Validation of the STarT Back Tool in the Military Health System
Abstract
Low back pain (LBP) is among the most frequent causes of medical visits and lost-duty time in the Military Health System (MHS), second only to the common cold as the most common symptomatic reason for a primary care visit in the MHS. In 2009, LBP resulted in 606,332 outpatient medical encounters, accounting for 6.4% of all outpatient visits for any illness or injury among active component members. The majority of patients with LBP in the MHS initially access healthcare through a primary care provider. Given the volume of patients with LBP managed in primary care, decisions in this setting have substantial implications on the subsequent course of a patient s symptoms and implications for overall healthcare cost. However, defining optimal primary care management of patients with LBP has proven elusive, and wide variations in primary care practice have been observed for decisions such as prescribing medication, ordering imaging, and referral to specialists. Initial referral decisions for the majority of patients with non-specific LBP are based on clinical intuition, despite evidence to suggest that such a strategy provides inefficient and inconsistent access to treatment. Recent studies examining healthcare utilization trends in the MHS demonstrate increasing rates in the utilization of imaging, epidural injections, surgery, and opioid medications for individuals with LBP, despite recommendations that initial care be focused on a wait and see approach based on advice to remain active and simple analgesics. Despite increasingly aggressive treatments, there is no evidence that clinical outcomes are improving; in fact, rates of chronicity related to an episode of LBP are increasing.
Document Details
- Document Type
- Technical Report
- Publication Date
- Mar 31, 2014
- Accession Number
- ADA613235
Entities
People
- John D. Childs