Effects of practice style in managing back pain

Michael Von Korff, William Barlow, Daniel Cherkin, Richard (Rick) Deyo

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Objective: To assess the effects of a practice style of back pain management consistent with self-care (infrequent prescribing of pain medications and bed rest) on long-term functional outcomes, costs of care, and patient satisfaction. Design: A quasi-experimental observational study in which primary care physicians (n = 44) were categorized according to one of three practice style groups defined by a low, moderate, or high frequency of prescribing pain medications and bed rest for many patients (average, 24 patients per physician). Setting: Primary care practices of a large, staff model health maintenance organization, Group Health Cooperative of Puget Sound. Patients: Consecutive patients with back or neck pain of participating primary care physicians. Patients were interviewed 1 month (n = 1071) and 1 year and 2 years (n = 911) after their index visits. Results: Patients in the three practice style groups rated similarly the quality of medical care received for back pain. Patients treated by physicians who infrequently prescribed pain 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 the statement, 'After your visit with the doctor, you fully understood how to take care of your back problem,' was 5.6 ± 3.6 among patients of physicians who frequently prescribed medication and rest and was 6.6 ± 3.5) among those who infrequently prescribed medication and bed rest. At 1 month, 30% of patients of physicians who infrequently prescribed medications and bed rest were graded as having moderate to severe activity limitation because of back pain, whereas 37% of patients in the moderate group had this grading, and 46% of patients of physicians who frequently prescribed were graded as having moderate to severe activity limitation. Differences in activity limitation by practice style group were no longer evident at 1 or 2 years of follow-up. The total 1-year costs of back care were higher among patients seen by physicians who frequently prescribed bed rest and pain medications (cost, $768 ± $1592) than among those seen by physicians who infrequently prescribed (cost, $428 ± $665), due largely to differences in inpatient and specialty care costs. The adjusted difference in costs, after controlling for case-mix variables, was $277 (95% CI, $85.50 to $471.32). Conclusions: A practice style consistent with back pain self-care yielded similar long-term pain and functional outcomes at lower cost and was associated with higher satisfaction with patient education compared with a practice style characterized by more frequent prescribing of pain medications and bed rest.

Original languageEnglish (US)
Pages (from-to)187-195
Number of pages9
JournalAnnals of Internal Medicine
Volume121
Issue number3
StatePublished - Aug 1 1994
Externally publishedYes

Fingerprint

Back Pain
Bed Rest
Physicians
Costs and Cost Analysis
Pain
Primary Care Physicians
Self Care
Health Maintenance Organizations
Neck Pain
Quality of Health Care
Diagnosis-Related Groups
Patient Education
Pain Management
Patient Satisfaction
Observational Studies
Inpatients
Primary Health Care
Education

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Von Korff, M., Barlow, W., Cherkin, D., & Deyo, R. R. (1994). Effects of practice style in managing back pain. Annals of Internal Medicine, 121(3), 187-195.

Effects of practice style in managing back pain. / Von Korff, Michael; Barlow, William; Cherkin, Daniel; Deyo, Richard (Rick).

In: Annals of Internal Medicine, Vol. 121, No. 3, 01.08.1994, p. 187-195.

Research output: Contribution to journalArticle

Von Korff, M, Barlow, W, Cherkin, D & Deyo, RR 1994, 'Effects of practice style in managing back pain', Annals of Internal Medicine, vol. 121, no. 3, pp. 187-195.
Von Korff M, Barlow W, Cherkin D, Deyo RR. Effects of practice style in managing back pain. Annals of Internal Medicine. 1994 Aug 1;121(3):187-195.
Von Korff, Michael ; Barlow, William ; Cherkin, Daniel ; Deyo, Richard (Rick). / Effects of practice style in managing back pain. In: Annals of Internal Medicine. 1994 ; Vol. 121, No. 3. pp. 187-195.
@article{6021dd214ce3477bb636c06eb489219c,
title = "Effects of practice style in managing back pain",
abstract = "Objective: To assess the effects of a practice style of back pain management consistent with self-care (infrequent prescribing of pain medications and bed rest) on long-term functional outcomes, costs of care, and patient satisfaction. Design: A quasi-experimental observational study in which primary care physicians (n = 44) were categorized according to one of three practice style groups defined by a low, moderate, or high frequency of prescribing pain medications and bed rest for many patients (average, 24 patients per physician). Setting: Primary care practices of a large, staff model health maintenance organization, Group Health Cooperative of Puget Sound. Patients: Consecutive patients with back or neck pain of participating primary care physicians. Patients were interviewed 1 month (n = 1071) and 1 year and 2 years (n = 911) after their index visits. Results: Patients in the three practice style groups rated similarly the quality of medical care received for back pain. Patients treated by physicians who infrequently prescribed pain 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 the statement, 'After your visit with the doctor, you fully understood how to take care of your back problem,' was 5.6 ± 3.6 among patients of physicians who frequently prescribed medication and rest and was 6.6 ± 3.5) among those who infrequently prescribed medication and bed rest. At 1 month, 30{\%} of patients of physicians who infrequently prescribed medications and bed rest were graded as having moderate to severe activity limitation because of back pain, whereas 37{\%} of patients in the moderate group had this grading, and 46{\%} of patients of physicians who frequently prescribed were graded as having moderate to severe activity limitation. Differences in activity limitation by practice style group were no longer evident at 1 or 2 years of follow-up. The total 1-year costs of back care were higher among patients seen by physicians who frequently prescribed bed rest and pain medications (cost, $768 ± $1592) than among those seen by physicians who infrequently prescribed (cost, $428 ± $665), due largely to differences in inpatient and specialty care costs. The adjusted difference in costs, after controlling for case-mix variables, was $277 (95{\%} CI, $85.50 to $471.32). Conclusions: A practice style consistent with back pain self-care yielded similar long-term pain and functional outcomes at lower cost and was associated with higher satisfaction with patient education compared with a practice style characterized by more frequent prescribing of pain medications and bed rest.",
author = "{Von Korff}, Michael and William Barlow and Daniel Cherkin and Deyo, {Richard (Rick)}",
year = "1994",
month = "8",
day = "1",
language = "English (US)",
volume = "121",
pages = "187--195",
journal = "Annals of Internal Medicine",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "3",

