Healthcare utilization and related costs among older people seeking primary care due to back pain: findings from the BACE-N cohort study.

OBJECTIVES: To describe healthcare utilization and estimate associated costs during 1 year of follow-up among older people seeking primary care due to a new episode back pain and to describe healthcare utilization across patients with different risk profiles stratified using the StarT Back Screening Tool (SBST). DESIGN: Prospective cohort study. PARTICIPANTS AND SETTING: A total of 452 people aged ≥55 years seeking Norwegian primary care with a new episode of back pain were included. OUTCOME MEASURES: The primary outcome of this study was total cost of healthcare utilization aggregated for 1 year of follow-up. Secondary outcomes included components of healthcare utilization aggregated for 1 year of follow-up. Healthcare utilization was self-reported and included: primary care consultations, medications, examinations, hospitalisation, rehabilitation stay, and operations. Costs were estimated based on unit costs collected from national pricelists. Healthcare utilization across patients with different SBST risk profiles was compared using Kruskal-Wallis test, post hoc Mann-Whitney U tests and Bonferroni adjustment. RESULTS: In total, 438 patients were included in the analysis. Mean (BCa 95% CI) total cost per patient over 1 year was €825 (682-976). Median (BCa 95% CI) total cost was €364 (307-440). The largest cost category was primary care consultations, accounting for 56% of total costs. Imaging rate was 34%. The most commonly used medication was paracetamol (27%-35% of patients). Medium- and high-risk patients had a significantly higher degree of healthcare utilization compared with low-risk patients (p<0.030). CONCLUSION: This study estimated a 1 year mean and median cost of healthcare utilization of €825 and €364, respectively. Patients within the top 25th percentile accounted for 77% of all costs. Patients classified as medium risk and high risk had a significantly higher degree of healthcare utilization compared with patients classified as low risk. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT04261309, results.

Contextualizing the lived experiences of patients with low back pain from different countries according to the ICF framework.

OBJECTIVE: To explore perspectives, including social and psychological aspects, of patients seeking manual care for low back pain, in order to understand constructs of functioning that are important across different cultural contexts. The International Classification of Functioning, Disability and Health (ICF) emphasizes the importance of these aspects to describe health-related functioning. DESIGN: Focus group interviews. PATIENTS: Patients from Botswana, Canada and Norway seeking manual care for their low back pain. METHODS: Interviews were conducted in the 3 countries, transcribed verbatim, translated into English, and linked to the ICF according to established rules. RESULTS: Seven focus groups yielded 1,863 meaningful concepts that were linked to ICF categories. The largest proportion of responses linked to the Activities and Participation domain. The most frequently mentioned chapters related to pain and its mental aspects, suggesting that the psychological impact of living with low back pain is important to patients. CONCLUSION: Despite cultural differences, patients seeking manual care for low back pain in Botswana, Canada and Norway reported similar experiences of disability across ICF domains. The relatively high ranking of psychosocial factors highlights their importance for patients, in addition to factors of biological origin, and indicates that the contextual nature of the lived experience of low back pain may not be covered in standard examinations used in manual medicine.