Neck pain care pathways and costs: association with the type of initial contact health care provider. A retrospective cohort study

BackgroundFor individuals with neck pain (NP) the type of health care provider (HCP) initially contacted and subsequent services used are less well understood than for low back pain (LBP). The purpose of this retrospective observational study of administrative data was to examine the association between type of HCP initially contacted by individuals with NP, service utilization, and total episode cost. MethodsA US national sample of NP episodes completed in 2017-2019 was analyzed. Separate analyses of a combined surgical and non-surgical (pooled) sample and a non-surgical sample were performed. Seventeen types of HCP initially contacted by an individual with NP was the primary independent variable. Dependent measures included rate and timing of use of fourteen types of health care services and total episode cost. A mixed effects model applied to pooled and non-surgical samples was used to test the association between initial contact HCP, total episode cost and rate of prescription opioid and NSAID use for NP. ResultsThe study included 323,348 continuously insured individuals aged 18 years and older with 390,992 complete episodes of NP involving 321,538 HCPs and incurring $472,399,064 in expenditures. 53.0% of episodes had initial contact with a primary care or specialist HCP, with these episodes associated with higher rates of imaging, pharmaceutical, and interventional services. 40.4% of episodes had initial contact with a non-prescribing HCP, with these episodes associated with higher rates of non-pharmaceutical services. Chiropractors (DC) were the most common type of HCP initially contacted (38.5% of episodes) and were associated with the lowest adjusted total episode cost. Results were consistent for individuals experiencing single or multiple episodes during the study period. ConclusionsThis study of a large US cohort of commercially insured individuals with NP helps fill a knowledge gap regarding NP care pathway attributes. Like LBP, the treatment of NP is highly variable with the initial HCP selected by an individual with NP associated with differences in services received and episode cost. Initial contact with a non-prescribing HCP was associated with lower rates of imaging, pharmacology, and interventional services.