Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Aug 12:8:523-35.
doi: 10.2147/JPR.S83599. eCollection 2015.

Patterns of health care utilization for low back pain

Walter F Stewart  1 , Xiaowei Yan  1 , Joseph A Boscarino  1 , Daniel D Maeng  1 , Jack Mardekian  2 , Robert J Sanchez  3 , Michael R Von Korff  4
Affiliations

Patterns of health care utilization for low back pain

Walter F Stewart et al. J Pain Res. .

Abstract

Background: The purpose of this study was to determine if primary care patients with low back pain (LBP) cluster into definable care utilization subgroups that can be explained by patient and provider characteristics.

Materials and methods: Adult primary care patients with an incident LBP encounter were identified from Geisinger Clinic electronic health records over 5 years. Two-thirds of the cohort had only one to two encounters. Principal component analysis was applied to the data from the remaining one-third on use of ambulatory, inpatient, emergency department, and surgery care and use of magnetic resonance imaging, injections, and opioids in 12 months following the incident encounter. Groups were compared on demographics, health behaviors, chronic and symptomatic disease burden, and a measure of physician efficiency.

Results: Six factors with eigenvalues >1.5 explained 71% of the utilization variance. Patient subgroups were defined as: 1-2 LBP encounters; 2+ surgeries; one surgery; specialty care without primary care; 3+ opioid prescriptions; laboratory dominant care; and others. The surgery and 3+ opioid subgroups, while accounting for only 10.4% of the cohort, had used disproportionately more magnetic resonance imaging, emergency department, inpatient, and injectable resources. The specialty care subgroup was characterized by heavy use of inpatient care and the lowest use of injectables. Anxiety disorder and depression were not more prevalent among the surgery patients than in the others. Surgery patients had features in common with specialty care patients, but were older, had higher prevalence of Fibromyalgia, and were associated primary care physicians with worse efficiency scores.

Conclusion: LBP care utilization is highly variable and concentrated in small subgroups using disproportionate amounts of potentially avoidable care that reflect both patient and provider characteristics.

Keywords: back surgery; low back pain; opioids; primary care; provider efficiency.

PubMed Disclaimer

References

    1. Vogt MT, Kwoh CK, Cope DK, Osial TA, Culyba M, Starz TW. Analgesic usage for low back pain: impact on health care costs and service use. Spine. 2005;30(9):1075–1081. - PubMed
    1. Deyo RA, Mirsa SK, Martin BI. Back pain prevalence and visit rates: estimates from the US national surveys, 2002. Spine. 2006;31:2724–2727. - PubMed
    1. Ricci JA, Stewart WF, Chee E, Leotta C, Foley K, Hochberg MC. Back pain exacerbations and lost productive time costs in United States workers. Spine. 2006;31:3052–3060. - PubMed
    1. Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. Lost productive time cost due to common pain conditions in the US workforce. JAMA. 2003;290:2443–2454. - PubMed
    1. Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 1999;354:581–585. - PubMed