RT Journal Article
SR Electronic
T1 Patient and Provider Characteristics Associated with Receipt of Image-guided Interventions for Low Back Pain
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP ajnr.A8502
DO 10.3174/ajnr.A8502
A1 Safazadeh, Ghazaleh
A1 Carlos, Ruth C.
A1 Shah, Lubdha M.
A1 Stoddard, Gregory J.
A1 Steed, Rebecca
A1 Hutchins, Troy A.
A1 Peckham, Miriam E.
YR 2024
UL http://www.ajnr.org/content/early/2024/10/18/ajnr.A8502.abstract
AB BACKGROUND AND PURPOSE: Low back pain commonly causes disability, often managed with conservative image-guided interventions before surgery. Research has documented racial disparities with these and other non-pharmacologic 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 low back pain within a large Utah healthcare system. The primary outcome was the association of provider and patient variables with the frequency of image-guided interventions received within one year of low back pain 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 one year of diagnosis.RESULTS: Among 812 subjects (41% underrepresented minority and 59% White/non-Hispanic), more White/non-Hispanic patients had at least one image-guided intervention within 12 months compared to underrepresented minority patients (7.2% vs. 12.5%, p = .001), despite underrepresented minorities having higher presenting pain scores (64.5% vs. 49.3%; pain intensity > 5, p = .001). Underrepresented minority patients more often saw generalists (71.7% vs. 52.6%, p < .001) and advanced practice clinician providers (33.6% vs. 25.6%, p < .02) compared to the White/non-Hispanic cohort. Both cohorts were referred to a specialist at the same rate (17.7% vs. 19.8%, p = .20); however, referral completion was noted less often (60.4% vs. 77.7%, p = .02) and took longer to complete in underrepresented minority patients (54 vs. 27.5; mean day, p = .003).CONCLUSIONS: Underrepresented minority patients had more severe low back pain 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 absence of a decision-making discussion, data do not support provider bias as a contributing factor to differences in receipt of image-guided interventions.ABBREVIATIONS: IGI = image-guided intervention; LBP = low back pain; URM = underrepresented minority; WNH = White/non-Hispanic; ICC = intraclass correlation coefficient.