Görge Magdalena, Ziehm Jeanette, Farin Erik
Section of Health Care Research and Rehabilitation Research, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
BMC Health Serv Res. 2017 Dec 6;17(1):812. doi: 10.1186/s12913-017-2757-3.
Patients with chronic back pain show an increased use of health-care services leading to high direct costs. Multidisciplinary rehabilitation reduces pain intensity, depression, disability and work inability. The study aims to investigate whether health-care utilization in patients with chronic back pain is lower after rehabilitation than before rehabilitation and if, in addition to sociodemographic, medical and psychological characteristics, changes in these characteristics immediately after rehabilitation can predict health-care utilization.
N = 688 patients with chronic back pain were asked about their overall health-care services use and the use of general practitioners, specialists, physiotherapy, psychotherapy, complementary therapist, massages, and admission to hospital both 6 months before and 6 months after rehabilitation. In addition, various sociodemographic, medical and psychological variables were assessed. To measure changes due to rehabilitation, differences in pain intensity, disability, impairment and coping, quality of life, and days on sick leave before and after rehabilitation were calculated. Dependent t-tests and hierarchical regression analyses were used to analyse the data.
Health-care utilization 6 months after rehabilitation was, except for physiotherapy and psychotherapy, significantly lower than before. The effect sizes were rather small (Cohens'd =. 01-.34). After rehabilitation between 15.2% and 39.9% of the variance of health-care utilization could be explained. The baseline values of health-care utilization explained between 3.2% and 15.9% of the incremental variances. The changes in psychological impairment and coping as well as in sick leave after rehabilitation could explain between 0.8% and 2.9% of the variance of health-care utilization after rehabilitation. Its influence was significant for the general use of health-care services, general practitioners and specialists.
The results indicate that use of health-care services after rehabilitation in the present study is slightly lower than before, which has an impact on direct costs due to chronic back pain in Germany. The predictors show the importance in terms of health-care utilization of improving work ability and psychological impairment.
慢性背痛患者对医疗服务的使用增加，导致直接成本高昂。多学科康复可减轻疼痛强度、缓解抑郁、改善残疾状况并减少工作能力丧失。本研究旨在调查慢性背痛患者康复后的医疗服务利用率是否低于康复前，以及除社会人口统计学、医学和心理特征外，康复后这些特征的变化是否能够预测医疗服务利用率。
对688例慢性背痛患者进行了调查，询问他们在康复前6个月和康复后6个月的整体医疗服务使用情况，以及全科医生、专科医生、物理治疗、心理治疗、辅助治疗师、按摩服务的使用情况和住院情况。此外，还评估了各种社会人口统计学、医学和心理变量。为衡量康复引起的变化，计算了康复前后疼痛强度、残疾、功能障碍和应对方式、生活质量以及病假天数的差异。采用配对t检验和分层回归分析对数据进行分析。
康复后6个月，除物理治疗和心理治疗外，医疗服务利用率显著低于康复前。效应量较小（科恩d值 = 0.01 - 0.34）。康复后，医疗服务利用率的方差有15.2%至39.9%可得到解释。医疗服务利用率的基线值可解释增量方差的3.2%至15.9%。康复后心理功能障碍和应对方式以及病假天数的变化可解释康复后医疗服务利用率方差的0.8%至2.9%。其影响对医疗服务的总体使用、全科医生和专科医生具有显著性。
结果表明，本研究中康复后的医疗服务使用率略低于康复前，这对德国慢性背痛的直接成本产生了影响。预测因素表明，提高工作能力和改善心理功能障碍对医疗服务利用率具有重要意义。
