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. 2018 Dec;53(6):4629-4646.
doi: 10.1111/1475-6773.12984. Epub 2018 May 23.

Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs

Bianca K Frogner  1 , Kenneth Harwood  2 , C Holly A Andrilla  1 , Malaika Schwartz  3 , Jesse M Pines  4
Affiliations

Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs

Bianca K Frogner et al. Health Serv Res. 2018 Dec.

Abstract

Objective: To compare differences in opioid prescription, health care utilization, and costs among patients with low back pain (LBP) who saw a physical therapist (PT) at the first point of care, at any time during the episode or not at all.

Data sources: Commercial health insurance claims data, 2009-2013.

Study design: Retrospective analyses using two-stage residual inclusion instrumental variable models to estimate rates for opioid prescriptions, imaging services, emergency department visits, hospitalization, and health care costs.

Data extraction: Patients aged 18-64 years with a new primary diagnosis of LBP, living in the northwest United States, were observed over a 1-year period.

Principal findings: Compared to patients who saw a PT later or never, patients who saw a PT first had lower probability of having an opioid prescription (89.4 percent), any advanced imaging services (27.9 percent), and an Emergency Department visit (14.7 percent), yet 19.3 percent higher probability of hospitalization (all p < .001). These patients also had significantly lower out-of-pocket costs, and costs appeared to shift away from outpatient and pharmacy toward provider settings.

Conclusions: When LBP patients saw a PT first, there was lower utilization of high-cost medical services as well as lower opioid use, and cost shifts reflecting the change in utilization.

Keywords: Physical therapy; health care costs; imaging; insurance claims; opioid.

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References

    1. American Physical Therapy Association . 2016. “A Summary of Direct Access Language in State Physical Therapy Practice Acts: Direct Access Therapy Laws: May 2016” [accessed on February 23, 2017]. Available at http://www.apta.org/uploadedFiles/APTAorg/Advocacy/State/Issues/Direct_A...
    1. Becker, A. , Held H., Redaelli M., Strauch K., Chenot J. F., Leonhardt C., Keller S., Baum E., Pfingsten M., Hildebrandt J., Basler H. D., Kochen M. M., and Donner‐Banzhoff N.. 2010. “Low Back Pain in Primary Care: Costs of Care and Prediction of Future Health Care Utilization.” Spine 35 (18): 1714–20. - PubMed
    1. Belotti, F. , Deb P., Manning W. G., and Norton E. C.. 2015. “twopm: Two‐Part Models.” The Stata Journal 15 (1): 3–20.
    1. Bohnert, A. S. , Valenstein M., Bair M. J., Ganoczy D., McCarthy J. F., Ilgen M. A., and Blow F. C.. 2011. “Association between Opioid Prescribing Patterns and Opioid Overdose‐related Deaths.” Journal of the American Medical Association 305 (13): 1315–21. - PubMed
    1. Brooks, J. M. , Irwin C. P., Hunsicker L. G., Flanigan M. J., Chrischilles E. A., and Pendergast J. F.. 2006. “Effect of Dialysis Center Profit‐Status on Patient Survival: A Comparison of Risk‐Adjustment and Instrumental Variable Approaches.” Health Services Research 41 (6): 2267–89. - PMC - PubMed

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