Evidence is lacking on the effect of direct access on costs and outcomes
Neck and back pain are among the most common painful conditions, and they are both associated with a high number of years lived with disability. The costs for treating both of these conditions is also extremely high and has been increasing steadily, while the same cannot be said for non-spine-related conditions. Despite the fact that these costs are increasing, there have been no significant improvements for the many individuals dealing with neck or back pain. Part of this lack of success may be due to the type and timing of care that is provided to patients, with some not receiving appropriate treatment soon enough. One way to help ensure that patients are getting the care they need in an expedient manner is with direct access to physical therapy. Unlike the traditional process of first seeing a doctor to get a referral, direct access allows individuals in all 50 states to seek out and receive care from a physical therapist directly, which may save them time and money; however, studies on the effect of direct access is limited. Therefore, researchers decided to conduct a study to evaluate the impact of direct access on costs and outcomes for patients with neck or back pain.
Patients given the option of direct access or traditional medical care
The study was run by a partnership between a private physical therapy organization and a South Carolina healthcare system, which created a neck and back care delivery program to offer alternative options to patients. A group of 447 individuals with neck or back pain were presented with the option of either seeing a physical therapist directly or going through the traditional model of seeing a doctor first for their condition. Once it was deemed appropriate, these patients were then treated with active physical therapy procedures, including education, various exercises and hands-on therapy, all of which were based on recent guidelines. All patients attended six treatment sessions at first, and if they improved, were approved for six more sessions for a maximum of 18. After completing treatment, patients were assessed for improvement and their total costs were calculated to determine how the approaches compared to one another.
Patients improve regardless of approach, but direct access is less expensive
Results showed that of the 447 patients included in the study, most (61.7%) chose the traditional medical route over direct access. Regardless of how patients accessed physical therapy, 67% completed the treatment program without additional referrals, and they experienced significant improvements in disability and pain. There were no notable differences between groups for these measurements, but patients who accessed physical therapy directly had fewer treatment sessions, fewer days in care, and lower physical therapy costs, radiology costs and total costs than those who accessed care traditionally. On average, treatment for each patient who received direct access cost $1,543 less than treatment for traditional patients.
Neck and back pain patients should see a physical therapist directly
Patients with neck or back pain have a choice when it comes to how to access physical therapy. Although some are more comfortable with the traditional approach of seeing their doctor first for a referral, this study clear shows that accessing physical therapy directly will result in fewer sessions and cost them less, all while leading to similar overall benefits. These patients should therefore be encouraged to make the smart decision of seeing a physical therapist first for the greatest benefits and lowest costs possible.
-Summarized by Greg Gargiulo
-As reported in the October '17 issue of JOSPT