Medical guidelines can help doctors understand the best way to treat health conditions. Surprisingly, according to a new study by scientists from the University of Utah Health and MDGuidelines, many doctors do not follow these regulations, which is a problem. Compared with those who received treatment according to the guidelines, those who suffered from low back pain received only low back pain treatment not recommended by the medical guidelines, and were absent from work for more than 11 days a year.The research results are published in Public Library One June 17.
Kurt Hegmann, MD, senior author of the study and director of the Rocky Mountain Center for Occupational and Environmental Health at the University of Utah, said: “The more closely people follow evidence-based guidelines, the better they will resolve their back pain. The sooner.”
This may be the case, but 65% of people in the study received at least some non-recommended treatment for low back pain. Among the nearly 60,000 people who analyzed medical claims:
- 14% only received non-recommended treatment,
- 51% received a combination of non-recommended and recommended treatments,
- 14% receive only recommended treatment,
- 21% did not receive any medical intervention.
People who received a combination of recommended treatment and non-recommended treatment received a moderate benefit. Compared with those who received only recommended treatment, they had an average of eight working days less in a year.
The most common non-recommended treatment is the prescription of opioids, which is discouraged because they enhance weakness rather than exercise, and can be addictive, as well as X-rays, which can lead to inaccurate diagnosis. The most common recommended treatments are non-steroidal anti-inflammatory drugs and muscle relaxants.
The data comes from claims made by California workers between 2009 and 2018. These workers suffered from uncomplicated acute low back pain or strain, which is the most common injury in the workplace. The researchers tracked whether the treatment prescribed during the first week after the injury was classified as recommended or not recommended in the peer-reviewed American Academy of Occupational and Environmental Medicine (ACOEM) guidelines, and assumed that similar treatment patterns would Continue with any subsequent clinic visits. Then, the scientists calculated the number of work days lost in the first year after the injury.
Although a large proportion of workers received non-recommended treatment, over time, healthcare providers have increased their compliance with medical guidelines. In 2009, 10% of people were treated according to guidelines, but by 2018 this proportion had risen to 18%. The treatment practice that has changed the most is the prescription of opioids, which has fallen by 86% in the past nine years.
The reduction in prescriptions for opioids is particularly impressive,” Hegman said. “In this case, even if opioids are prescribed, the insurance company may not pay. It shows what might happen when the’carrot’ of good health care is missed and replaced by the’stick’ of following guidelines. “
Kurt Hegman, MD, SecondLearning trumpetAdvanced AUtor Director, Rocky Mountain Occupational and Environmental Health Center, University of Utah
Clinical practice guidelines are based on a systematic review of scientific evidence and are designed to guide healthcare providers in deciding how to treat patients’ health conditions. Usually, guidelines are updated every few years, which can make it difficult for healthcare providers to keep up. Doctors may not follow the guidelines because they do not know these guidelines, do not know how to implement the recommended treatment methods, prefer to continue the practices they have used in the past, or for other reasons.
In any case, the dramatic reduction in prescriptions of opioids for low back pain suggests that additional incentives, such as insurance’s refusal to pay for non-recommended treatments, will increase compliance with the guidelines. Hegmann and Dr. Fraser Gaspar, the first author of the study, said it would be better for patients to implement decision support tools and other methods to promote compliance with guidelines.
“Unemployment affects many aspects of your life,” said Gasper, who conducted this research when he was a scientist at MDGuidelines. “In addition to the physical disability that causes people to miss work, workers are earning less and less money, and they often incur additional costs and experience mental stress. It’s really important to get people back to their normal lives. Our research shows that following The guidelines make this happen faster.”
University of Utah Health
Gasper, forward, Wait(2021) California Workers’ Compensation System Guidelines for Acute Low Back Pain and Loss of Working Days. PLOS one. doi.org/10.1371/journal.pone.0253268.