Archive for the ‘A New Gatekeeper for Back Pain’ Category

A New Gatekeeper for Back Pain

March 28, 2010

1.  Chiropractic vs. Medicine for Acute Low Back Pain- Spine Journal 2010

2.   Chiropractic cost effective-Blue Cross Blue Shield claims analysis-JMPT 2010

Factors Associated with Choosing a Chiropractor for Episodes of Back Pain Care

Med Care 1995; 33(8): 842-850. -(The official Journal of the Medical Care Section, American Public Health Association)-Paul Shekelle, M.D., PhD, Martin Markovich MBA, Rachel Louie, M.S

Back pain is a common illness and chiropractors provide a large proportion of back pain care in the United States.

This is the first study to systematically compare chiropractic patients with those who saw other providers for back pain.

Visits were grouped into episodes using decision rules and clinical judgment. The primary provider of back pain care was defined as the provider who delivered most of the services.

Sociodemographic and health status and attitudes variables of patients were examined for association with the choice of chiropractor. Multivariate logistic regression models were constructed to calculate adjusted odds ratios for independent predictors.

There were 1020 episodes of back pain care made by 686 different persons and encompassing 8825 visits.

Results indicated that chiropractors were the primary provider for 40% of episodes, and retained as primary provider a greater percentage of their patients (92%) who had a second episode of back pain care than did medical doctors.

Health insurance experiment site, white race, male sex, and high school education were independent predictors of choosing a chiropractor.

Conclusions suggested that chiropractors were the choice of one third of all patients who sought back pain care, and provided care for 40% of all episodes of care. Geographic site, education, gender, and income were independent patient factors predicting chiropractic use.
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The authors analyzed data from the RAND Health Insurance Experiment, a community-based study of the use of health services. Insurance claims forms were examined for all visits specified by the patient as occurring for back pain.

A New Gatekeeper for Back Pain

American Journal of Managed Care (Am J Man Care 1998;4:576-579)

Alan D. Horwitz, DC; Ronald Hosek, PhD, DC, MPH; Joseph Boyle, DC, DABCN, FICC;Arnold Cianciulh, MS, DC; Jon Glass, MD; and Ronald Codario, MDAbstract

Managed care programs have evolved in response to the escalating costs of healthcare in the United States.

Expenses related to back pain represent a significant portion of these costs.

Chiropractic physicians handle more back pain visits than do medical doctors and are playing an increasing role in the management of neuromusculoskeletal problems in general.

Furthermore, chiropractic patients are more satisfied with their care than are patients of family physicians. A number of studies have shown chiropractic medicine to have high efficacy and cost-effectiveness.

Its utilization for neuromusculoskeletal problems in the managed care setting may well offer competitive advantages. Using chiropractic physicians as gate- keepers for back pain would result in more expedient movement through the algorithmic process and facilitate treatment of the patient with acute back pain.

Many medical facilities are enhancing their services by utilizing chiropractic physicians as gate- keepers for the diagnosis and treatment of neuromusculoskeletal disorders.

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The authoritative AHCPR clinical guidelines, Acute Low Back Problems in Adults,1 recommended only spinal manipulation as an intervention for both “symptomatic relief and functional improvement.”

Many literature reviews by health economists, (2-3) epidemiologists  (4) and other health services researchers have documented that chiropractic consistently improves patient function in a safe, conservative, and cost-effective manner; reducing the incidence of hospitalization, surgery, and the use of medications.
1. Bigos S. et al. Acute Low Back Problems in Adults, Clinical Practice Guideline No. 14, AHCPR, Dec. 1994: 118.

2. Manga P et al. The Effectiveness and Cost-effectiveness of Chiropractic Management of Low Back Pain. Ontario Ministry of Health 1993.

3. Stano M et al. J Am Health Policy 1992; Nov/Dec: 39-45.

4. Cherkin D. J Fam Practice 1992; 35(5): 505-506.

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New Study Pilot on Quality Shows Cost-Effectiveness of Chiropractic Care for Musculoskeletal Disorders

A new pilot program shows that conservative heath care, including chiropractic, may reduce overall health care costs in patients with musculoskeletal disorders, such as back and neck pain.

The pilot, conducted by Wellmark Blue Cross and Blue Shield to measure quality of patient care for its members in Iowa and South Dakota, also shows promising outcomes for the patients choosing chiropractic and other conservative care.

“The cost-effectiveness and safety of chiropractic has been documented in several studies. ACA is pleased that insurance companies are starting to recognize the value that doctors of chiropractic and other conservative providers can offer to their members,” said ACA President Glenn Manceaux, DC. “Especially during the health care reform debate, it’s important that chiropractic and other conservative care methods are taken into serious consideration as a cost-effective alternative to the utilization of expensive surgery and hospital-based care,” he added.

Wellmark conducted the Physical Medicine Pilot on Quality in 2008 for Iowa and South Dakota physical medicine providers. A total of 238 chiropractors, physical therapists and occupational therapists provided care to 5,500 members with musculoskeletal disorders. According to Wellmark, data from participating clinicians show that 89 percent of the patients treated in the pilot reported a greater than 30-percent improvement in 30 days.

The pilot compared data for Wellmark members who received care from doctors of chiropractic or physical therapists with a member population with similar demographics who did not receive such services. The comparison showed that those who received chiropractic care or physical therapy were less likely to have surgery and experienced lower total health care costs, according to Wellmark.

Chiropractic is widely recognized as one of the safest non-invasive therapies available for the treatment of back pain, neck pain, headaches and other neuromusculoskeletal complaints.

A significant amount of evidence shows that chiropractic care for certain conditions can be more effective and less costly than traditional medical care. Recent research includes:

A study published in the October 2005 issue of the Journal of Manipulative and Physiological Therapeutics (JMPT) found that chiropractic and medical care have comparable costs for treating chronic low-back pain, with chiropractic care producing significantly better outcomes.

A March 2004 study in JMPT found that chiropractic care is more effective than medical care at treating chronic low-back pain in patients’ first year of symptoms.

A study published in a 2003 edition of the Medical Journal Spine found that manual manipulation provides better short-term relief of chronic spinal pain than do a variety of medications.

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October 12, 2009Mercer Health and Benefits, San Francisco
Niteesh Choudhry, MD, PhD-Harvard Medical School Arnold Milstein, MD, MPH-Mercer Health and Benefits

Do Chiropractic Physician Services for Treatment of Low Back and Neck Pain Improve the Value of Health Benefit Plans?

An Evidence-Based Assessment of Incremental Impact on Population Health and Total Health Care Spending A report prepared for the Foundation for Chiropractic Progress.

Conclusion

Using data from high-quality randomized controlled EU trials and contemporary US based average unit prices payable by commercial insurers, we project that insurance coverage for chiropractic physician care for low back and neck pain for conditions other than fracture and malignancy is likely to drive improved cost-effectiveness of US care.

For neck pain it is also likely to reduce total US health care spending. These favorable results would likely occur within a 12-month timeframe.

The validity of our estimates depends on the equivalence between the US and EU of relative differences in the cost-effectiveness of chiropractic and medical physician services.

In combination with the existing US-based literature, our findings support the value of health insurance coverage of chiropractic care for low back and neck pain at average fees currently payable by US commercial insurers.

Why Does Back Pain Recur?

Why do Some Patients Keep Hurting Their Back-J of Pain 2009

This 2 min video is on spinal decompression, but it gives you a good idea of what is happening as the spine decompresses:  DRX9000 Spinal Decompression Therapy:: Degenerative Disc Disease

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