Efficiency of primary spine care as compared to conventional primary care: a retrospective observational study at an Academic Medical Center

Abstract

Background Primary Spine Care (PSC) is an innovative model for the primary management of patients with spine-related disorders (SRDs), with a focus on the use of non-pharmacological therapies which now constitute the recommended first-line approach to back pain. PSC clinicians serve as the initial or early point of contact for spine patients and utilize evidence-based spine care pathways to improve outcomes and reduce escalation of care (EoC; e.g., spinal injections, diagnostic imaging, hospitalizations, referrals to a specialist). The present study examined 6-month outcomes to evaluate the efficiency of care for patients who received PSC as compared to conventional primary care. We hypothesized that patients seen by a PSC clinician would have lower rates of EoC compared to patients who received usual care by a primary care (PC) clinician. Methods This was a retrospective observational study. We evaluated 6-month outcomes for two groups seen and treated for an SRD between February 01, 2017 and January 31, 2020. Patient groups were comprised of N = 1363 PSC patients (Group A) and N = 1329 PC patients (Group B). We conducted Pearson chi-square and logistic regression (adjusting for patient characteristics that were unbalanced between the two groups) to determine associations between the two groups and 6-month outcomes. Results Within six months of an initial visit for an SRD, a statistically significantly smaller proportion of PSC patients utilized healthcare resources for spine care as compared to the PC patients. When adjusting for patient characteristics, those who received care from the PSC clinician were less likely within 6 months of an initial visit to be hospitalized (OR = .47, 95% CI .23–.97), fill a prescription for an opioid analgesic (OR = .43; 95% CI .29–.65), receive a spinal injection (OR = .56, 95% CI .33–.95), or have a visit with a specialist (OR = .48, 95% CI .35–.67) as compared to those who received usual primary care. Conclusions Patients who received PSC in an academic primary care clinic experienced significantly less escalation of their spine care within 6 months of their initial visit. The PSC model may offer a more efficient approach to the primary care of spine problems for patients with SRDs, as compared to usual primary care.

Chiropractors in interprofessional practice settings: a narrative review exploring context, outcomes, barriers and facilitators

“…Although we categorized ‘funding’ as a neutral factor, it is clear from our primary investigation data that a poor understanding of reimbursement is likely to cripple interprofessional service provision endeavours [ 12 , 21 , 22 ]. Our findings are in tune with recent research conducted in a fee-for-service context and focusing on the introduction of chiropractors as primary spine care practitioners [ 3 ],). It would appear that, notwithstanding the offering being an efficient primary care service, poor reimbursement of the chiropractic clinician and high patient copayment, represent a significant structural barrier to service utilization [ 15 , 16 ].…”

Low back pain service utilization and costs: association with timing of first-line services for individuals initially contacting a primary care provider. A retrospective cohort study

“…When initially contacted by an individual with LBP, PCPs and PSs generally incorporate second-and third-line services more frequently than CPG recommended first-line services 17 . Several barriers to PCP referral for first-line therapies have been identified [19][20][21][22][23][24] , and comparisons of early versus late referral for first-line therapies reveal mixed results [25][26][27][28][29][30][31][32][33][34] .…”

“…17 Several barriers to PCP referral for first-line therapies have been identified 19-24 , and comparisons of early versus late referral for first-line therapies reveal mixed results. 25-34…”

Low back pain service utilization and costs: association with timing of first-line services for individuals initially contacting a physician specialist. A retrospective cohort study

“…[5][6][7] The timing of introduction of CPG recommended first-line services has been identified as being potentially important. [8][9][10][11][12][13][14][15][16][17] Management of LBP that is not concordant with CPGs increases the risk of LBP transitioning from an acute to a chronic condition 18 and is an important source of "low-value" care [19][20][21][22] , described as health care services generating cost without, or with minimal, beneficial impact on outcomes. 23,24 The type of health care provider (HCP) initially contacted by an individual with LBP has been used as a method to evaluate variation in service utilization and cost outcomes.…”

“…5-7 The timing of introduction of CPG recommended first-line services has been identified as being potentially important. 8-17 Management of LBP that is not concordant with CPGs increases the risk of LBP transitioning from an acute to a chronic condition 18 and is an important source of “low-value” care 19-22 , described as health care services generating cost without, or with minimal, beneficial impact on outcomes. 23,24…”