Following a low back pain study that yielded similar conclusions, a retrospective observational study also in preprint (and also authored by insurance-affiliated researchers) examined type of initial-contact health care provider (HCP), the services they provide and total episode cost for managing neck pain (NP).
The study included 323,348 adult patients with 390,992 complete episodes of NP involving 321,538 HCPs.
Chiropractors (38.5% of episodes) and medical PCPs (27.6%) were the most common initial-contact HCPs, with orthopedic surgeons (6.2%) the most common initial-contact specialist HCP.
The most frequently provided first-line services (the most guideline concordant) were chiropractic manipulation (40.2% of episodes), active care (21.5%) and passive therapy (18.%). Frequently provided second-line services included radiographs (26.5%), skeletal muscle relaxants (19.2%) and prescription NSAIDs (18.3%). Opioids (11.6%), spinal injections (5.0%) and spinal surgery (4.2%) were the most common third-line services.
Initial contact with non-prescribing HCPs was associated with one or more first-line therapies. Pharmacological, imaging and interventional services were infrequently provided, other than radiography; and if provided, were introduced later in an episode.
For both the nonsurgical and pooled samples, DCs had significantly lower total episode cost. The adjusted total episode cost was lowest when a DC was the initial-contact HCP. These results were consistent for individuals experiencing single or multiple episodes during the study period.
Conversely, initial contact with medical primary care provider (PCP), specialist or emergency/urgent care HCPs was associated with pharmacologic, imaging and interventional services, with specialist HCPs having significantly higher total episode costs compared to the med-ical PCP reference group.
Sadly, only 8.3% of patients who initially saw a medical PCP were referred to a DC – and then only after an average of 39 days from their initial visit. Nurses referred 10.8% of their patients to DCs 25 days after their initial visit. Specialists were even less likely to refer patients to a DC (6.4%), with emergency/urgent care providers the least likely to refer (3.0%). Interestingly, PTs referred 10.6% of their patients to DCs, with acupuncturists referring 11.4%.
The authors note: "Similar to LBP, for NP two actions appear potentially important to improve guideline concordance and reduce cost of care. The first is supporting individual decision-making regarding the most appropriate type of initial HCP. With the persistent high rate of pharmacologic, imaging, and interventional services identified in this study, this remains an important area of focus. The second is, when appropriate, supporting primary care and specialist HCPs in making timely referrals for non-pharmacologic services."
Editor's Note: As this study is a preprint pending peer review, findings should not be used yet to guide clinical practice.
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