Article type
Year
Abstract
Background: Since the early 1990s, a dozen national evidence-based guidelines have been published on the management of low-back pain (LBP), each recommending that plain film radiography only be used to assess high-risk patients. Evidence for the use of full spine radiography, except for scoliosis evaluation, is also lacking. Unnecessary radiography is associated with health risk and high cost. Previous studies suggest that chiropractors have high utilization rates of radiography for assessing LBP and that a high proportion of chiropractic patients receive full spine radiography. In Ontario, chiropractors are important players in the management of LBP, seeing 1/3 of all patients who seek care for LBP.
Objectives: The main objective of the study was to describe utilization and cost trends for lumbar and full spine plain film radiography among chiropractors in Ontario over a seven-year period.
Methods: Descriptive analysis of Ontario Health Insurance Plan (OHIP) and Workplace Safety and Insurance Board (WSIB) claims data, including the number, type and cost of radiography services billed from 1994-5 to 2000-01 fiscal years.
Results: The number of lumbar spine radiographic services billed decreased by an average of 2.3% per year for OHIP and 7% per year for WSIB during this seven-year period, despite an 18% increase in claimants and a 40% increase in chiropractors. OHIP full spine radiographic services dropped by 11% in the first year, but showed little change in the subsequent six years. Over the seven-year period, combined OHIP and WSIB costs for lumbar spine radiography decreased by 7% to about $0.6 M, while costs for full spine radiography increased by 6% to about $1.1M.
Conclusions: While the use of lumbar spine radiographs is decreasing, the use of full spine radiography remains relatively unchanged. This is reflected in decreased overall costs for lumbar spine radiography, whereas the costs for full spine radiography have increased over the seven-year period.
References: 1. Koes B, van Tulder M, Ostelo R, Burton K, Waddell G. Clinical guidelines for the management of low back pain in primary care. Spine. 2001;26 (22):2504-2514. 2. Mootz RD, Hoffman LE, Hansen DT. Optimizing clinical use of radiography and minimizing radiation exposure in chiropractic practice. Topics in Clinical Chiropractic. 1997;4(1):34-44 3. Hurwitz EL, Coulter ID, Adams AH, Genovese BJ, Shekelle PG. Use of chiropractic services from 1985 through 1991 in the United States and Canada. Am J Public Health. May 1998;88(5):771-76
Objectives: The main objective of the study was to describe utilization and cost trends for lumbar and full spine plain film radiography among chiropractors in Ontario over a seven-year period.
Methods: Descriptive analysis of Ontario Health Insurance Plan (OHIP) and Workplace Safety and Insurance Board (WSIB) claims data, including the number, type and cost of radiography services billed from 1994-5 to 2000-01 fiscal years.
Results: The number of lumbar spine radiographic services billed decreased by an average of 2.3% per year for OHIP and 7% per year for WSIB during this seven-year period, despite an 18% increase in claimants and a 40% increase in chiropractors. OHIP full spine radiographic services dropped by 11% in the first year, but showed little change in the subsequent six years. Over the seven-year period, combined OHIP and WSIB costs for lumbar spine radiography decreased by 7% to about $0.6 M, while costs for full spine radiography increased by 6% to about $1.1M.
Conclusions: While the use of lumbar spine radiographs is decreasing, the use of full spine radiography remains relatively unchanged. This is reflected in decreased overall costs for lumbar spine radiography, whereas the costs for full spine radiography have increased over the seven-year period.
References: 1. Koes B, van Tulder M, Ostelo R, Burton K, Waddell G. Clinical guidelines for the management of low back pain in primary care. Spine. 2001;26 (22):2504-2514. 2. Mootz RD, Hoffman LE, Hansen DT. Optimizing clinical use of radiography and minimizing radiation exposure in chiropractic practice. Topics in Clinical Chiropractic. 1997;4(1):34-44 3. Hurwitz EL, Coulter ID, Adams AH, Genovese BJ, Shekelle PG. Use of chiropractic services from 1985 through 1991 in the United States and Canada. Am J Public Health. May 1998;88(5):771-76