}

TY - JOUR

T1 - Effects of practice style in managing back pain

AU - Von Korff, Michael

AU - Barlow, William

AU - Cherkin, Daniel

AU - Deyo, Richard (Rick)

PY - 1994/8/1

Y1 - 1994/8/1

N2 - Objective: To assess the effects of a practice style of back pain management consistent with self-care (infrequent prescribing of pain medications and bed rest) on long-term functional outcomes, costs of care, and patient satisfaction. Design: A quasi-experimental observational study in which primary care physicians (n = 44) were categorized according to one of three practice style groups defined by a low, moderate, or high frequency of prescribing pain medications and bed rest for many patients (average, 24 patients per physician). Setting: Primary care practices of a large, staff model health maintenance organization, Group Health Cooperative of Puget Sound. Patients: Consecutive patients with back or neck pain of participating primary care physicians. Patients were interviewed 1 month (n = 1071) and 1 year and 2 years (n = 911) after their index visits. Results: Patients in the three practice style groups rated similarly the quality of medical care received for back pain. Patients treated by physicians who infrequently prescribed pain 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 the statement, 'After your visit with the doctor, you fully understood how to take care of your back problem,' was 5.6 ± 3.6 among patients of physicians who frequently prescribed medication and rest and was 6.6 ± 3.5) among those who infrequently prescribed medication and bed rest. At 1 month, 30% of patients of physicians who infrequently prescribed medications and bed rest were graded as having moderate to severe activity limitation because of back pain, whereas 37% of patients in the moderate group had this grading, and 46% of patients of physicians who frequently prescribed were graded as having moderate to severe activity limitation. Differences in activity limitation by practice style group were no longer evident at 1 or 2 years of follow-up. The total 1-year costs of back care were higher among patients seen by physicians who frequently prescribed bed rest and pain medications (cost, $768 ± $1592) than among those seen by physicians who infrequently prescribed (cost, $428 ± $665), due largely to differences in inpatient and specialty care costs. The adjusted difference in costs, after controlling for case-mix variables, was $277 (95% CI, $85.50 to $471.32). Conclusions: A practice style consistent with back pain self-care yielded similar long-term pain and functional outcomes at lower cost and was associated with higher satisfaction with patient education compared with a practice style characterized by more frequent prescribing of pain medications and bed rest.

AB - Objective: To assess the effects of a practice style of back pain management consistent with self-care (infrequent prescribing of pain medications and bed rest) on long-term functional outcomes, costs of care, and patient satisfaction. Design: A quasi-experimental observational study in which primary care physicians (n = 44) were categorized according to one of three practice style groups defined by a low, moderate, or high frequency of prescribing pain medications and bed rest for many patients (average, 24 patients per physician). Setting: Primary care practices of a large, staff model health maintenance organization, Group Health Cooperative of Puget Sound. Patients: Consecutive patients with back or neck pain of participating primary care physicians. Patients were interviewed 1 month (n = 1071) and 1 year and 2 years (n = 911) after their index visits. Results: Patients in the three practice style groups rated similarly the quality of medical care received for back pain. Patients treated by physicians who infrequently prescribed pain 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 the statement, 'After your visit with the doctor, you fully understood how to take care of your back problem,' was 5.6 ± 3.6 among patients of physicians who frequently prescribed medication and rest and was 6.6 ± 3.5) among those who infrequently prescribed medication and bed rest. At 1 month, 30% of patients of physicians who infrequently prescribed medications and bed rest were graded as having moderate to severe activity limitation because of back pain, whereas 37% of patients in the moderate group had this grading, and 46% of patients of physicians who frequently prescribed were graded as having moderate to severe activity limitation. Differences in activity limitation by practice style group were no longer evident at 1 or 2 years of follow-up. The total 1-year costs of back care were higher among patients seen by physicians who frequently prescribed bed rest and pain medications (cost, $768 ± $1592) than among those seen by physicians who infrequently prescribed (cost, $428 ± $665), due largely to differences in inpatient and specialty care costs. The adjusted difference in costs, after controlling for case-mix variables, was $277 (95% CI, $85.50 to $471.32). Conclusions: A practice style consistent with back pain self-care yielded similar long-term pain and functional outcomes at lower cost and was associated with higher satisfaction with patient education compared with a practice style characterized by more frequent prescribing of pain medications and bed rest.

UR - http://www.scopus.com/inward/record.url?scp=0028235510&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028235510&partnerID=8YFLogxK

M3 - Article

C2 - 8017745

AN - SCOPUS:0028235510

VL - 121

SP - 187

EP - 195

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 3

ER -