Predictive factors for care intensification in a no co-pay physical therapy model for musculoskeletal pain.

BACKGROUND: Musculoskeletal pain conditions are prevalent and costly, with practice guidelines consistently recommending non-pharmacologic interventions as first-line treatments. Physical therapists are common providers of non-pharmacologic pain care, and early access to their services is believed to reduce the risk of care intensification, including opioid use, injections, surgery, and emergency department visits. New programs that remove visit copays to encourage early use of physical therapy are being implemented, but intensification rates and predictors of intensification among patients that use these programs are poorly understood. This study aims to (1) describe care intensification rates and (2) identify patient-level factors associated with the intensification of care among beneficiaries using a program that removes co-pays to promote early access physical therapy for musculoskeletal conditions. METHODS: A secondary analysis was conducted using retrospective health care claims and registry data from patients initiating care in a no co-pay physical therapy program. The study included patients (n = 1,171) treated for musculoskeletal conditions between April 2020 and June 2021. Care intensification was defined as the receipt of advanced imaging, injections, surgery, or opioid prescriptions within 30 days and 12 months following the initiation of physical therapy. RESULTS: In the 12 months following program initiation, 13.1% of patients experienced care intensification to advanced imaging, 7.5% underwent surgery, 17.3% received injections, and 10.3% were prescribed new opioids. Overall, 31.9% of patients experienced some form of care intensification. At the individual service level, 20.9% of advanced imaging, 10.2% of surgeries, 27.2% of injections, and 14.9% of new opioid prescription escalations occurred within 30 days of program initiation. Older age was consistently associated with higher odds of care intensification across different types of services. Body region was not a significant predictor of care intensification. CONCLUSION: Almost one-third of patients using a no copay physical therapy program experienced some form of care intensification within a year, with rates of intensification similar across body regions of pain. Older age was a consistent predictor of care intensification and future research should determine if and how these programs can be improved to meet the needs of older adults. CLINICAL TRIAL NUMBER: Not applicable.

Duke Scholars

Author Steven Zachary George Orthopaedic Surgery

Author Trevor A. Lentz Orthopaedic Surgery

Author Chad E. Cook Orthopaedic Surgery, Physical Therapy

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