July 8, 2014 – The Foundation for Chiropractic Progress (F4CP), a not-for-profit organization dedicated to raising awareness about the benefits of chiropractic care, points to the findings of a new study, “Tracking Low Back Problems in a Major Self-Insured Workforce: Toward Improvement in the Patient’s Journey,” published in the Journal of Occupational and Environmental Medicine in June 2014, which underscores the value that chiropractic brings to the delivery of care for low back pain.
The study examined the total direct (medical, pharmaceutical) and
indirect (lost productivity, absenteeism, workers compensation, short
and long-term disability) cost outcomes associated with care for back
problems reported by workers at a major self-insured heavy manufacturer
in the U.S. Over a third of the 21,080 employees tracked from 2001 to
2009 reported one or more back problems. The analyses identified five
treatment approaches based on the first six weeks of claims and used
published guidelines to focus on the 10,406 low back pain episodes
reported across the nine-year study period.
Lead author Harris
Allen comments, “Care congruent with ten of the eleven guidelines we
tested was linked to lower total costs. Of the five approaches, which
ranged from complex medical management to information and advice,
employee patients in the chiropractic group were the least likely to use
any of the five most frequently prescribed classes of medications, to
receive medically intensive procedures like surgeries, and to record
guideline-incongruent use of imaging, medications and procedures when
the latter were delivered. They also averaged significantly lower total
costs per episode, even when statistical adjustments were made to
improve group comparability.”
The overall results added to the
growing body of research that supports the proposition that good health
care is good value. Yet, in some cases, cheaper care was not necessarily
the better value, as was shown when chiropractor and physical therapist
visits were further analyzed.
“The eleventh guideline we
assessed,” says Allen, “was interpreted to recommend that the first
visit to a chiropractor or physical therapist takes place after a
two-week waiting period. Yet, we found that when this first visit to
either type of provider occurred before the two-week mark, total costs
were reduced. Adjusted, the estimates ranged from approximately $2,200
to $1,200 less than the overall average across years one, two and three
per episode for neurological diagnoses to approximately $1,100 to $200
less across years one, two and three per episode for non-neurological
diagnoses.”
While more research is needed, these findings
indicate that delaying chiropractic care, although cheaper upfront, is
likely to be linked to higher total costs over the long term, F4CP said.
When
asked as an expert external to the project team for his assessment,
Paul Papanek, medical doctor and speaker of the house of delegates for
the American College of Occupational and Environmental Medicine and
seasoned clinician in the treatment of employee low back pain,
concludes, “This paper makes a significant contribution, and
demonstrates that, by focusing on adherence to quality guidelines for
low back care, company health plans and providers will see better
outcomes and lower costs.”
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