Physician referrals to physical therapists for the treatment of spine disorders

Abstract

Background context Individuals with spine disorders often seek care from physical therapists (PTs). Because most insurance plans will reimburse only for PT services prescribed by a physician, physicians play an important role in access to and the appropriate use of PTs. Problems with access to or inappropriate use of PTs may affect the quality and cost of care received by patients with spine problems. Purpose To identify factors associated with physician referrals to PTs for the treatment of spine disorders. Study design/setting Cross-sectional analysis of data collected at 20 US spine centers (1998–2002). Patient sample A total of 30,255 patients with spine disorders who were seen for an initial evaluation. Outcome measure Whether the physician made a PT referral. Methods A logistic regression analysis was conducted to identify factors associated with physician referrals to PTs. Explanatory variables included health-related characteristics, compensation-related characteristics, past provider use, demographics, and patient expectations. Center effects were also accounted for in the analysis. Results Of the total sample, 38% was referred to a PT. Although several health-related variables explained variation in PT referral, other variables were also associated with PT referral. Patients who were older or male were less likely to be referred. Patients who were more educated were more likely to be referred. There was also significant center-to-center variation in PT referral. Conclusions Variation in PT referral, as a result of factors other than health and need, may be indicative of problems with access to or inappropriate use of PT.