Low Back Imaging When Not Indicated: A Descriptive Cross-System Analysis

Gold, Rachel; Esterberg, Elizabeth; Hollombe, Celine; Arkind, Jill; Vakarcs, Patricia A; Tran, Huong H.; Burdick, Tim; DeVoe, Jennifer E.; Horberg, Michael A.

doi:10.7812/tpp/15-081

Cited by 9 publications

(9 citation statements)

References 25 publications

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“…It is interesting to note that physical therapists were more likely to recommend some form of imaging study for patients with acute LBP than physicians in this study. Perhaps the physical therapists in this study, especially those without diagnostic imaging privileges, were less likely to be familiar with the current imaging guidelines compared to physicians or think they do not apply to the case at hand [21]. In studies that have examined clinical practice patterns of physical therapists who have diagnostic imaging privileges, physical therapists are less likely to order diagnostic when compared to physicians in similar practice settings [24,25].…”

Section: Discussionmentioning

confidence: 90%

“…This increased patient interaction may play a part in physical therapists having less difficulty in assessing patient motivation. Despite numerous published clinical guidelines, Mafi et al [19] determined that the management of non-specific LBP has relied increasingly on guideline discordant care, which is associated with an increased risk of diagnostic imaging, invasive procedures, and prolonged disability [20][21][22][23]. More specifically, Mafi et al [19] observed a significant rise in the frequency of treatments including use of advanced imaging, such as computed tomography or magnetic resonance imaging, referrals to other physicians (presumably for procedures or surgery), and use of narcotics.…”

Section: Discussionmentioning

confidence: 99%

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The knowledge of low back pain management between physical therapists and family practice physicians

Ross

Adams

Engle

et al. 2018

Journal of Manual & Manipulative Therapy

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Objectives: The purpose of this study was to compare knowledge in managing patients with low back pain (LBP) between physical therapists and family practice physicians. Methods: Seventy-three physical therapists and 30 family practice physicians completed standardized examinations assessing knowledge, attitudes, the usefulness of clinical practice guidelines, and management strategies for patients with LBP. Beliefs of physical therapists and family practice physicians about LBP were compared using relative risks and independent t-tests. Results: Scores related to knowledge, attitudes, and the usefulness of clinical practice guidelines were generally similar between the groups. In addition, there was no difference between the groups for knowledge regarding optimal management strategies for patients with LBP. However, physical therapists were less likely to have difficulty assessing motivation levels of patients with LBP compared to family practice physicians (64.6% vs 26.7%; relative risk: 2.41 [95% confidence interval: 1.30-4.48] and physical therapists were less likely to agree that interventions by health care providers have little positive effect on the natural history of acute LBP (17.8% vs. 50.0%; relative risk: 0.36 [95% confidence interval: 0.19-0.66]). Discussion: The results of this study may have implications for third-party payers and health care administrators regarding the utilization of physical therapists in the management of patients with LBP in expanded scopes of practice, including direct access and potential placement in primary care clinics.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

The knowledge of low back pain management between physical therapists and family practice physicians

Ross

Adams

Engle

et al. 2018

Journal of Manual & Manipulative Therapy

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“…This interval defined a new episode in previous studies. 6 , 22 Patients with prior care for low back pain could initiate a new episode if at least 6 months had elapsed without care for back pain.…”

Section: Methodsmentioning

confidence: 99%

Assessment of Primary Care Clinician Concordance With Guidelines for Use of Magnetic Resonance Imaging in Patients With Nonspecific Low Back Pain in the Veterans Affairs Health System

et al. 2020

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Key Points Question What are rates of concordance with guidelines for the use of magnetic resonance imaging in patients with nonspecific low back pain among primary care clinicians in the US Department of Veterans Affairs (VA)? Findings In this cohort study of 1 285 405 primary care visits of 920 547 patients, an early magnetic resonance imaging scan of the lumbar spine was performed in 2.42% of primary care episodes for uncomplicated low back pain in VA primary care clinics. Meaning Results of this study suggest that the use of magnetic resonance imaging in nonspecific low back pain by VA primary care clinicians is lower than rates that have been reported for US patients with commercial insurance.

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“…[58] Its treatment, however, is complex. [59] Studies indicate that both inappropriate imaging [11,12,60,61] and prescribing of opioids [59,62,63] are highly prevalent. However, there is a lack of information about the prevalence of inappropriate prescribing for LBP in the Netherlands.…”

Section: Boxes Figures and Tablesmentioning

confidence: 99%

Low-value pharmaceutical care among Dutch GPs: a retrospective cohort study

Müskens¹,

Dulmen²,

Wiersma

et al. 2022

Br J Gen Pract

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Background: Low-value pharmaceutical care exists in general practice. However, the extent among Dutch general practitioners (GPs) remains unknown. Aim: To assess the prevalence of low-value pharmaceutical care among Dutch GPs. Design and Setting: Retrospective cohort study using patient record data. Method: We examined the prevalence of three types of pharmaceutical care, topical antibiotics for conjunctivitis, benzodiazepines for non-specific lower back pain (LBP), and chronic acid reducing medication (ARM) prescriptions, prescribed by GPs between 2016-2019. Multilevel logistic regression analysis was performed to assess prescribing variation and the influence of patient characteristics on receiving a low-value prescription. Results: Large variation in prevalence and practice variation was observed among the examined types of low-value pharmaceutical GP care. Between 53%-61% of patients received an inappropriate antibiotics prescription for conjunctivitis, around 3% of LBP patients received an inappropriate benzodiazepine prescription and 88% received an inappropriate chronic ARM prescription during the years examined. The odds of receiving an inappropriate antibiotic or benzodiazepine prescription increased with age (p<0.01), but decreased for chronic inappropriate ARM prescriptions (p<0.01). Gender affected only the odds of receiving a non-indicated chronic ARM, with men being at higher risk (p<0.05). The odds for receiving an inappropriate ARM also increased with neighbourhood socio-economic status (p<0.05). Increasing practice size also decreased the odds of inappropriate antibiotic and benzodiazepine prescriptions (p<0.01). Conclusion: Our results show that the prevalence of low-value pharmaceutical GP care varies between the clinical problem examined. Significant variation in inappropriate prescribing exists between different types of pharmaceutical care - and GP practices.

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Low Back Imaging When Not Indicated: A Descriptive Cross-System Analysis

Cited by 9 publications

References 25 publications

The knowledge of low back pain management between physical therapists and family practice physicians

The knowledge of low back pain management between physical therapists and family practice physicians

Assessment of Primary Care Clinician Concordance With Guidelines for Use of Magnetic Resonance Imaging in Patients With Nonspecific Low Back Pain in the Veterans Affairs Health System

Low-value pharmaceutical care among Dutch GPs: a retrospective cohort study

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