Influence of Initial Provider on Health Care Utilization in Patients Seeking Care for Neck Pain

Mayo Clin Proc Innov Qual Outcomes. 2017 Oct 19;1(3):226-233. doi: 10.1016/j.mayocpiqo.2017.09.001. eCollection 2017 Dec.


Objective: To examine patients seeking care for neck pain to determine associations between the type of provider initially consulted and 1-year health care utilization.

Patients and methods: A retrospective cohort of 1702 patients (69.25% women, average age, 45.32±14.75 years) with a new episode of neck pain who consulted a primary care provider, physical therapist (PT), chiropractor (DC), or specialist from January 1, 2012, to June 30, 2013, was analyzed. Descriptive statistics were calculated for each group, and subsequent 1-year health care utilization of imaging, opioids, surgery, and injections was compared between groups.

Results: Compared with initial primary care provider consultation, patients consulting with a DC or PT had decreased odds of being prescribed opioids within 1 year from the index visit (DC: adjusted odds ratio [aOR], 0.54; 95% CI, 0.39-0.76; PT: aOR, 0.59; 95% CI, 0.44-0.78). Patients consulting with a DC additionally demonstrated decreased odds of advanced imaging (aOR, 0.43; 95% CI, 0.15-0.76) and injections (aOR, 0.34; 95% CI, 0.19-0.56). Initiating care with a specialist or PT increased the odds of advanced imaging (specialist: aOR, 2.96; 95% CI, 2.01-4.38; PT: aOR, 1.57; 95% CI, 1.01-2.46), but only initiating care with a specialist increased the odds of injections (aOR, 3.21; 95% CI, 2.31-4.47).

Conclusion: Initially consulting with a nonpharmacological provider may decrease opioid exposure (PT and DC) over the next year and also decrease advanced imaging and injections (DC only). These data provide an initial indication of how following recent practice guidelines may influence health care utilization in patients with a new episode of neck pain.

Keywords: ACP, American College of Physicians; CDC, Centers for Disease Control and Prevention; DC, chiropractor; ICD-9, International Classification of Diseases, Ninth Revision; IQR, interquartile range; MRI, magnetic resonance imaging; PCP, primary care provider; PT, physical therapist; UUHP, University of Utah Health Plans; aOR, adjusted odds ratio.