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首页> 外文期刊>Archives of Physical Medicine and Rehabilitation >Initial management decisions after a new consultation for low back pain: Implications of the usage of physical therapy for subsequent health care costs and utilization
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Initial management decisions after a new consultation for low back pain: Implications of the usage of physical therapy for subsequent health care costs and utilization

机译：新的腰痛咨询后的初始管理决策：物理疗法对后续医疗费用和使用的影响

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Objectives: To describe the utilization of physical therapy following a new primary care consultation for low back pain (LBP) and to examine the relations between physical therapy utilization and other variables with health care utilization and costs in the year after consultation. Design: Retrospective cohort obtained from electronic medical records and insurance claims data. Setting: Single health care delivery system. Participants: Individuals (N=2184) older than 18 years with a new consultation for LBP from 2004 to 2008. Interventions: Patients were categorized as receiving initial physical therapy management if care occurred within 14 days after consultation. Main Outcome Measures: Total health care costs for all LBP-related care received in the year after consultation were calculated from claims data. Predictors of utilization of emergency care, advanced imaging, epidural injections, specialist visits, and surgery were identified using multivariate logistic regression. The generalized linear model was used to compare LBP-related costs based on physical therapy utilization and identify other cost determinants. Results: Initial physical therapy was received by 286 of the 2184 patients (13.1%), and was not a determinant of LBP-related health care costs or utilization of specific services in the year after consultation. Older age, mental health, or neck pain comorbidity and initial management with opioids were determinants of cost and several utilization outcomes. Conclusions: Initial physical therapy management was not associated with increased health care costs or utilization of specific services following a new primary care LBP consultation. Additional research is needed to examine the cost consequences of initial management decisions made following a new consultation for LBP.
机译：目的：描述新的下腰痛（LBP）初级保健咨询后的物理疗法利用率，并检查咨询后一年中物理疗法利用率与其他变量之间的关系以及医疗保健利用率和费用。设计：从电子病历和保险索赔数据获得的回顾性队列。单位：单一医疗保健提供系统。参与者：2004年至2008年对18岁以上的LBP进行了新咨询的患者（N = 2184）。干预措施：如果在咨询后14天内进行了护理，则将患者分类为接受初始物理治疗。主要指标：咨询后一年获得的所有与LBP相关的护理的医疗费用总额是根据索赔数据计算得出的。使用多因素logistic回归分析确定了急诊服务，先进影像学，硬膜外注射，专科医生就诊和手术的利用率。广义线性模型用于比较基于物理疗法利用率的LBP相关费用，并确定其他费用决定因素。结果：2184例患者中有286例接受了初始物理治疗（占13.1％），并且在咨询后的一年中，这不是LBP相关医疗保健费用或特定服务使用率的决定因素。老年，心理健康或颈部疼痛合并症以及阿片类药物的初始治疗是成本和几种使用效果的决定因素。结论：在新的初级保健LBP咨询后，最初的物理治疗管理与增加的医疗保健费用或特定服务的利用无关。需要进行进一步的研究，以检查针对LBP进行新咨询后做出的初始管理决策的成本后果。

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