Patients who see primary-care physicians for acute low back pain face lower health-care costs than patients treated by chiropractors or orthopedic surgeons, even though overall recovery rates were similar, according to a recent study.
"This is the first study to look simultaneously at comprehensive function, satisfaction and outpatient charges in patients with acute low back pain," said Timothy Carey, chief of general medicine and senior research associate at the Sheps Center for Health Services Research. "Currently, primary-care physicians appear to offer the most efficient outpatient treatment."
The study, reported in the New England Journal of Medicine, was conducted by the Sheps Center and the schools of Medicine and Public Health. Besides Carey, authors are Joanne Garrett and Anne Jackman, Sheps Center researchers; Curtis McLaughlin, professor of business; John Fryer, research professor in biostatistics; and Douglas R. Smucker, clinical fellow in family medicine.
The three-year study, which monitored 1,633 North Carolina patients with acute back pain lasting less than two months, found satisfaction greatest among patients seeing chiropractors and lowest among primary-care physicians.
"There is a great challenge to primary-care physicians to improve patient satisfaction," Carey said.
For outpatient care, the average cost per episode of back pain was lowest for urban primary care ($508) and highest for an urban chiropractor ($783)--due to higher use of X-rays and greater number of visits. Charges included medicine, radiology, physical therapy and office costs.
"The U.S. spends over $25 billion a year on back pain," he said. "For acute back pain, the best care may be minimal care--a single doctor's visit combined with medication and an exercise program."
Funding for the research was provided by the U.S. Agency for Health Care Policy and Research.
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