First Provider Seen for an Acute Episode of Low Back Pain Influences Subsequent Health Care Utilization.

Abstract

Costs associated with low back pain (LBP) continue to rise. Despite numerous clinical practice guidelines, the evaluation and treatments for LBP are variable and depend largely on the individual provider. As yet, little attention has been given to the first choice of provider. Early research indicates that the choice of first provider and the timing of interventions for LBP appear to influence utilization. This study sought to examine the association between the first provider seen and utilization. Using 2015-2018 data from a large insurer, this retrospective analysis focused on patients (29,806) seeking care for a new episode of LBP. The study identified the first provider chosen and examined the following year of medical utilization. Cox proportional hazards models were calculated using inverse probability weighting on propensity scores to evaluate the time to event and the relationship to the first choice of provider. The primary outcome was the timing and utilization of health care resources. Total health care utilization was lowest in those who first sought care with chiropractic care or physical therapy. Highest health care utilization was seen in those patients who chose the emergency department. Overall, there appears to be an association between the first choice of provider and future health care utilization. Chiropractic care and physical therapy provide nonpharmacologic and nonsurgical, guideline-based interventions. Their participation appears related to a decrease in immediate and long-term utilization of health care resources. This study expands the existing body of literature and provides a compelling case for the influence of the first provider on an acute episode of LBP. The first provider seen for an acute episode of LBP influences immediate treatment decisions, the trajectory of a specific patient episode, and future health care choices in the management of LBP.