Evaluation of a physician education intervention to improve primary care for low-back pain. II. Impact on patients.

Abstract

A physician education intervention was previously found to have significantly improved perceived physician knowledge, confidence, and patient-reassuring behavior in the treatment of low-back pain. This study examined whether this intervention, presented in a health maintenance organization clinic, had an effect on patient outcomes. Outcomes of care for 148 patients seen for low-back pain before the intervention were compared with outcomes of care for 157 patients seen after the intervention. Patients were telephoned 2-4 weeks after their back-pain visit and were asked about symptom improvement, amount of disability, and satisfaction with care. Satisfaction was measured with a three-dimensional instrument for low-back pain developed specifically for this study, which was found to be valid and reliable. The preintervention and postintervention patient cohorts were similar in terms of key baseline variables. Despite its apparent benefit to physicians, the intervention did not result in significant improvements in any patient outcomes, even for the subset of patients whose physicians had perceived the greatest benefit.