• Christopher T Joyce, Eric J Roseen, Clair N Smith, Charity G Patterson, Christine M McDonough, Emily Hurstak, Natalia E Morone, Jason Beneciuk, Joel M Stevans, Anthony Delitto, and Robert B Saper.
• From the School of Physical Therapy, Massachusetts College of Pharmacy and Health Sciences, Worcester, MA (CTJ); Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA (EJR, EH, NEM); School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA (CNS, CGP, CMM, JMS, AD); Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States (JB); Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL, United States (JB); Department of Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, OH, USA (RBS). Christopher.Joyce@mcphs.edu.
• J Am Board Fam Med. 2024 Jan 5; 36 (6): 986995986-995.

PurposePrimary care physicians (PCPs) often face a complex intersection of patient expectations, evidence, and policy that influences their care recommendations for acute low back pain (aLBP). The purpose of this study was to elucidate patterns of PCP orders for patients with aLBP, identify the most common patterns, and describe patient clinical and demographic characteristics associated with patterns of aLBP care.MethodsThis prospective cohort study included 9574 aLBP patients presenting to 1 of 77 primary care practices in 4 geographic locations in the United States. We performed a cluster analysis of PCP orders extracted from electronic health records within the first 21 days of an initial visit for aLBP.Results1401 (15%) patients did not receive a PCP order related to back pain within the first 21 days of their initial visit. These patients predominantly had aLBP without leg pain, less back-related disability, and were at low-risk for persistent disability. Of the remaining 8146 patients, we found 4 distinct order patterns: combined nonpharmacologic and first-line medication (44%); second-line medication (39%); imaging (10%); and specialty referral (7%). Among all patients, 29% received solely 1 order from their PCP. PCPs more often combined different guideline concordant and discordant orders. Patients with higher self-reported disability and psychological distress were more likely to receive guideline discordant care.ConclusionGuideline discordant orders such as steroids and NSAIDS are often combined with guideline recommended orders such as physical therapy. Further defining patient, clinician, and health care setting characteristics associated with discordant care would inform targeted efforts for deimplementation initiatives.© Copyright by the American Board of Family Medicine.

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