Abstract:
OBJECTIVE:To explore the relationship between type of initial care as well as the likelihood of recurrence and consequent care seeking behavior. RESEARCH DESIGN:Prospective observational cohort recruited from 208 randomly selected North Carolina practices. Cohort study examined the recurrence of low back pain among patients free of back pain 3 months after their index visit to a practitioner for that problem. The following four practitioner strata were examined: primary care providers, chiropractors, orthopedic surgeons, and practitioners in a group model HMO. Patients were interviewed by telephone at 6 and 22 months after the initial visit. MAIN OUTCOME MEASURES:Rates of disabling and non-disabling low back pain; functional status using the Roland back disability scale; and care seeking. RESULTS:Rates of recurrence were substantial; functionally disabling recurrence rates varied between 8% and 14% between 3 to 6 months, and 20% to 35% between 6 to 22 months. Differences in rates among practitioner strata were statistically significant only between 6 to 22 months with higher recurrence rates for HMO patients. Functional status, number of bed days, and time off work were very similar among the practitioner strata. Care seeking, however, was greater among those patients who had initially seen a chiropractor for their back pain. Patients with recurrence saw the same practitioner type they had seen for the index episode 88% of the time. Satisfaction was slightly greater for patients who saw chiropractors when compared with patients seeing allopathic physicians. CONCLUSIONS:The recurrence of low back pain is common. Severe disability is rare. Patients who had sought care from chiropractors are more likely to return for recurrences than patients who had initially sought care from MDs.
journal_name
Med Carejournal_title
Medical careauthors
Carey TS,Garrett JM,Jackman A,Hadler Ndoi
10.1097/00005650-199902000-00006keywords:
subject
Has Abstractpub_date
1999-02-01 00:00:00pages
157-64issue
2eissn
0025-7079issn
1537-1948journal_volume
37pub_type
杂志文章相关文献
MEDICAL CARE文献大全abstract::Although self-care is emerging as a growing movement wherein lay persons are assuming more responsibility for prvention, detection and treatment of health problems, we have almost no basic descriptive studies of attitudes toward self-care of professionals and consumers. The present study explored the reliability and v...
journal_title:Medical care
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00005650-198008000-00009
更新日期:1980-08-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to identify hospital organizational characteristics consistently associated with adherence to multiple clinical practice guidelines (CPGs). We examined the relationship between organizational and patient population characteristics and adherence to three screening CPGs implemented...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200212000-00005
更新日期:2002-12-01 00:00:00
abstract:BACKGROUND:Little is known about the health care experiences of American Indians and Alaska Natives (AIANs) due to limited data. OBJECTIVE:The objective of this study was to investigate the health care experiences of AIAN Medicare beneficiaries relative to non-Hispanic Whites using national survey data pooled over 5 y...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001392
更新日期:2020-11-01 00:00:00
abstract::The application of health status measures in policy research relies considerably on patterns of mortality, life expectancy, and health status indicators, such as hospital readmission and institutionalization rates. In recent years the state of the art in health status measurement has advanced substantially with the de...
journal_title:Medical care
pub_type: 杂志文章,评审
doi:10.1097/00005650-198903001-00002
更新日期:1989-03-01 00:00:00
abstract:BACKGROUND:Emergency Department (ED) boarding threatens patient safety. It is unclear whether boarding differentially affects patients admitted to intensive care units (ICUs) versus non-ICU settings. RESEARCH DESIGN AND SUBJECTS:We performed a 2-hospital, 18-month, cross-sectional, observational, descriptive study of ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000902
更新日期:2018-05-01 00:00:00
abstract::This paper describes a comparative analysis of questionnaire-based measures of functional status and clinical ratings of disability made by general practitioners and health visitors. Both approaches to functional assessment were used in rating 92 elderly primary care patients in terms of their performance of 13 mobili...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197908000-00003
更新日期:1979-08-01 00:00:00
abstract:BACKGROUND:Performance measures often fail to account for legitimate reasons why patients do not achieve recommended treatment targets. METHODS:We tested a novel performance measurement system for blood pressure (BP) control that was designed to mimic clinical reasoning. This clinically guided approach focuses on (1) ...
