Variations in Patterns of Utilization and Charges for the Care of Low Back Pain in North Carolina, 2000 to 2009: A Statewide Claims’ Data Analysis

Hurwitz, Eric L.; Li, Dongmei; Guillen, Jenni; Schneider, Michael J.; Stevans, Joel M.; Phillips, Reed B.; Phelan, Shawn P.; Lewis, Eugene A.; Armstrong, Richard C.; Vassilaki, Maria

doi:10.1016/j.jmpt.2016.02.006

Cited by 15 publications

(14 citation statements)

References 18 publications

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“…Of the patients who were diagnosed with AS by other providers and subsequently saw a rheumatologist, 42% had their diagnosis of AS confirmed by the rheumatologist; the remaining 58% were found to have other disorders, such as joint effusion, unspecified back disorder, RA, rheumatism not otherwise specified, osteoarthritis, and spondylosis [26]. A study by Hurwitz et al looked at claims data for low back pain from 2000 to 2009 and examined patterns of care among different providers [27]. This study reported that patients with low back pain were most often seen by physicians, chiropractors, and physical therapists; the number of patients seen by each type of provider increased during the study [27].…”

Section: Us Prevalence Of Axspamentioning

confidence: 99%

“…A study by Hurwitz et al looked at claims data for low back pain from 2000 to 2009 and examined patterns of care among different providers [27]. This study reported that patients with low back pain were most often seen by physicians, chiropractors, and physical therapists; the number of patients seen by each type of provider increased during the study [27]. Taken together, these studies indicate that patients with suspected axSpA in the USA commonly receive care from providers other than rheumatologists and that these providers may be unfamiliar with differentiating this condition from other common causes of back pain and, hence, miss the diagnosis of axSpA in a substantial proportion of patients.…”

Section: Us Prevalence Of Axspamentioning

confidence: 99%

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Axial spondyloarthritis in the USA: diagnostic challenges and missed opportunities

Danve

Deodhar

2018

Clin Rheumatol

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Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease that primarily affects the sacroiliac joints and spine. Delayed or inadequate treatment may decrease quality of life and lead to poor long-term outcomes, including irreversible loss of spinal function. In this review, we discuss clinical practice related to axSpA within the USA, including prevalence, diagnosis, reasons for delayed/missed diagnosis, and suggestions for making early diagnosis. The US population prevalence of axSpA (0.9-1.4%) is higher than the diagnostic prevalence (0.2-0.7%). Although the estimated diagnostic delay for axSpA is 14 years in the USA, the disease can be identified earlier if appropriately preselected patients are quickly referred to rheumatologists. Only 37% of patients with ankylosing spondylitis in the USA are diagnosed by rheumatologists; the remaining 63% are diagnosed by primary care (26%), chiropractic/physical therapy (7%), orthopedic surgery (4%), pain clinics (4%), acute care (3%), and other settings (19%). To help reduce diagnostic delay, non-rheumatologist-healthcare professionals are urged to refer patients with back pain and ≥ 1 of 3 SpA features (HLA-B27 positivity, current inflammatory back pain, or x-ray/MRI evidence of sacroiliitis) to a rheumatologist. Prevalence and diagnosis rates of axSpA are disparate in the USA due to the lack of awareness and knowledge among non-rheumatologists. Progress has been made in identifying hurdles causing diagnostic delays. Public health initiatives are needed to guide primary care physicians, physical therapists, chiropractors, and other specialists seeing patients with chronic back pain on methods for suspecting or identifying axSpA and early referral to rheumatologists.Keywords Ankylosing spondylitis . Axial spondyloarthritis . Clinical practice in the USA . Inflammatory back pain . Non-radiographic axial spondyloarthritis . Referral strategy

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Section: Us Prevalence Of Axspamentioning

confidence: 99%

Section: Us Prevalence Of Axspamentioning

confidence: 99%

Axial spondyloarthritis in the USA: diagnostic challenges and missed opportunities

Danve

Deodhar

2018

Clin Rheumatol

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“…The high prevalence may be attributed to the design of the health care system in Australia. Studies reported that referrals for medical imaging, medical interventions, and affordability were solid predictors for individuals with back pain consulting a conventional practitioner [18][19][20].…”

Section: Discussionmentioning

confidence: 99%

The Characteristics of Women Aged 59-64 Years Who Consult Health Care Practitioners for Back Pain from the Australian Longitudinal Study on Women's Health (ALSWH)

Maddela¹,

Frawley²,

Adams³

et al. 2021

Integr J Med Sci

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Background: Back pain affects a substantial proportion of the adult population, and back pain sufferers tend to explore a wide range of health care options. This study investigates the use of medical and physiotherapy services by Australian women with back pain. Method: This is a sub-study of the Australian Longitudinal Study on Women's Health (ALSWH), designed to investigate multiple factors affecting the health and well-being of women over a 20-year period. The study focuses on 1,851 women aged 59-64 years, who had indicated that they had previously sought help from a health care practitioner for back pain. Results: Half of the women (56.5%) with back pain had consulted a general practitioner (GP), 16.2% had consulted a medical specialist, and 37.3% had consulted a physiotherapist for their back pain. Women with regular or continuous back pain were more likely to consult a GP (OR=3.98), medical specialist (OR=5.66) and a physiotherapist (OR=1.63). Conclusion: Australian women with back pain were more likely to consult a GP, medical specialist or physiotherapist if they had more regular/continuous back pain. Future research needs to investigate further the consultation and referral patterns identified in this study.

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“…A major strength of the study is the large amount of neck pain claims available (3 324 364 claims) for analyses in the different pathways of healthcare services, over the 2000-2009 decade in North Carolina. This study, and the series of papers it has generated on the treatment of low back pain, 28 neck pain and headache, 29 provides an opportunity to healthcare policy makers and legislators for a unique economic examination. When accumulating provider costs are viewed vertically as if in "silos" (eg, DC-only costs, MD-only costs), increasing utilization of one particular provider or another can be seen as a net cost increase.…”

Section: Study Strengthsmentioning

confidence: 99%

Variations in Patterns of Utilization and Charges for the Care of Neck Pain in North Carolina, 2000 to 2009: A Statewide Claims’ Data Analysis

Hurwitz

Guillen

et al. 2016

Journal of Manipulative and Physiological Therapeutics

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Variations in Patterns of Utilization and Charges for the Care of Low Back Pain in North Carolina, 2000 to 2009: A Statewide Claims’ Data Analysis

Abstract: Chiropractic care alone or DC with MD care incurred appreciably fewer charges for ULBP than MD care with or without PT care. This finding was reversed for CLBP. Adjusted charges for both ULBP and CLBP patients were significantly lower for DC patients.

Cited by 15 publications

References 18 publications

Axial spondyloarthritis in the USA: diagnostic challenges and missed opportunities

Axial spondyloarthritis in the USA: diagnostic challenges and missed opportunities

The Characteristics of Women Aged 59-64 Years Who Consult Health Care Practitioners for Back Pain from the Australian Longitudinal Study on Women's Health (ALSWH)

Variations in Patterns of Utilization and Charges for the Care of Neck Pain in North Carolina, 2000 to 2009: A Statewide Claims’ Data Analysis

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