title: Physician referrals to physical therapists for the treatment of spine disorders.
abstract: BACKGROUND
  Individuals with spine disorders often seek care from physical therapists (PTs). Because most insurance plans will reimburse only for PT services prescribed by a physician, physicians play an important role in access to and the appropriate use of PTs. Problems with access to or inappropriate use of PTs may affect the quality and cost of care received by patients with spine problems.
  
  
  OBJECTIVE
  To identify factors associated with physician referrals to PTs for the treatment of spine disorders.
  
  
  METHODS
  Cross-sectional analysis of data collected at 20 US spine centers (1998-2002).
  
  
  METHODS
  A total of 30,255 patients with spine disorders who were seen for an initial evaluation.
  
  
  METHODS
  Whether the physician made a PT referral.
  
  
  METHODS
  A logistic regression analysis was conducted to identify factors associated with physician referrals to PTs. Explanatory variables included health-related characteristics, compensation-related characteristics, past provider use, demographics, and patient expectations. Center effects were also accounted for in the analysis.
  
  
  RESULTS
  Of the total sample, 38% was referred to a PT. Although several health-related variables explained variation in PT referral, other variables were also associated with PT referral. Patients who were older or male were less likely to be referred. Patients who were more educated were more likely to be referred. There was also significant center-to-center variation in PT referral.
  
  
  CONCLUSIONS
  Variation in PT referral, as a result of factors other than health and need, may be indicative of problems with access to or inappropriate use of PT.
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Airport Road, Chapel Hill, NC 27599-7590, USA. janet_freburger@unc.edu
authors.forename: Janet K
authors.initials: JK
authors.lastname: Freburger
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Carey
authors.forename: G Mark
authors.initials: GM
authors.lastname: Holmes
mesh_terms: D000328:Adult; D000368:Aged; D001416:Back Pain / Q000628:therapy; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D026761:Physical Therapy Specialty; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013122:Spinal Diseases / Q000628:therapy*; D014481:United States