Comparing the Costs Between Provider Types of Episodes of Back Pain Care

Shekelle, Paul G; Markovich, Martin; Louie, Rachel

doi:10.1097/00007632-199501150-00018

Cited by 91 publications

(49 citation statements)

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“…Persistieren die Beschwerden über mehr als 12 Wochen, ist der weitere Verlauf oft chronisch. Als Resultat belastet diese Gruppe chronischer Rückenschmerzpatienten durch hohe Krankheitskosten, Arbeitsausfall und Arbeitsunfähigkeit überproportional die Kranken-und Rentensysteme [2,37].…”

Section: Hinweise Auf Verminderte Schmerzinhibitionunclassified

Zentrale Schmerzverarbeitung bei chronischem Rückenschmerz

Giesecke

Gracely

Clauw

et al. 2006

Schmerz

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Section: Hinweise Auf Verminderte Schmerzinhibitionunclassified

Zentrale Schmerzverarbeitung bei chronischem Rückenschmerz

Giesecke

Gracely

Clauw

et al. 2006

Schmerz

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“…For example, in the USA, several studies have analysed the health insurance costs of patients with acute back pain who visit chiropractors and compared them with costs of those who visit their GP or an orthopaedic surgeon. 2 The obvious weakness of this type of study is the likelihood that patients seeing the various practitioners had different severity of back pain.…”

Section: Introductionmentioning

confidence: 99%

Do General Practices Which Provide An Acupuncture Service Have Low Referral Rates and Prescription Costs? A Pilot Survey

Johnson¹,

White

Livingstone³

2008

Acupunct Med

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Background Studies by individual acupuncture practitioners have given an indication that offering acupuncture in primary care may reduce the need for referral to secondary care and reduce the costs of prescriptions. It would be informative to find out whether these findings can be supported by data from other practices. The aim of this study was to test the feasibility of surveying national data on referrals and prescribing. Methods Three primary care trusts (PCTs) were selected, and all practices within each trust were sent an email asking whether any member of the primary care team offered acupuncture, and if so how many appointments per week. Data on rates of referral to orthopaedic, physiotherapy, pain and rheumatology clinics were then sought from the PCT, both for the practices offering acupuncture and for the PCT as a whole. Similarly, data on costs of prescriptions for non-steroidal (NSAID) and non-opioid analgesic drugs were obtained from the Prescription Pricing Authority. Results Out of the 109 practices surveyed, a total of 14 (13%) offered acupuncture services to some extent. There was wide variation in provision between the different PCTs. The eight practices which offered at least one appointment per week for every 2000 registered patients were included in the analysis. The mean values (and SDs) for the three PCTs and for the eight acupuncture practices, respectively, were as follows: for referral to various clinics: orthopaedic 32.3 (16.2) and 27.4 (10.87); pain clinic 1.6 (1.3) and 2.8 (1.6); physiotherapy 13.4 (14.5) and 29.5 (10.0); and rheumatology 4.7 (2.3) and 6.4 (3.0). The mean values for costs of non-opioid analgesics were £1820 (£442) and £2008 (£762); and for NSAIDs were £4148 (£269) and £4476 (£1366), respectively. There were no trends towards a reduction of clinic referral or prescription costs. Conclusions We have conducted the first survey of the effects of provision of acupuncture in UK general practice, using data provided by the NHS, and uncovered a wide variation in the availability of the service in different areas. We have been unable to demonstrate any consistent differences in the prescribing or referral rates that could be due to the use of acupuncture in these practices. The wide variation in the data means that if such a trend exists, a very large survey would be needed to identify it. However, we discovered inaccuracies and variations in presentation of data by the PCTs which have made the numerical input, and hence our results, unreliable. Thus the practicalities of access to data and the problems with data accuracy would preclude a nationwide survey.

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“…[11][12][13][14] Our practice-based, nonrandomized comparative study showed a clinically important advantage for chiropractic care over medical care for chronic patients and a marginal advantage for acute patients. 15 Early cost studies showed both lower [16][17][18] and higher [19][20][21] costs for chiropractic care than for other interventions. These studies had diverse designs, payment types, and analytic methods.…”

mentioning

confidence: 99%