Abstract
BackgroundInitial management decisions following a new episode of low back pain (LBP) are thought to have profound implications for health care utilization and costs. The purpose of this study was to evaluate the impact of early and guideline adherent physical therapy for low back pain on utilization and costs within the Military Health System (MHS).MethodsPatients presenting to a primary care setting with a new complaint of LBP from January 1, 2007 to December 31, 2009 were identified from the MHS Management Analysis and Reporting Tool. Descriptive statistics, utilization, and costs were examined on the basis of timing of referral to physical therapy and adherence to practice guidelines over a 2-year period. Utilization outcomes (advanced imaging, lumbar injections or surgery, and opioid use) were compared using adjusted odds ratios with 99% confidence intervals. Total LBP-related health care costs over the 2-year follow-up were compared using linear regression models.Results753,450 eligible patients with a primary care visit for LBP between 18–60 years of age were considered. Physical therapy was utilized by 16.3% (n = 122,723) of patients, with 24.0% (n = 17,175) of those receiving early physical therapy that was adherent to recommendations for active treatment. Early referral to guideline adherent physical therapy was associated with significantly lower utilization for all outcomes and 60% lower total LBP-related costs.ConclusionsThe potential for cost savings in the MHS from early guideline adherent physical therapy may be substantial. These results also extend the findings from similar studies in civilian settings by demonstrating an association between early guideline adherent care and utilization and costs in a single payer health system. Future research is necessary to examine which patients with LBP benefit early physical therapy and determine strategies for providing early guideline adherent care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0830-3) contains supplementary material, which is available to authorized users.
Highlights
Initial management decisions following a new episode of low back pain (LBP) are thought to have profound implications for health care utilization and costs
M2 includes data from both the direct care system and commercial network claims, these databases were merged for the purposes of this analysis
Recent studies involving Medicare [19] and commercial insurance samples [18] have demonstrated that early access to physical therapy regardless of adherence was strongly associated with a reduction in subsequent health care utilization and costs, evidenced by reduced risks of advanced imaging, surgery, spinal injections, and opioid use
Summary
Initial management decisions following a new episode of low back pain (LBP) are thought to have profound implications for health care utilization and costs. The purpose of this study was to evaluate the impact of early and guideline adherent physical therapy for low back pain on utilization and costs within the Military Health System (MHS). Combined direct and indirect costs for LBP are reported to be between $85 billion and $238 billion, The Military Health System (MHS) is responsible for providing health care to 10 million active duty and retired military personnel and their dependents, representing one of the largest single payer health systems in the United States. High costs of treatment for LBP and its impact on readiness of active duty members make LBP a particular concern for the MHS. Opioid medications are frequently overused as an initial strategy for managing pain conditions such as LBP, a particular concern for the MHS, [10]. The need to improve the management of patients with pain has become a priority for the MHS [11]
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