整脊治疗的区域供应情况以及因背部和颈部疼痛而就诊于初级保健医生的情况。
Regional Supply of Chiropractic Care and Visits to Primary Care Physicians for Back and Neck Pain.
作者信息
Davis Matthew A, Yakusheva Olga, Gottlieb Daniel J, Bynum Julie P W
机构信息
From the University of Michigan, Ann Arbor (MAD, OY); and the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Geisel School of Medicine, Hanover, NH (MAD, DJG, JPWB).
出版信息
J Am Board Fam Med. 2015 Jul-Aug;28(4):481-90. doi: 10.3122/jabfm.2015.04.150005.
BACKGROUND
Whether availability of chiropractic care affects use of primary care physician (PCP) services is unknown.
METHODS
We performed a cross-sectional study of 17.7 million older adults who were enrolled in Medicare from 2010 to 2011. We examined the relationship between regional supply of chiropractic care and PCP services using Spearman correlation. Generalized linear models were used to examine the association between regional supply of chiropractic care and number of annual visits to PCPs for back and/or neck pain.
RESULTS
We found a positive association between regional supply of chiropractic care and PCP services (rs = 0.52; P <.001). An inverse association between supply of chiropractic care and the number of annual visits to PCPs for back and/or neck pain was apparent. The number of PCP visits for back and/or neck pain was 8% lower (rate ratio, 0.92; 95% confidence interval, 0.91-0.92) in the quintile with the highest supply of chiropractic care compared to the lowest quintile. We estimate chiropractic care is associated with a reduction of 0.37 million visits to PCPs nationally, at a cost of $83.5 million.
CONCLUSIONS
Greater availability of chiropractic care in some areas may be offsetting PCP services for back and/or neck pain among older adults.
背景
脊椎按摩治疗服务的可获得性是否会影响初级保健医生（PCP）服务的使用尚不清楚。
方法
我们对2010年至2011年参加医疗保险的1770万老年人进行了一项横断面研究。我们使用Spearman相关性分析了脊椎按摩治疗服务的区域供应与初级保健医生服务之间的关系。使用广义线性模型来研究脊椎按摩治疗服务的区域供应与因背部和/或颈部疼痛每年就诊初级保健医生次数之间的关联。
结果
我们发现脊椎按摩治疗服务的区域供应与初级保健医生服务之间存在正相关（rs = 0.52；P <.001）。脊椎按摩治疗服务的供应与因背部和/或颈部疼痛每年就诊初级保健医生的次数之间存在负相关。与供应最低的五分位数相比，脊椎按摩治疗服务供应最高的五分位数中，因背部和/或颈部疼痛就诊初级保健医生的次数低8%（率比，0.92；95%置信区间，0.91 - 0.92）。我们估计，脊椎按摩治疗服务在全国范围内使就诊初级保健医生的次数减少了37万次，费用为8350万美元。
结论
在某些地区，脊椎按摩治疗服务的可获得性增加可能会抵消老年人因背部和/或颈部疼痛而使用的初级保健医生服务。
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