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Harwood K.1, Frogner B.2, Pines J.3, Andrilla H.4, Schwartz M.4
1George Washington University, Clinical Research and Leadership, Washington, United States, 2University of Washington, Family Medicine, Seattle, United States, 3George Washington University, Center for Healthcare Innovation and Policy Research, Washington, DC, United States, 4University of Washington, Department of Family Medicine, Seattle, United States
Background: Back pain results in $90.6 billion in direct costs and $19.8 billion in indirect costs in the US. Despite ever-growing guidelines for treatment for low back pain that encourage an active program and less reliance on costly diagnostics and medication, intervention trends continue to vary widely. Ivanova et al (2011) found that 42% of persons with LBP filled a prescription for opioid pain medication whereas only 23% received exercise therapy and 8% received cognitive behavioral therapy. Limited evidence suggests that early treatment by physical therapists (PTs) may reduce costs and lower use of health services. Although all 50 states and DC allow some form of direct access to PTs, over 32 states still have limitations that prevent unrestricted access to PTs.
Purpose: The purpose of the study was to determine whether unrestricted access to physical therapy services lowers utilization and health care costs for patients with LBP in the US.
Methods: Using 2009-2013 private health insurance administrative data from 6 western US states with different levels of direct access, we extracted patients between 18-64 years old with a primary diagnosis of LBP. The final sample size was 148,866 cases. Cases were divided into three cohorts: 1) visited PT at first point of LBP, 2) visited PT but not at first point, and 3) never visited a PT. Since this study was observational, the authors use instrumental variables approach to reduce the unobserved bias. The authors used descriptive statistics, regression analysis and Cox Hazard modeling to compare cost, quality and utilization outcomes among groups.
Results: Patients with LBP (PLBP) seeing a PT at any point in time versus no PT had significantly reduced ED visits (32.2%), opioid prescription (87.6%), and MRI/CT (26.0%). PLBP who saw a PT first saw slightly larger reductions with 38.3% fewer ED visits, 89.4% fewer opioid prescriptions, and 27.9% fewer MRI/CT compared to PLBP who never saw a PT. PLBP who saw a PT first had significantly lower costs including out-of-pocket costs and PLBP who saw a PT at any point had significantly lower outpatient, pharmacy, and out-of-pocket costs than PLBP who saw another provider with a few exceptions.
Conclusion(s): The findings from this study suggest that seeing a physical therapist as the first point of care compared to seeing a physical therapist at a later point in time or no PT may reduce utilization of potentially costly services, which have an impact on health care costs across all settings.
Implications: Access to PT within state law may affect the amount of health care utilization and cost savings for PLBP. The potential reduction in opioid prescriptions is notable given the increasing awareness on the over-prescription of opioids and the high risk of substance abuse.
Funding acknowledgements: Funded by the Health Care Cost Institute State Health Policy Grant Program and the Laura and John Arnold Foundation.
Topic: Globalisation: health systems, policies & strategies
Ethics approval: The University of Washington and The George Washington University Institutional Review Boards did not considered human subjects research.
All authors, affiliations and abstracts have been published as submitted.
