• Bezdjian S
• Whedon JM
• Russell R
• Goehl JM
• Kazal LA Jr

• Affiliation / Geisel School of Medicine at Dartmouth
• Affiliation / Southern California University of Health Sciences
• Affiliation(G) / United States / California / Whittier
• Affiliation(G) / United States / New Hampshire / Hanover
• Back Pain / therapy
• Chiropractic Clinics
• Low Back Pain / therapy
• Open Access Document
• Primary Health Care / statistics and numerical data
• Retrospective Studies
• Spinal Diseases / statistics and numerical data
• Spinal Diseases / therapy
• Treatment Outcome

Background: Primary Spine Care (PSC) is an innovative model for the primary management of patients with spine-related disorders (SRDs), with a focus on the use of non-pharmacological therapies which now constitute the recommended first-line approach to back pain. PSC clinicians serve as the initial or early point of contact for spine patients and utilize evidence-based spine care pathways to improve outcomes and reduce escalation of care (EoC; e.g., spinal injections, diagnostic imaging, hospitalizations, referrals to a specialist). The present study examined 6-month outcomes to evaluate the efficiency of care for patients who received PSC as compared to conventional primary care. We hypothesized that patients seen by a PSC clinician would have lower rates of EoC compared to patients who received usual care by a primary care (PC) clinician.

Methods: This was a retrospective observational study. We evaluated 6-month outcomes for two groups seen and treated for an SRD between February 01, 2017 and January 31, 2020. Patient groups were comprised of N = 1363 PSC patients (Group A) and N = 1329 PC patients (Group B). We conducted Pearson chi-square and logistic regression (adjusting for patient characteristics that were unbalanced between the two groups) to determine associations between the two groups and 6-month outcomes.

Results: Within six months of an initial visit for an SRD, a statistically significantly smaller proportion of PSC patients utilized healthcare resources for spine care as compared to the PC patients. When adjusting for patient characteristics, those who received care from the PSC clinician were less likely within 6 months of an initial visit to be hospitalized (OR = .47, 95% CI .23–.97), fill a prescription for an opioid analgesic (OR = .43; 95% CI .29–.65), receive a spinal injection (OR = .56, 95% CI .33–.95), or have a visit with a specialist (OR = .48, 95% CI .35–.67) as compared to those who received usual primary care.

Conclusions: Patients who received PSC in an academic primary care clinic experienced significantly less escalation of their spine care within 6 months of their initial visit. The PSC model may offer a more efficient approach to the primary care of spine problems for patients with SRDs, as compared to usual primary care.

Author keywords: Primary care — Primary spine care —  Spine-related disorders —  Low back pain —  Spine pain escalation of care —  Academic primary care clinic —  Chiropractic —  Efficiency

Author affiliations: SB, JMW, RR: Southern California University of Health Sciences, Whittier, California, United States; JMG, LAKJR: Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States
Corresponding author: Serena Bezdjian—SerenaBezdjian@scuhs.edu

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