Liu A C, Byrne E
Palo Alto Medical Foundation, Los Altos Center, CA 94022, USA.
J Fam Pract. 1995 May;40(5):449-55.
Low back pain is a common presenting complaint in primary care, and the rate of utilization of resources among physicians treating this condition varies. Charges associated with the care of patients with low back pain were analyzed for a series of patients in a multispecialty group practice setting.
One hundred seventy managed care patients were selected for review. Use of laboratory, plain radiography, magnetic resonance imaging (MRI), subspecialty referrals, and physical therapy was examined based on patient characteristics and physician specialty. Appropriateness of MRI and lumbar spine radiography according to published criteria was also studied.
Overall utilization was higher for patients who were referred to a subspecialist, and costs for visits to subspecialists were higher. Charges for physician services and MRI accounted for a majority of the total charges. Patients who were referred for subspecialty care or MRI but did not meet criteria for utilization of these resources comprised 6% of the study population but accounted for 27% of the total charges. Five of 14 patients undergoing MRI did not meet the published clinical criteria determining need for MRI, and 10 of 17 patients referred to subspecialists did not meet referral criteria. Other patients who met criteria for MRI or subspecialty consultation did not receive these services. Seventeen percent of the patients referred for physical therapy had a symptom duration of 2 weeks or less at the time of referral and accounted for 17% of all physical therapy charges.
The majority of costs associated with care for low back pain in this study were attributable to physician charges and the use of MRI. Charges for subspecialty physician services, lumbar spine radiographs, and MRI in patients not meeting appropriate criteria accounted for 19% of all costs.
腰痛是基层医疗中常见的就诊主诉，治疗该疾病的医生资源利用率各不相同。对多专科联合诊所环境下的一系列患者的腰痛治疗相关费用进行了分析。
选择170名管理式医疗患者进行回顾。根据患者特征和医生专业，对实验室检查、普通X线摄影、磁共振成像（MRI）、专科转诊及物理治疗的使用情况进行了检查。还根据已发表的标准研究了MRI和腰椎X线摄影的合理性。
转诊至专科医生的患者总体利用率较高，专科医生就诊费用也更高。医生服务和MRI费用占总费用的大部分。被转诊至专科护理或进行MRI检查但不符合这些资源使用标准的患者占研究人群的6%，但占总费用的27%。14名接受MRI检查的患者中有5名不符合已发表的确定MRI需求的临床标准，17名转诊至专科医生的患者中有10名不符合转诊标准。其他符合MRI或专科会诊标准的患者未接受这些服务。17%被转诊进行物理治疗的患者在转诊时症状持续时间为2周或更短，占所有物理治疗费用的17%。
本研究中与腰痛治疗相关的大部分费用归因于医生收费和MRI的使用。不符合适当标准的患者的专科医生服务、腰椎X线片和MRI费用占所有费用的19%。
