Evidence-based practice for low back pain in primary care: Patient outcomes and cost of careObjective: Provider adherence with clinical practice guidelines (CPG) for acute low back pain (LBP) and the impact on clinical outcomes and cost are controversial. Objective: To determine the rate of provider adherence to the Department of Defense/Veteran’s Administration CPG for Acute Low Back Pain and the extent to which provider adherence is associated with patient satisfaction, general health, functional outcome, and health care cost.
Results: Between 10- 40% of cases received CPG adherent care during guideline specified intervals within a 75 day period of care. This was observed prior to and 3 years following system wide implementation. No differences were found between LBP and upper extremity diagnoses groups in their rates of change in the four outcomes over years. Multivariable regression analyses controlling for a number of demographic and clinical variables indicated that CPG adherence was related to better functional outcomes and lower health care costs. Cases who received higher levels of adherent care also reported higher levels of patient satisfaction and general health. Although receipt of CPG adherent care was related to better outcomes provider adherence was low and did not improve over years.