D RHon, T Greenlee, R Boeth, X Yuan

Objectives:

To compare the history and demographic factors of patients initially treated for low back pain (LBP) across different settings: primary care, tertiary care, and immediate care (emergency or urgent care clinics).

Summary of Background Data:

LBP is one of the most common reasons to seek medical care. Care for LBP has been characterized as highly variable, creating challenges with efforts to optimize care. Exploring settings where patients initially receive care may provide insights for optimizing care at the health system level.

Materials and Methods:

The cohort comprised adults aged 18 to 65 years with LBP seeking care in the US Military Health System (MHS) from 2015 to 2019, identified through the MHS Data Repository. Diagnosis and procedure codes were used to identify the cohort and health care utilization variables. Proportional rates and adjusted odds of comorbidity were reported, stratified by clinical setting.

Results:

Out of 1,049,546 patients, 73.4% were initially seen in primary care, 9.8% in immediate care, and 16.8% in tertiary care settings. The median [IQR] age was 31 [24–41] years, 64.4% males. Females had the highest proportion of visits in immediate care settings, at 40.6% of all visits, compared with ∼35% in both primary and tertiary care. Younger patients were less likely to be seen in primary care and more likely to be seen in tertiary care than in immediate care settings. Enlisted personnel were more likely than officers to seek care in immediate care settings.

Conclusion(s):

The initial entry point for LBP varied systematically with sex, rank, age, service branch, and comorbidity burden. One in 10 patients entered through an immediate care setting were less medically complex and less likely to have back-related leg pain than patients entering through primary or tertiary care. One in six entered through specialty care, with greater chronic pain history and radicular symptoms. System-level efforts to improve LBP care will have to account for these differences across settings.

Rhon DI, Greenlee TA, Boeth R, Yuan X. