就诊的患者中有 17.3% (95% CI 17.1-17.6) 接受了 PT。两次或多次就诊的患者中，42.2% (95% CI 41.8-42.5) 接受非甾体抗炎药 (NSAID)，16.9% (95% CI 16.6-17.1) 接受肌肉松弛剂，26.2% (95% CI 25.9-26.6) 接受曲马多。 32.3% (95% CI 31.9-32.6) 两次或多次就诊的患者接受阿片类药物治疗； 52.4% (95% CI 51.7-53.0) 的患者未接受 NSAID 处方治疗，82.2% (95% CI 81.7-82.7) 未接受 PT。许多出现新 LBP 的患者在接受 PT 和处方 NSAID 等其他治疗方式之前接受了与指南不一致的护理，例如早期高级成像和阿片类药物。
New low back pain (LBP) is a common outpatient complaint. Little is known about how care is delivered over the course of a year to patients who develop new LBP and whether such care patterns are guideline-concordant. This retrospective analysis included Medicare claims of 162,238 opioid-naïve beneficiaries with new LBP from January 1, 2011, through December 31, 2014. Simple rates of modality use (computed tomography [CT] and magnetic resonance imaging [MRI] [“advanced imaging”], physical therapy [PT], opioid and non-opioid medications) and percentiles (5th percentile, 25th percentile, median, 75 percentile, and 95th percentile) were reported. Within the first year, 29.4% (95% confidence interval [CI] 29.1-29.8) of patients with two or more visits for new LBP received advanced imaging, and 48.4% (95% CI 47.7-49.0) of these patients received advanced imaging within 6 weeks of the first visit. 17.3% (95% CI 17.1-17.6) of patients with two or more visits received PT. 42.2% (95% CI 41.8-42.5) of patients with two or more visits received nonsteroidal anti-inflammatory drugs (NSAIDs), 16.9% (95% CI 16.6-17.1) received a muscle relaxant, and 26.2% (95% CI 25.9-26.6) received tramadol. 32.3% (95% CI 31.9-32.6) of patients with two or more visits received opioids; 52.4% (95% CI 51.7-53.0) of these patients had not received a prescription NSAID and 82.2% (95%CI 81.7-82.7) of these patients had not received PT. Many patients who develop new LBP receive guideline non-concordant care such as early advanced imaging and opioids before other modalities like PT and prescription NSAIDs.