Primary Care Management of Patients with Pain Complaints and the Influence of Physician Training in Mechanical Diagnosis and Therapy

Department

Physical Therapy

Document Type

Article

Publication Source

Journal of Public Health

Publication Date

2020-10-26

Abstract

Background: Chronic pain affects 20% of the adult population, and pain-related consultations comprise a significant amount of all primary care visits.

Objective: The purpose of this study was to describe health care utilization by primary care physicians for patients with a consultation for pain and to compare subsequent health care utilization and costs for a physician trained in the McKenzie method, or mechanical diagnosis and therapy (MDT), with a group of physicians that were not trained in MDT.

Design, setting, and participants: This study was a single-center retrospective quality and cost metrics data analysis performed at a community regional health-care system; patients seen by primary care physicians for a consultation for pain had subsequent health care utilization and costs compared for a physician trained in MDT with a group of 19 physicians who were not trained in MDT. A total of 22,907 continuously eligible patients were seen during the 12-month period for a pain-related complaint; 1282 patients (6%) were seen by the physician trained in MDT, and 21,625 patients (94%) were seen by the group of physicians that were not trained in MDT (n = 19).

Key results: The patients seen by the physician trained in MDT had a decreased likelihood of medication use including both opioids and non-opioid pain pills, diagnostic imaging, electromyography/nerve conduction velocity testing, specialty referrals, injections (joint and spinal injections), surgeries, emergency room visits, and inpatient admissions. Also, patients who were seen by the physician trained in MDT cost significantly less to the system ($3481 per member per year versus $4852, p < 0.001), despite being older and having more medical problems and pain complaints.

Conclusions: Although further research is necessary to either support or refute these findings, these results may have important implications for health policy decisions for designing optimal primary care models and consideration of MDT in primary care.

DOI

10.1007/s10389-020-01386-w

https://doi.org/10.1007/s10389-020-01386-w

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