Provider Practice Patterns for Acute Lower Back Pain Within the Military Health System (2017-2022)
Kyle Patrick Apilado1,2, Sarah Selica T Miura1,2, Andrew J Schoenfeld3
1Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.
Background:
Acute low back pain (LBP) represents the leading cause of disability in the United States and affects up to 80% of adults. Clinical practice guidelines for the U.S. Military Health System (MHS) advise against certain modalities for the diagnosis and treatment of LBP because of inefficient or detrimental results. This study examines acute LBP practice patterns among providers within the MHS during the COVID-19 pandemic.
Materials And Methods:
We conducted an open retrospective study using electronic medical records from the MHS Data Repository between the fiscal years 2018 and 2022, divided into pre-pandemic, early-pandemic, and late-pandemic. We identified the first instance of LBP treatment by provider type and personnel category. Targeted practices were computed tomography, magnetic resonance imaging, X-ray, and prescription medications. Binomial logistic regression was used to calculate odds ratios by provider type.
Results:
A total of 621,834 eligible LBP patients were identified. Over the course of the study period, all provider types observed an increasing likelihood of utilizing diagnostic imaging and a decreasing likelihood of administering prescription nonsteroidal anti-inflammatory drugs for LBP. Nurse practitioners (1.09, OR; 1.07-1.11, 95% CI) and physician assistants (1.24, OR; 1.22-1.26, 95% CI) were significantly more likely to utilize diagnostic imaging for LBP cases in comparison to physicians. Furthermore, nurse practitioners (1.13, OR; 1.12-1.15, 95% CI) and physician assistants (1.32, OR; 1.30-1.33, 95% CI) were more likely to prescribe nonsteroidal anti-inflammatory drugs compared to physicians. When assessing personnel categories, both contractor (1.13, OR; 1.11-1.15, 95% CI) and civilian (1.06, OR; 1.05-1.08, 95% CI) personnel displayed a greater likelihood of administering targeted practices for LBP compared to active duty providers.
Conclusions:
Differing treatment practices for acute LBP necessitate further clinical guideline adherence to promote consistent treatment among all providers, particularly given that nurse practitioners and physician assistants become an increasingly integral component of the MHS. Further investigation is needed to refine acute LBP management practices and minimize low-value care services within the MHS.
