The purpose of this study was to compare the history and demographic factors of patients being treated initially for low back pain (LBP) across three different settings: primary care, tertiary care and emergency care.
The study cohort was comprised of patients seeking care for LBP in the US Military Health System (MHS) from 2015-2019 based on data from the MHS Data Repository, which is the corporate digital warehouse for all data from from electronic medical records in military clinics (51 hospitals and >400 clinics) and claims data from civilian clinic encounters. Codes from the World Health Organization’s International classification of Disease and Current Procedural Terminology were used to identify the cohort and healthcare of interest. Individuals were adults (18+ years) with an initial visit for LBP, defined as no previous visit for LBP in the preceding six months. Anyone with red flags present within the first 90 days after initial LBP visit was also excluded (e.g., cancer, infection, fracture, cauda equina syndrome). Care-seeking for pain-related comorbidities (chronic pain, cardiovascular, metabolic syndromes, insomnia, apnea, anxiety, depression) in the preceding six months was also assessed.
Out of 1,171,260 patients meeting eligibility criteria, the majority were initially seen in primary care (62.6%), followed by tertiary care (35.9%), and emergency care (1.4%). The median [IQR] age of the cohort was 32 [24, 43], with males making up 63.5%. Army sponsors (either personnel or their dependents) were responsible for almost half of all patients (45.5%). Females had the highest proportion of visits in emergency care settings, at 43.1% of all visits, and the lowest in tertiary care, at 20% of all visits. Younger and enlisted personnel were more likely to initially seek care in emergency care settings. The presence of pain-related comorbidities was generally low, ranging from 0.5% for concussion to 8.5% for metabolic syndromes. The odds were significantly lower for presence of comorbidity in younger patients and those initially seen in primary or tertiary care settings compared to emergency care.
There were several significant differences in the types of patients initially presenting for LBP in different care settings. Females presented at a higher proportion in emergency care settings compared to the other settings. Younger and enlisted patients also had higher odds of seeking initial care in emergency care settings. Patients presenting to emergency care settings were more likely to have a comorbid pain condition, compared to patients initially presenting to primary or tertiary care settings. Future research is necessary to explore any variations in delivery of initial interventions and subsequent outcomes across initial care settings.
Understanding implications of the different settings in which patients can initiate care for LBP may help health systems better guide and monitor effective treatment pathways.
initial care setting
epidemiology
