Background & Aims
Low back pain (LBP) is a highly prevalent and challenging condition for health systems worldwide. Physiotherapy interventions are recommended by clinical guidelines for the management of low back pain within the scope of primary health care. Referral of patients with LBP to Physiotherapists working within primary health care reduces the use of low-value resources aiming to sustainability and evidence-based actions, though it needs to be consolidated in Brazil. Therefore, to understand this scenario, the aim of this study was to investigate access at a national level, by characterizing the population, quantity, frequency, and time of referral, of people with LBP to Physiotherapists within the primary health care in Brazil. Secondarily, the objective was to investigate the use of health resources by these individuals.
Methods
Observational study with anonymized data from the Primary Care Health Information System, identified by ICD-10 and CIAP-2 codes, totaling 2,177,086 visits between January 2019 and December 2020. A total of 1,459,710 people with LBP with more than 18 years of age were included. We defined access as quantity, frequency, and referral time to Physiotherapy care. Participants were grouped according to professionals providing care, as follow: G1) Physician only (N: 1,405,145); G2) Physician and referral to Physiotherapists (N: 14,079); G3) Physiotherapist as the professional of first contact (N: 40,486). The records were grouped chronologically by access, including the use of procedures (imaging tests and specialist’s consultations). Data were analyzed descriptively.
Results
The mean age was 49 years (SD: 17), and 56 percent was women. Less than 1% of the individuals (N: 14,079) received a referral to a physiotherapist during the period investigated. Of these, 8,085 (57.4%) had a referral time of less than 90 days (mean 17.4 days, SD: 65.6), and the remaining individuals (N 5,994) presented a late referral time according to Brazilian regulations (mean of 261.1 days, SD: 146.9). Physician and Physiotherapists consultations totaled 290 and 42/1,000 people, respectively. Imaging was prescribed 152,150 times for 8.9 percent of the individuals, and referrals to specialists were performed 187,939 times for 12.9 percent. G1 presented a rate of 105.65 exams/1,000 people, and 128.03 referrals to specialists/1,000 inhabitants. G2 presented 196.32 exams and 384.76 referrals to specialists/1,000 people, and in G3, the ratio was 22.87 exams and 64.89 referrals to specialists/1,000 people.
Conclusions
We showed that people with LBP were mainly middle-aged women. The access to Physiotherapists was reduced and presented prolonged referral times, indicating problems with the care pathway. These findings raise concerns, especially because of overmedicalization and frequent use of imaging. Further research is warranted to investigate healthcare costs and if guidelines recommendations are being implemented within this setting.
Declaration of funding: This study was supported by FAPDF; CNPq; UnB/DPI; and CAPES.
References
Buchbinder R, Underwood M, Hartvigsen J, Maher CG. The Lancet Series call to action to reduce low value care for low back pain: an update. Pain. 2020 Sep;161 Suppl 1(1):S57-S64
Custódio LA, Marques YA, de Toledo AM, de Sá Ferreira A, van Tulder M, da Silva EN, Carregaro RL. The care pathway of individuals with spinal disorders in a Health Care Network in the Federal District, Brazil: a retrospective study. Braz J Phys Ther. 2023 Sep-Oct;27(5):100553
Saes MO, Saes-Silva E, Duro SMS, Neves RG. Inequalities in the management of back pain care in Brazil – National Health Survey, 2019. Cien Saude Colet. 2023 Feb;28(2):437-446
Kamper SJ, Logan G, Copsey B, Thompson J, Machado GC, Abdel-Shaheed C, Williams CM, Maher CG, Hall AM. What is usual care for low back pain? A systematic review of health care provided to patients with low back pain in family practice and emergency departments. Pain. 2020 Apr;161(4):694-702
Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021 Sep 28;9(9):CD009790
Liu X, Hanney WJ, Masaracchio M, Kolber MJ, Zhao M, Spaulding AC, Gabriel MH. Immediate Physical Therapy Initiation in Patients With Acute Low Back Pain Is Associated With a Reduction in Downstream Health Care Utilization and Costs. Phys Ther. 2018 May 1;98(5):336-347
Presenting Author
Rodrigo Luiz Carregaro
Poster Authors
Rodrigo Carregaro
PhD
University of Brasília (UnB), Brasília, Brazil; Department of Health Sciences, Faculty of Science
Lead Author
Taís Lacerda
University of Brasília (UnB), Brasília, Brazil.
Lead Author
Pedro Lacerda Montes
BS
University of Brasília (UnB), Brasília, Brazil.
Lead Author
Henry Maia Peixoto
University of Brasília (UnB), Brasília, Brazil.
Lead Author
Everton Nunes da Silva
University of Brasília (UnB), Brasília, Brazil.
Lead Author
Topics
- Access to Care