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

Serena Bezdjian,James M Whedon,Justin M Goehl,Robb Russell,Louis A Kazal

doi:10.1186/s12998-022-00411-x

Serena Bezdjian, James M Whedon + Show 3 more

Open Access

https://doi.org/10.1186/s12998-022-00411-x

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Abstract

BackgroundPrimary 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.MethodsThis 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.ResultsWithin 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.ConclusionsPatients 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.

Highlights

Primary Spine Care (PSC) is an innovative model for the primary management of patients with spinerelated disorders (SRDs), with a focus on the use of non-pharmacological therapies which constitute the recommended first-line approach to back pain
Because many of the non-pharmacological treatment approaches recommended in clinical practice guidelines [7] such as spinal manipulation, acupuncture, and massage therapy are not taught in allopathic medical schools, it is often a challenge for primary care physicians (PCP) to operationalize these guidelines within their clinical settings
Patients presenting with LBP were predominantly seen by a primary care clinician and received standard care for LBP with most patients being referred by the primary care clinician to the PSC clinician

Summary

Introduction

Primary Spine Care (PSC) is an innovative model for the primary management of patients with spinerelated disorders (SRDs), with a focus on the use of non-pharmacological therapies which constitute the recommended first-line approach to back pain. It is critical to implement guideline-concordant clinical pathways that improve outcomes, improve the efficiency of care, and reduce escalation of care (EoC)—the unnecessary use of healthcare resources—for the management of patients with SRDs. Most patients with back pain in the U.S are initially seen by a primary care clinician. One promising solution is to embed within the primary care environment a dedicated spine care clinician who has the requisite knowledge and skills needed to manage patients with SRDs and provide guidance through the maze of spine treatment options [8] This approach, known as Primary Spine Care (PSC) is an innovative model of for the management of SRDs. PSC is defined as management, case coordination, and follow-up of spine patients within a conventional clinical care setting, under the direction of a dedicated PSC clinician [8,9,10]. The PSC clinician can serve as the initial or early point of contact for spine patients, and as an alternative to the usual primary care pathway, which often requires referral for non-pharmacological care and is less efficient from the start [11]

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