title: Impact of a medical back care program on utilization of services and primary care physician satisfaction in a large, multispecialty group practice health maintenance organization.
abstract: METHODS
  Samples of patients with new back pain were compared at two medical centers, one with and one without a medical back care program.
  
  
  OBJECTIVE
  To measure the impact of a medical back care program on use of services and physician satisfaction in a health maintenance organization.
  
  
  BACKGROUND
  A medical back care program is staffed with specially trained primary care physicians and provides consultative and educational services to the medical center.
  
  
  METHODS
  Program impact on services was measured by comparing the number of physician office visits, consultations, physical therapy referrals, and imaging procedures provided to a sample of patients with back pain at the two medical centers. Physician satisfaction with care provided to patients with back pain was measured by a survey sent to primary care physicians at both medical centers.
  
  
  RESULTS
  At the medical center with a back care program, 42% fewer consultations, 59% fewer physical therapy referrals, and 33% fewer imaging procedures were ordered. Less expensive consultations with back care physicians in medicine or family practice were ordered more frequently than consultations with either neurologists or orthopedists. This change in pattern of care took place without significantly altering clinical course. The effect of the program on the rate of surgery was not measured.
  
  
  CONCLUSIONS
  The results of this study support the benefits of an organized medical back care program.
authors.affiliation: Department of Operations Support Services, Kaiser Permanente Medical Care Program, Oakland, California, USA.
authors.forename: B
authors.initials: B
authors.lastname: Branthaver
authors.forename: G F
authors.initials: GF
authors.lastname: Stein
authors.forename: A
authors.initials: A
authors.lastname: Mehran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001416:Back Pain / Q000191:economics / Q000628:therapy*; D003952:Diagnostic Imaging; D011307:Drug Prescriptions; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D026741:Physical Therapy Modalities; D010821:Physicians, Family; D015397:Program Evaluation; D012017:Referral and Consultation