Branthaver B, Stein G F, Mehran A
Department of Operations Support Services, Kaiser Permanente Medical Care Program, Oakland, California, USA.
Spine (Phila Pa 1976). 1995 May 15;20(10):1165-9. doi: 10.1097/00007632-199505150-00011.
Samples of patients with new back pain were compared at two medical centers, one with and one without a medical back care program.
To measure the impact of a medical back care program on use of services and physician satisfaction in a health maintenance organization.
A medical back care program is staffed with specially trained primary care physicians and provides consultative and educational services to the medical center.
Program impact on services was measured by comparing the number of physician office visits, consultations, physical therapy referrals, and imaging procedures provided to a sample of patients with back pain at the two medical centers. Physician satisfaction with care provided to patients with back pain was measured by a survey sent to primary care physicians at both medical centers.
At the medical center with a back care program, 42% fewer consultations, 59% fewer physical therapy referrals, and 33% fewer imaging procedures were ordered. Less expensive consultations with back care physicians in medicine or family practice were ordered more frequently than consultations with either neurologists or orthopedists. This change in pattern of care took place without significantly altering clinical course. The effect of the program on the rate of surgery was not measured.
The results of this study support the benefits of an organized medical back care program.
在两个医疗中心对新发背痛患者的样本进行比较，一个医疗中心有医疗背部护理项目，另一个没有。
评估医疗背部护理项目对健康维护组织中服务使用情况和医生满意度的影响。
医疗背部护理项目配备了经过专门培训的初级保健医生，并为医疗中心提供咨询和教育服务。
通过比较两个医疗中心为背痛患者样本提供的医生门诊就诊次数、会诊次数、物理治疗转诊次数和影像检查程序数量，来衡量该项目对服务的影响。通过向两个医疗中心的初级保健医生发送调查问卷，来衡量医生对为背痛患者提供的护理的满意度。
在设有背部护理项目的医疗中心，会诊次数减少了42%，物理治疗转诊次数减少了59%，影像检查程序减少了33%。与医学或家庭医学领域的背部护理医生进行的费用较低的会诊，比与神经科医生或骨科医生的会诊更频繁。护理模式的这种变化在没有显著改变临床病程的情况下发生。该项目对手术率的影响未作评估。
本研究结果支持有组织的医疗背部护理项目的益处。
