目的:这项研究的目的是检查非医疗初始提供者对下腰痛患者的医疗保健利用和结果的影响的证据范围。
方法:使用范围审查方法,从成立到2021年6月,我们对4个数据库进行了电子搜索。确定了研究非医疗初始医疗保健提供者对新出现的下腰痛患者的管理。成对的审稿人筛选了标题,摘要,和合格的全文研究。我们提取了医疗保健利用率和患者结局,并使用JoannaBriggs研究所检查表评估了纳入研究的方法学质量。两名审稿人描述性地分析了数据,并按结果衡量对发现进行了分类。
结果:共筛选了26,462篇引文,11项研究符合资格。研究主要是使用基于索赔的数据进行回顾性队列设计。四项研究的偏倚风险较低。确定了五种医疗保健结果:药物,成像,寻求关怀,护理费用,和医疗保健程序。患者结果包括患者满意度和功能恢复。与与医疗提供者开始护理的患者相比,在非医疗服务提供者处开始治疗的患者显示,与阿片类药物处方和影像学检查订购率降低但寻求治疗率增加相关.护理费用的结果,医疗保健程序,和患者结果不一致。
结论:在第一护理点优先考虑非医疗服务提供者可能会减少低价值护理的使用,如阿片类药物处方和影像学转诊,但可能会导致增加的卫生保健访问的人照顾下背痛。需要高质量的随机对照试验来证实我们的发现。
结论:这项范围审查提供了初步证据,证明非医疗从业者,作为初始提供者,可能有助于减少患者的阿片类药物处方和选择性成像。在本次范围审查中观察到的趋势对护理途径和非医疗提供者的作用具有重要意义。比如物理治疗师,在初级卫生保健系统中。
背景:这项范围审查提供了初步证据,证明非医疗从业人员,作为初始提供者,可能有助于减少患者的阿片类药物处方和选择性成像。需要高质量的随机对照试验来证实这些发现。
The aim of this research was to examine the scope of evidence for the influence of a nonmedical initial provider on health care utilization and outcomes in people with low back pain (LBP).
Using scoping review methodology, we conducted an electronic search of 4 databases from inception to June 2021. Studies investigating the management of patients with a new onset of LBP by a nonmedical initial health care provider were identified. Pairs of reviewers screened titles, abstracts, and eligible full-text studies. We extracted health care utilization and patient outcomes and assessed the methodological quality of the included studies using the Joanna Briggs Institute checklist. Two reviewers descriptively analyzed the data and categorized findings by outcome measure.
A total of 26,462 citations were screened, and 11 studies were eligible. Studies were primarily retrospective cohort designs using claims-based data. Four studies had a low risk of bias. Five health care outcomes were identified: medication, imaging, care seeking, cost of care, and health care procedures. Patient outcomes included patient satisfaction and functional recovery. Compared with patients initiating care with medical providers, those initiating care with a nonmedical provider showed associations with reduced opioid prescribing and imaging ordering rates but increased rates of care seeking. Results for cost of care, health care procedures, and patient outcomes were inconsistent.
Prioritizing nonmedical providers at the first point of care may decrease the use of low-value care, such as opioid prescribing and imaging referral, but may lead to an increased number of health care visits in the care of people with LBP. High-quality randomized controlled trials are needed to confirm our findings.
This scoping review provides preliminary evidence that nonmedical practitioners, as initial providers, may help reduce opioid prescription and selective imaging in people with LBP. The trend observed in this scoping review has important implications for pathways of care and the role of nonmedical providers, such as physical therapists, within primary health care systems.
This scoping review provides preliminary evidence that nonmedical practitioners, as initial providers, might help reduce opioid prescription and selective imaging in people with LBP. High-quality randomized controlled trials are needed to confirm these findings.