Initial Medical Screening in Patients With Musculoskeletal Pain That is Likely Chronic

Purpose: To explore medical diagnostic testing of new cases of musculoskeletal conditions associated with chronic pain. Methods: Using nationally representative data from the 2007-2015 National Ambulatory Medical Care Survey, we analyzed cross-sectional data of people having visits with a new musculoskeletal pain (MSKP) condition that is likely chronic identified using pre-determined ICD-9 codes. We documented depression screening, prescribing of diagnostic imaging and blood tests and explored associations between patient and provider factors for each. Results: Over the 9-years of the survey, there were 11,994 initial visits for chronic MSKP, resulting in an average of 36.8 million weighted visits per year or approximately 11.8% of the population. Proportions for depression screening, prescribed imaging and blood tests were: 1.79%, 36.34%, and 9.70%. People on any public health insurance had twice the increased relative odds to be screened for depression Odds ratio (OR) 2.26 95% confidence interval (CI) (1.20, 4.28). Orthopedists had three times increased relative odds to prescribe imaging compared to family physicians OR 2.77 95% CI (2.25, 3.42). Oncologists had four times increased relative odds to prescribe blood tests OR 4.00 95%CI (1.34, 11.93). Survey year was significantly associated with depression screening (Wald p-value=0.0202) and ordering any type of imaging (Wald p-value=0.0001). Conclusions: Observed rates of depression screening and non-indicated imaging for patients with chronic MSKP have fluctuated over time. The impact of these fluctuations on clinical practice is as yet unknown. The type of non-recommended actions varied by specialty of the physician. Future studies should assess the underlying reasons affecting imaging rates and their trends, to increase our understanding of prescribing related to these tests.

ABSTRACTS IN PRESS