Affiliations: [a] Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA | [b] Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA | [c] Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA | [d] Department of Orthopedics, Vanderbilt University Medical Center, Nashville, TN, USA | [e] Departments of Physical Medicine and Rehabilitation, Orthopaedics, and Population and Data Sciences, University of Texas Southwestern, USA
Correspondence:
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Corresponding author: Byron J. Schneider, Department of Physical Medicine and Rehabilitation, Center for Musculoskeletal Research, Vanderbilt University Medical Center, 2201 Children’s Way, Suite 1318, Nashville, TN 37212, USA. Tel.: +1 615 322 0738; Fax: +1 615 322 7454; E-mail: byron.j.schneider@vumc.org.
Abstract: BACKGROUND: Back pain is a leading reason for seeking care in the United States (US), and is a major cause of morbidity. OBJECTIVE: To analyze demographic, patient, and visit characteristics of adult ambulatory spine clinic visits in the United States from 2009–2016. METHODS: Data from the National Ambulatory Medical Care Survey from 2009–2016 were used and were sample weighted. RESULTS: Most patients presenting for ambulatory spine care were 45–64 years (45%), were most commonly female (56.8%), and private insurance (45%) and Medicare (26%) were most common payors. The percentage of visits for spine care done at a primary care setting was 50.1% in 2009–2010 and 48.3% in 2014–2015. Approximately 15.5% were seen in orthopedic surgery clinics in 2009–2010 and 7.3% in 2015–2016. MRI was utilized in 11.7% in 2009–2010 and 11.0% in 2015–2016. Physical therapy was prescribed in 13.2% and narcotic analgesic medications were prescribed in 36.2% of patients in 2015–2016. CONCLUSIONS: MRI was used more frequently than guidelines recommended, and physical therapy was less frequently utilized despite evidence. A relatively high use of opiates in treatment of back pain was reported and is concerning. Although back pain represents a substantial public health burden in the United States, the delivery of care is not evidence-based.
Keywords: Low back pain, epidemiology, primary care
