Patient and Provider Characteristics Associated with the Receipt of Image-Guided Interventions for Low Back Pain.

Abstract

Background and purpose: Low back pain (LBP) commonly causes disability, often managed with conservative image-guided interventions before surgery. Research has documented racial disparities with these and other nonpharmacologic treatments. We posited that individual chart reviews may provide insight into the disparity of care types through documented patient/provider discussions and their effect on treatment plans.

Materials and methods: This retrospective analysis involved adults newly diagnosed with LBP in a large Utah health care system. The primary outcome was the association of provider and patient variables with the frequency of image-guided interventions received within 1 year of LBP diagnosis between White/non-Hispanic and underrepresented minority cohorts. Secondary outcomes were receipt of additional treatment types (physical therapy and lumbar surgery), time to any treatment, time to image-guided intervention, and discussion/receipt of therapy between cohorts within 1 year of diagnosis.

Results: Among 812 subjects (59% White/non-Hispanic and 41% underrepresented minority), more White/non-Hispanic patients had at least 1 image-guided intervention within 12 months compared with underrepresented minority patients (12.5% versus 7.2%, P = .01), despite underrepresented minorities having higher presenting pain scores (64.5% versus 49.3%; pain intensity, >5; P = .001). Underrepresented minority patients more often saw generalists (71.7% versus 52.6%, P < .001) and advanced practice clinician providers (33.6% versus 25.6%, P < .02) compared with the White/non-Hispanic cohort. Both cohorts were referred to a specialist at the same rate (17.7% versus 19.8%, P = .20); however, referral completion was noted less often (60.4% versus 77.7%, P = .02) and took longer to complete in underrepresented minority patients (mean, 54 versus 27.5 days; P = .003).

Conclusions: Underrepresented minority patients had more severe LBP on presentation but received image-guided interventions less often than White/non-Hispanic patients. Our in-depth chart analysis supports the lack of referral completion and evaluation from a spine specialist provider as the main deterrent to the receipt of image-guided interventions in this cohort. While there may be systematic provider barriers such as an absence of decision-making discussion, data do not support provider bias as a contributing factor to differences in receipt of image-guided interventions.