Factors Associated With Care Seeking From Physicians, Physical Therapists, or Chiropractors...

STUDY DESIGN: Secondary analysis of longitudinal population-based survey data. OBJECTIVES: To investigate factors associated with care seeking for physician referred physical therapy (MD/PT) as compared to physician only (MD) or chiropractic only (DC) care for spinal pain. BACKGROUND: Although a large proportion of ambulatory physical therapy visits are related to spinal pain, physical therapists are not the most commonly seen provider. The majority of visits are to physicians followed by chiropractors. We attempted to understand more about this disparity by examining social and demographic factors that differentiate between persons who see these providers. METHODS: Episodes of care were constructed from participants in 2 panels from the Medical Expenditure Panel Survey who had spinal pain. The provider of care was identified for each episode and logistic regression was used to determine factors associated with MD/PT use compared to MD use; and MD/PT use compared to DC use. RESULTS: MDs see the majority [61%] of patients with spinal pain followed by DC [28%] and MD/PT [11%]. Female sex, higher levels of education, and higher income were significantly associated with MD/PT over MD care. Increased age, female sex, lower self health rating, and presence of at least 1 disability day were all significantly associated with MD/PT care over DC care. CONCLUSION: Socio-demographic and clinical factors are associated with who gets care via an MD/PT route as compared to MD or DC care seeking. We found evidence of an access disparity for physical therapy and identified population characteristics that both increase and reduce the likelihood of physical therapy service use.

J Orthop Sports Phys Ther. 2011 Jun 7. Chevan J, Riddle DL.