{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T15:52:19Z","timestamp":1784044339802,"version":"3.55.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2023,6,28]],"date-time":"2023-06-28T00:00:00Z","timestamp":1687910400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Costs associated with low back pain (LBP) continue to rise. Despite numerous clinical practice guidelines, the evaluation and treatments for LBP are variable and largely depend on the individual provider. As yet, little attention has been given to the first choice of provider. Early research indicates that the choice of first provider and the timing of interventions for LBP appear to influence utilization. We sought to examine the association between the first provider seen and health care utilization.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Using 2015\u20132018 data from a large insurer, this retrospective analysis focused on patients (29,806) seeking care for a new episode of LBP. The study identified the first provider chosen and examined the following year of medical utilization. Cox proportional hazards models were calculated using inverse probability weighting on propensity scores to evaluate the time to event and the relationship to the first choice of provider.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The primary outcome was the timing and use of health care resources. Total health care use was lowest in those who first sought care with chiropractic care or physical therapy. Highest health care use was seen in those patients who chose the emergency department.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Overall, there appears to be an association between the first choice of provider and future health care use. Chiropractic care and physical therapy provide nonpharmacologic and nonsurgical, guideline-based interventions. The use of physical therapists and chiropractors as entry points into the health system appears related to a decrease in immediate and long-term use of health resources. This study expands the existing body of literature and provides a compelling case for the influence of the first provider on an acute episode of LBP.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Impact<\/jats:title>\n                  <jats:p>The first provider seen for an acute episode of LBP influences immediate treatment decisions, the trajectory of a specific patient episode, and future health care choices in the management of LBP.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ptj\/pzad067","type":"journal-article","created":{"date-parts":[[2023,6,28]],"date-time":"2023-06-28T17:47:04Z","timestamp":1687974424000},"source":"Crossref","is-referenced-by-count":24,"title":["First Provider Seen for an Acute Episode of Low Back Pain Influences Subsequent Health Care Utilization"],"prefix":"10.1093","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3714-5671","authenticated-orcid":false,"given":"Christopher G","family":"Bise","sequence":"first","affiliation":[{"name":"University of Pittsburgh School of Health and Rehabilitation Science, Department of Physical Therapy, , Pittsburgh, Pennsylvania , USA"},{"name":"UPMC Health Plan , Department of Health Economics, Pittsburgh, Pennsylvania , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Schneider","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Health and Rehabilitation Science, Department of Physical Therapy, , Pittsburgh, Pennsylvania , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Freburger","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Health and Rehabilitation Science, Department of Physical Therapy, , Pittsburgh, Pennsylvania , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G Kelley","family":"Fitzgerald","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Health and Rehabilitation Science, Department of Physical Therapy, , Pittsburgh, Pennsylvania , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Galen","family":"Switzer","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Department of Medicine, , Pittsburgh, Pennsylvania , USA"},{"name":"Veterans Affairs Pittsburgh Healthcare System Center for Health Equity Research and Promotion (CHERP), , Pittsburgh, Pennsylvania , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garry","family":"Smyda","sequence":"additional","affiliation":[{"name":"UPMC Health Plan , Department of Health Economics, Pittsburgh, Pennsylvania , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Peele","sequence":"additional","affiliation":[{"name":"UPMC Health Plan , Department of Health Economics, Pittsburgh, Pennsylvania , USA"},{"name":"University of Pittsburgh Graduate School of Public Health, , Pittsburgh, Pennsylvania , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Delitto","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Health and Rehabilitation Science, Department of Physical Therapy, , Pittsburgh, Pennsylvania , USA"},{"name":"University of Pittsburgh School of Health and Rehabilitation Science, Office of the Dean, , Pittsburgh, Pennsylvania , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,6,28]]},"reference":[{"key":"2023092720583781400_ref1","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1001\/jama.299.6.656","article-title":"Expenditures and health status among adults with back and neck problems","volume":"299","author":"Martin","year":"2008","journal-title":"JAMA"},{"key":"2023092720583781400_ref2","doi-asserted-by":"crossref","first-page":"2724","DOI":"10.1097\/01.brs.0000244618.06877.cd","article-title":"Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002","volume":"31","author":"Deyo","year":"2006","journal-title":"Spine"},{"key":"2023092720583781400_ref3","volume-title":"BMUS: The Burden of Musculoskeletal Diseases in the United States","author":"Yellin EH, Watkins-Castillo SI. 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