EFFECTS OF PRACTICE STYLE IN MANAGING BACK PAIN

Objective: To assess the effects of a practice style of back pain mana gement consistent with self-care (infrequent prescribing of pain medic ations and bed rest) on long-term functional outcomes, costs of care, and patient satisfaction. Design: A quasi-experimental observational s tudy in which primary care physicians (n = 44) were categorized accord ing to one of three practice style groups defined by a low, moderate, or high frequency of prescribing pain medications and bed rest for man y patients (average, 24 patients per physician). Setting: Primary care practices of a large, staff model health maintenance organization, Gr oup Health Cooperative of Puget Sound. Patients: Consecutive patients with back or neck pain of participating primary care physicians. Patie nts were interviewed 1 month (n = 1071) and 1 year and 2 years (n = 91 1) after their index visits. Results: Patients in the three practice s tyle groups rated similarly the quality of medical care received for b ack pain. Patients treated by physicians who infrequently prescribed p ain medications and bed rest were more satisfied with education about back pain. On a scale of 0 to 10, the mean rating of agreement with th e statement, ''After your visit with the doctor, you fully understood how to take care of your back problem,'' was 5.6 +/- 3.6 among patient s of physicians who frequently prescribed medication and rest and was 6.6 +/- 3.5) among those who infrequently prescribed medication and be d rest. At 1 month, 30% of patients of physicians who infrequently pre scribed medications and bed rest were graded as having moderate to sev ere activity limitation because of back pain, whereas 37% of patients in the moderate group had this grading, and 46% of patients of physici ans who frequently prescribed were graded as having moderate to severe activity limitation. Differences in activity limitation by practice s tyle group were no longer evident at 1 or 2 years of follow-up. The to tal 1-year costs of back care were higher among patients seen by physi cians who frequently prescribed bed rest and pain medications (cost, $ 768 +/- $1592) than among those seen by physicians who infrequently pr escribed (cost, $428 +/- $665), due largely to differences in inpatien t and specialty care costs. The adjusted difference in costs, after co ntrolling for case-mix variables, was $277 (95% Cl, $85.50 to $471.32) . Conclusions: A practice style consistent with back pain self-care yi elded similar long-term pain and functional outcomes at lower cost and was associated with higher satisfaction with patient education compar ed with a practice style characterized by more frequent prescribing of pain medications and bed rest.