Article Figures & Data
Tables
Additional Files
Supplemental Tables 1-6 & Supplemental Figure 1
Supplemental Tables 1-6 & Figure 1
Files in this Data Supplement:
- Supplemental data: Tables & Figure - PDF file, 7 pages
The Article in Brief
Effect of Stratified Care for Low Back Pain in Family Practice (IMPaCT Back): A Prospective Population-Based Sequential Comparison
Nadine E. Foster , and colleagues
Background Back pain can be difficult to resolve and may lead to disability. This study used stratified care, in which a prognostic screening tool classifies patients by level of risk for disability and matches them with appropriate treatment. In particular, the study examines whether the use of stratified care in a primary care setting is clinically effective, leads to more targeted use of healthcare resources by changing physician referral behavior, and reduces healthcare costs.
What This Study Found Risk-stratified care for low back pain in primary care results in significant improvements in patient disability outcomes and reductions in work absence without an increase in health care costs. Patients with low back pain who received stratified care had modest improvements in physical function, fear avoidance beliefs, satisfaction with care and time off work. Average time off work was 50% shorter (4 vs 8 days) and the proportion of patients given sickness certifications was 30% lower (9% vs 15%) in the post-intervention group. Significant changes to physician clinical behavior included increased numbers of risk-appropriate referrals to physical therapy, reduced prescribing of nonsteroidal medications and fewer sickness certifications. There was also a small overall reduction in health care resource use and large societal cost savings due to fewer periods of pain-related work absence.
Implications
- The authors recommend widespread implementation of stratified care based on its association with benefits for patients and more targeted use of health care resources without increasing health care costs.