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J Eval Clin Pract. 2017 Dec;23(6):1218-1226. doi: 10.1111/jep.12763. Epub 2017 May 16.

Impact of co-morbidities on resource use and adherence to guidelines among commercially insured adults with new visits for back pain.

Author information

1
Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
2
Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Seattle, WA, USA.
3
Department of Radiology, University of Washington, Seattle, WA, USA.
4
Department of Pharmacy, University of Washington, Seattle, WA, USA.
5
Department of Health Services, University of Washington, Seattle, WA, USA.

Abstract

RATIONALE, AIMS AND OBJECTIVES:

To assess if co-morbidity is associated with higher use of back-related care and adherence to back pain guidelines.

METHODS:

We conducted a retrospective cohort study using administrative claims data from 2007-2011. We included individuals ≥18 years with an index visit for back pain. Co-morbidities were measured 12 months prior to index. Co-morbidity burden was measured using Quan's Co-morbidity Index. Co-morbidities categories were measured using chronic condition indicators from the Agency for Healthcare Research and Quality. Total lumbar spine-related resource use for three years was ascertained using procedure codes. A clustering algorithm identified higher long-term utilizer. We identified initial use from day 0-42 for several categories of spine-related care. We used logistic regression to test the association between co-morbidities and resource use.

RESULTS:

Greater co-morbidity burden was associated with higher long-term spine-related resource use. Those with ≥2 on Quan's Co-morbidity Index had 29% higher odds of being a high back-specific resource user compared to those with no co-morbidities [Odds Ratio (OR): 1.29, 95% Confidence Interval (CI): 1.23-1.35]. Greater co-morbidity burden was associated with more frequent initial use of imaging, emergency visits, injections, and opioid fills; and less frequent initial use of medical and physical therapy visits. Co-morbid musculoskeletal conditions had the strongest association with being a high utilizer of long-term back-specific resources (OR: 1.53, 95% CI: 1.50-1.57).

CONCLUSIONS:

Co-morbidity burden and the presence of specific chronic conditions, such as musculoskeletal conditions, were associated with high long-term use of back-related care and care inconsistent with guidelines.

KEYWORDS:

co-morbidity; guidelines; health care use; low back pain; opioids

PMID:
28508556
DOI:
10.1111/jep.12763
[Indexed for MEDLINE]

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