Healthcare utilization in patients with spinal disorders referred for specialist evaluation in Norway: an observational register-based cohort study

Abstract Background Healthcare utilization is high for people with spinal disorders. We aimed to investigate differences in recommended versus actual healthcare use among individuals with back & neck pain compared to individuals with isolated back or neck pain. Additionally, we aimed to examine variations in healthcare utilization patterns before and after a specialist evaluation based on the location of pain. Methods We linked the Norwegian Neck and Back Registry with health registries, including patients with spinal disorders registered between January 1 st , 2016, and December 31 st , 2020 (9316 patients (63% with back pain, 27% with neck pain, 11% with back & neck pain) aged 18–70 years, mean (SD) age 44 (13) years, 57% females). We studied the percentages being recommended and actually visiting primary care physicians, physical therapists, and chiropractors in primary care and outpatient and inpatient consultations in specialist care after an outpatient specialist evaluation (index consultation), focusing on differences between groups based on the location of spinal pain. Results In total, ~20%-80% followed healthcare recommendations. Patients with back & neck pain followed recommendations less often than patients with back pain (39% (95% CI 35.7, 41.8) vs 45% (95% CI 43.9, 46.4)) or neck pain (44% (95% CI 42.4, 46.3)). Participants with back & neck pain had a proportion of consultations with physical therapists at 29.7% (95% CI 25.1, 34.2) and 25.4% (95% CI 20.7, 30.1) in years 1 and 2 after index consultation, ~6 percentage points higher than the back pain group (1st: −5.8% (95% CI −10.6, −1.0), 2nd: −6.0% (95% CI −11.0, −0.9). They also had a 2 percentage point higher proportion of consultations with primary care physicians compared to the neck pain group (1st: −2.4% (95% CI −4.1, −0.8), 2nd: −1.5% (95% CI −2.7, −0.3)). Conclusions Patients with mixed back & neck pain have lower adherence to recommended care and higher utilization of physical therapy and primary care physicians two years after specialist evaluation compared to patients with isolated spinal pain. These results suggest that the current approach to managing spinal pain should be reconsidered to better address the complex needs of this patient group.