Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.
Centre for Intelligent Musculoskeletal Health, Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway.
Eur J Pain. 2024 Nov;28(10):1799-1810. doi: 10.1002/ejp.2310. Epub 2024 Jul 5.
To describe the frequency of primary care seeking for neck or back-related conditions among people with chronic neck and low back pain and to develop prediction models of primary care seeking and frequent visits.
We included participants of the Trøndelag Health Study (HUNT4, 2017-19) in Norway who self-reported chronic neck and/or low back pain in the preceding year, and extracted data of primary care visits from the Norwegian primary healthcare registry. We investigated a total of 23 potential predictors and used multivariable logistic regression models to predict primary care seeking for neck or back-related conditions and frequent visits by healthcare provider (i.e., the highest quartile of number of visits).
Among the 15,352 HUNT4 participants with chronic neck and/or low back pain, 6231 participants (40.6%) sought primary care for neck or back-related conditions (median = 5 visits, IQR 2-15) within 2 years after the study. Participants who consulted physical therapists sought care the most frequently (median = 10 visits, IQR 3-26). Discrimination of the best-fit prediction model of primary care seeking and frequent visits by healthcare provider, assessed by C-statistic, ranged from 0.66-0.76. Participants who made frequent primary care visits in the preceding year were highly likely to continue frequent care seeking in the following 2 years.
Around 40% of people seek primary care for chronic neck and low back pain, and frequent care seeking may continue for years. Future studies should investigate strategies to reduce recurrent primary care visits, especially seeking physical therapist care, and promote self-management of chronic pain.
People with chronic neck and low back pain who seek physical therapist care had the highest frequency of care seeking, underscoring the significant burden on healthcare systems. The high frequency of visits and associated healthcare expenditures highlight the critical need for effective and valuable primary care for chronic pain management. To mitigate recurrent visits and reduce costs, it is essential to provide patients with evidence-based treatments and self-management interventions.
描述慢性颈痛和腰痛患者中因颈痛和背痛相关疾病初次就诊的频率，并建立初次就诊和频繁就诊的预测模型。
我们纳入了挪威特隆赫姆健康研究（HUNT4，2017-19 年）中报告过去 1 年有慢性颈痛和/或腰痛的参与者，并从挪威初级保健登记处提取初级保健就诊数据。我们共调查了 23 个潜在预测因素，并使用多变量逻辑回归模型预测因颈痛和背痛相关疾病和由医疗保健提供者进行的频繁就诊（即就诊次数最多的四分之一）。
在 HUNT4 中有慢性颈痛和/或腰痛的 15352 名参与者中，6231 名（40.6%）在研究后 2 年内因颈痛和/或背痛相关疾病初次就诊（中位数=5 次就诊，IQR 2-15）。咨询物理治疗师的参与者就诊最频繁（中位数=10 次就诊，IQR 3-26）。通过 C 统计量评估，最佳拟合的初次就诊和由医疗保健提供者进行频繁就诊预测模型的区分度范围为 0.66-0.76。在前一年中进行了频繁初级保健就诊的参与者，在接下来的 2 年内极有可能继续进行频繁就诊。
约 40%的慢性颈痛和腰痛患者会寻求初级保健治疗，且频繁就诊可能会持续多年。未来的研究应探讨减少反复初级保健就诊的策略，特别是减少寻求物理治疗师治疗的次数，并促进慢性疼痛的自我管理。
因慢性颈痛和腰痛而寻求物理治疗师治疗的患者就诊频率最高，这突显了医疗系统的巨大负担。高就诊频率及其相关的医疗支出突出表明，慢性疼痛管理需要有效的、有价值的初级保健。为了减少反复就诊和降低成本，为患者提供基于证据的治疗和自我管理干预措施至关重要。
