THE OUTCOMES AND COSTS OF CARE FOR ACUTE LOW-BACK-PAIN AMONG PATIENTSSEEN BY PRIMARY-CARE PRACTITIONERS, CHIROPRACTORS, AND ORTHOPEDIC SURGEONS

Background. Patients with back pain receive quite different care from different types of health care practitioners. We performed a prospecti ve observational study to determine whether the outcomes of and charge s for care differ among primary care practitioners, chiropractors, and orthopedic surgeons. Methods. Two hundred eight practitioners in Nort h Carolina were randomly selected from six strata: urban primary care physicians (n = 39), rural primary care physicians (n = 48), urban chi ropractors (n = 32), rural chiropractors (n = 32), orthopedic surgeons (n = 29), and primary care providers at a group-model health maintena nce organization (HMO) (n = 28). The practitioners enrolled consecutiv e patients with acute low back pain. The patients were contacted by te lephone periodically for up to 24 weeks to assess functional status, w ork status, use of health care services, and satisfaction with the car e received. Results. The status at six months was ascertained for 1555 of the 1633 patients enrolled in the study (95 percent). The times to functional recovery, return to work, and complete recovery from low b ack pain were similar among patients seen by all six groups of practit ioners, but there were marked differences in the use of health care se rvices. The mean total estimated outpatient charges were highest for t he patients seen by orthopedic surgeons and chiropractors and were low est for the patients seen by HMO and primary care providers. Satisfact ion was greatest among the patients who went to the chiropractors. Con clusions. Among patients with acute low back pain, the outcomes are si milar whether they receive care from primary care practitioners, chiro practors, or orthopedic surgeons. Primary care practitioners provide t he least expensive care for acute low back pain.