CARE SEEKING AND CONSULTATION WITH SPINE SPECIALISTS

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Acute low back pain is a common symptom. Costs associated with low back pain care are estimated to be as high as 25 billion dollars per year. Most patients with acute low back pain seek care from a chiropractor or a primary care physician. While the overall prognosis of acute back pain is good, we have found that 30% of patients seek care from a second health care provider. Orthopedic and neurologic surgeons have special expertise in spine disease. We propose to expand on previous work performed by our group on the natural history and course of acute low back pain utilizing a pre-existing population- based survey and prospective cohort of 1,633 patients. We will address two questions: 1 (a). What are the correlates of care seeking from a spine specialist-orthopedic or neurologic surgeon? 1 (b). What factors are associated with care seeking from a spine specialist among patients who had initially sought care from a practitioner in another specialty? 2. What is the relationship between patient satisfaction and consultation with a spine specialist? We anticipate that duration of symptoms will be a major determinant of consultation with a spine specialist. The prospective nature of the data will allow us to quantify this relationship. We will also examine a number of variables which may be associated with use of a spine specialist: demographic factors; specialty of the initial provider seen (primary care vs. chiropractor vs. HMO); workers' compensation status; insurance status; poor satisfaction with the index provider and others. We shall also examine patients with long- duration back pain (more than 3 months) who did not seek care from a spine specialist. Such patients are candidates for such consultation in many guidelines. The study thus can examine the factors associated with consultation or referral, and the consequences of current guidelines on possible over and under-utilization of spine specialists.