journal_title:Medical care
pub_type: 杂志文章,多中心研究
doi:10.1097/MLR.0b013e318245a147
更新日期:2012-05-01 00:00:00
abstract:OBJECTIVES:This study sought to compare the performance of the old and new versions of the Simplified Acute Physiology Score, SAPS and SAPS II, in classifying patients according to the risk of hospital mortality. METHODS:To compare the performance of the two systems, measures of association between the scores and obse...
journal_title:Medical care
pub_type: 杂志文章,多中心研究
doi:10.1097/00005650-199809000-00009
更新日期:1998-09-01 00:00:00
abstract:BACKGROUND:Econometric modeling of healthcare costs and expenditures has become an important component of decision-making across a wide array of real-world settings. OBJECTIVES:The objective of this article is to provide a brief summary of important conceptual and analytical issues involved in econometric healthcare c...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e31819c9593
更新日期:2009-07-01 00:00:00
abstract:OBJECTIVE:To investigate patterns of complementary and alternative medicine (CAM) use disclosure across medical and sociobehavioral factors and to provide a model that takes into account factors in explaining those patterns. SUBJECTS:A total of 21,849 CAM use episodes from 7347 respondents in the 2007 US National Heal...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000165
更新日期:2014-08-01 00:00:00
abstract::Patients often receive medical care from many different providers. Consequently, the various episodes of care may not be integrated into a meaningful whole, and the quality of care may suffer. Before this possibility can be evaluated, it is necessary to develop a measure of the integrating process. The authors studied...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198405000-00004
更新日期:1984-05-01 00:00:00
abstract:BACKGROUND:Cost-utility analyses using formulas to convert depression-free days (DFDs) to utility-weighted scores are increasingly common. These formulas are based on linear extrapolation of data documenting the correlation between depression symptom severity and generic health-related quality of life. OBJECTIVE:We so...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000256971.81184.aa
更新日期:2007-04-01 00:00:00
abstract:OBJECTIVE:To compare trends in office-based treatment of mental disorders between Hispanics and non-Hispanics. DESIGN, SETTING, AND PARTICIPANTS:Analysis of a nationally representative sample of visits to office-based physicians conducted between 1993 and 2002 (N = 251,905). Visits were grouped into 3 discrete time pe...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3180ca95d3
更新日期:2007-11-01 00:00:00
abstract::There has been controversy about whether confounding by indication for treatment--that is, owing to physicians' conscious efforts to base treatment decisions on patients' pretreatment prognoses--makes nonrandomized, observational comparisons of treatments invalid. Some now believe evidence from studies of practice var...
journal_title:Medical care
pub_type: 杂志文章
doi:
更新日期:1995-04-01 00:00:00
abstract:BACKGROUND:Similarities and differences in physician work intensity among specialties are poorly understood but have implications for quality of care, patient safety, practice organization and management, and payment. OBJECTIVE:To determine the magnitude and important dimensions of physician work intensity for 4 speci...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e31822dcdc7
更新日期:2011-11-01 00:00:00
abstract:OBJECTIVE:To identify consistent provision of clinical preventive services, we sought to benchmark all acute care Veterans Affairs Medical Centers (VAMCs) against each other nationally on the basis of multiple evidence-based, performance measures to identify facilities performing consistently higher and lower than expe...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200206000-00011
更新日期:2002-06-01 00:00:00
abstract:OBJECTIVE:Compare healthcare utilization and total payments for community-acquired pneumonia (CAP) episodes-of-care among 5 health plan designs spanning the continuum of managed care. RESEARCH DESIGN:Medical and prescription claims analysis of CAP episodes among enrollees of employer-sponsored health plans. Episode ch...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3181a8116d
更新日期:2009-10-01 00:00:00
abstract:BACKGROUND:Most studies have found that black men are less likely to receive aggressive therapy for nonmetastatic prostate cancer, even after controlling for covariates. However, previous studies have not accounted for the clustering of outcomes by facility. OBJECTIVE:We sought to compare the proportions of black and ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000257144.29928.f0
更新日期:2007-05-01 00:00:00
