Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs

• Published in: Health services research 2018-12, Vol.53 (6), p.4629-4646
• Main Authors: Frogner, Bianca K., Harwood, Kenneth, Andrilla, C. Holly A., Schwartz, Malaika, Pines, Jesse M.
• Format: Article
• Language: English
• Subjects: Adult; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - economics; Analysis; Back pain; Costs; Effective Ambulatory Care; Emergency medical care; Emergency medical services; Emergency services; Extraction; Female; Forecasts and trends; Health care costs; Health Care Costs - statistics & numerical data; Health care expenditures; Health care policy; Health insurance; Health services utilization; Help seeking behavior; Hospitalization; Humans; imaging; Insurance Claim Review; insurance claims; Low back pain; Low Back Pain - diagnostic imaging; Low Back Pain - epidemiology; Low Back Pain - rehabilitation; Male; Market trend/market analysis; Medical care, Cost of; Medical diagnosis; Medical imaging; Middle Aged; Narcotics; opioid; Opioid abuse; Opioids; Pain; Patient Acceptance of Health Care - statistics & numerical data; Patients; Pharmacy; Physical therapists; Physical therapy; Physical Therapy Modalities - economics; Physical Therapy Modalities - statistics & numerical data; Physiotherapy; Prescription drugs; Primary Health Care - economics; Retrospective Studies; Utilization
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/1475-6773.12984

Objective To compare differences in opioid prescription, health care utilization, and costs among patients with low back pain (LBP) who saw a physical therapist (PT) at the first point of care, at any time during the episode or not at all. Data Sources Commercial health insurance claims data, 2009–2013. Study Design Retrospective analyses using two‐stage residual inclusion instrumental variable models to estimate rates for opioid prescriptions, imaging services, emergency department visits, hospitalization, and health care costs. Data Extraction Patients aged 18–64 years with a new primary diagnosis of LBP, living in the northwest United States, were observed over a 1‐year period. Principal Findings Compared to patients who saw a PT later or never, patients who saw a PT first had lower probability of having an opioid prescription (89.4 percent), any advanced imaging services (27.9 percent), and an Emergency Department visit (14.7 percent), yet 19.3 percent higher probability of hospitalization (all p