Chronic low back pain—user types of ambulatory care: Cluster analysis of the utilization of ambulatory health care resources with administrative data of the AOK Baden–Württemberg

Abstract

Background: Chronic low back pain (CLBP) is one of the most common musculoskeletal disorders. Ambulatory care currently does not provide a structured multimodal approach, even though multimodal therapy is recommended. Objectives: The goal was to explore utilization of ambulatory health care resources concerning a multimodal therapy approach in the first year of CLBP and determine user types. Materials and methods: A two-step cluster analysis was executed with administrative data of 11,182 incident cases. The age was between 18 and 65 years and data of four consecutively quarters per patient were analyzed. With the administrative data from orthopedics, pain therapy, psychotherapy, exercise therapy, analgesics and opioids, clusters were determined. Further results were provided by variables of patients and the structure of care. Results: The analysis reveals four user types: 39.7% used no specialist care and less exercise therapy; 37.3% used orthopedics; 15.6% used orthopedics and pain therapy; and 7.4% used orthopedics, pain therapy and/or psychotherapy. Characteristics for multimodal utilization were the following: female, high use of analgesics (m = 143.94 DDD), high use of opioids (m = 37.12 DDD), high costs of exercise therapy (m = 631.79 €), acupuncture, antidepressants, hospitalization, interdisciplinary case conference, and consult neurologists. In all, 60.4% of the study population received analgesics. Conclusions: The cluster analysis indicated differential user types. Approximately 23% of the study population receives the recommended multimodal therapy.