abstract:BACKGROUND:Estimates of the costs of medical care vary across patient populations, data sources, and methods. The objective of this study was to compare 3 approaches for estimating the incidence costs of colorectal cancer (CRC) care using similar patient populations, but different data sources and methods. METHODS:We ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3181a4f482
更新日期:2009-07-01 00:00:00
abstract::This paper examines relationships between true and treated prevalence of mental illness in a community by examining the use of mental health and other professional services for emotional problems and the relationship of this use to the individual's diagnostic status. The results are based upon a third round of 515 int...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198001000-00009
更新日期:1980-01-01 00:00:00
abstract::This paper investigates the difficulties that people encounter in their attempt to obtain needed health services, other than their third-party coverage or lack of it. These problems can be temporal, geographic, attitudinal, or financial (even with insurance). A state-wide sample survey conducted in 1989 revealed that ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199405000-00001
更新日期:1994-05-01 00:00:00
abstract:OBJECTIVES:The authors identify demographic and clinical characteristics associated with noncompliance in patients beginning medical therapy for the treatment of glaucoma in a managed care setting. METHODS:The authors describe a retrospective cohort study in a group-model health maintenance organization in Massachuset...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199803000-00012
更新日期:1998-03-01 00:00:00
abstract:BACKGROUND:In the setting of declining U.S. literacy, new policies include use of clear communication and low-literacy accessibility practices with all patients. Reliable methods for adapting health information to meet such criteria remain a pressing need. OBJECTIVES:To report method validation (study 1) and method re...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318249d6c8
更新日期:2012-04-01 00:00:00
abstract:OBJECTIVES:Most tests of the practice-makes-perfect hypothesis have used cross-sectional data, which reveal that patients receiving surgery in high-volume hospitals tend to experience better postsurgery outcomes. This study uses longitudinal data to explicitly examine whether any given hospital's patient outcomes chang...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199806000-00012
更新日期:1998-06-01 00:00:00
abstract::To test the hypothesis that the ability of physicians to speak the same language as asthmatic patients promotes patient compliance and the use of scheduled office appointments in preference to emergency services, the charts of 96 Spanish-speaking patients with asthma were reviewed. Of these patients, 65 were cared for...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198812000-00003
更新日期:1988-12-01 00:00:00
abstract::Issues that arise in the development of methods for measuring adequacy of physician performance (MAPP) are discussed. The comparative content validity, scorability, cost, and acceptability of four MAPP strategies are assessed using a sample of clinic-based physicians treating 30 patients with chronic obstructive pulmo...
journal_title:Medical care
pub_type: 临床试验,杂志文章
doi:
更新日期:1984-07-01 00:00:00
abstract:BACKGROUND:Hospitals will increasingly bear the costs for healthcare-acquired conditions such as infection. Our goals were to estimate the costs attributable to healthcare-acquired infection (HAI) and conduct a sensitivity analysis comparing analytic methods. METHODS:A random sample of high-risk adults hospitalized in...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3181ef60a2
更新日期:2010-11-01 00:00:00
abstract:BACKGROUND:High opioid dosage has been associated with overdose, and clinical guidelines have cautioned against escalating dosages above 100 morphine-equivalent mg (MEM) based on the potential harm and the absence of evidence of benefit from high dosages. However, this 100 MEM threshold was chosen somewhat arbitrarily....
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000505
更新日期:2016-05-01 00:00:00
abstract::A prospective study was undertaken to characterize 2,000 patients attending a chiropractic teaching clinic and the effectiveness of the care they received. Fifty-two percent of the patients were between 21 and 34 years old; 41% categorized their occupation as professional and 14% as skilled blue collar; 79% presented ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198706000-00006
更新日期:1987-06-01 00:00:00
abstract:BACKGROUND:In 2007 Cancer Care Ontario (CCO) implemented standardized systematic symptom evaluation in all cancer patients in Ontario using the Edmonton Symptom Assessment System. The initial implementation did not include symptom management guidance and this limited the success of the implementation. Within a short ti...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000001084
更新日期:2019-05-01 00:00:00