Abstract
BackgroundFew studies have compared the factors that drive patients’ decision to choose a chiropractor, physician or physiotherapist as their first healthcare provider for occupational back pain. The purpose of this study is to identify characteristics associated with the choice of first healthcare provider seen for acute uncomplicated occupational back pain.MethodsWe analyzed data collected by the Workplace Safety and Insurance Board from a cohort of workers with compensated back pain in 2005 in Ontario (Canada). Multivariable logistic regression models were created to identify factors associated with the type of first healthcare provider seen (chiropractor, physician, or physiotherapist). Adjustments to the final models were evaluated using the area under the receiver-operating characteristics curve (ROC).ResultsAccording to the 5520 analyzed claims, 85.3 % of the patients saw a physician, 11.4 % saw a chiropractor, and 3.2 % saw a physiotherapist. Longer job tenure (odds ratio (OR) = 1.02, P = 0.004), higher gross personal income (OR = 1.06, P = 0.018), mixed-manual job (OR = 1.35, P = 0.004) and previous similar injury (OR = 1.60, P < 0.001) increased the odds of seeing a chiropractor rather than a physician, while the size of the community (>500,000 inhabitants) and the availability of an early return to work program in the workplace (OR = 0.77, P = 0.035) decreased it. The odds of seeing a physiotherapist rather than a physician increased with increasing age (OR = 1.19, P = 0.019), previous similar injury (OR = 1.71, P < 0.001) and severity of injury (OR = 2.03, P = 0.010). Increased age (OR = 1.28, P = 0.008) and size of community (>1,500,000 inhabitants; OR = 2.58, P = 0.002) increased the odds of seeing a physiotherapist rather than a chiropractor, while holding a mixed-manual job significantly decreased those odds (OR = 0.63, P = 0.044). The area under the ROC curve of our multivariable models varied from 0.62 to 0.64.ConclusionThe type of first healthcare provider sought for occupational back pain is influenced by injury-and work-related factors and by the worker’s age, income and community size. Contrary to previous studies, the workers who first sought a physician did not have higher odds of having a severe injury.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1298-y) contains supplementary material, which is available to authorized users.
Highlights
Few studies have compared the factors that drive patients’ decision to choose a chiropractor, physician or physiotherapist as their first healthcare provider for occupational back pain
The analyzed sample was predominantly male (61.9 %) with an average age of 36.6 years, and manufacturing was the most frequently represented sector of activity (24.0 %). Those characteristics are similar to those of the overall population of workers compensated by the Workplace Safety and Insurance Board (WSIB) [11]
They were less likely to live in community larger than 1,500,000 inhabitants (P < 0.001) and to have a manual job (P = 0.041) than the workers who first consulted a physician or a physiotherapist
Summary
Few studies have compared the factors that drive patients’ decision to choose a chiropractor, physician or physiotherapist as their first healthcare provider for occupational back pain. In Ontario, the WSIB plays the role of public insurer to workers and employers. It provides financial support, medical assistance and rehabilitation for return to work. Workers could go directly (without referrals from other professionals) to a physician or a chiropractor; the new policy expanded direct access to physiotherapists and registered nurses (extended class). According to a systematic review of studies conducted between 1993 and 2012, direct access to physiotherapy care was associated with better patient outcomes and satisfaction and a reduction in the use of healthcare resources (number of consultations, imaging, medication, consultations with other providers) and costs [14]
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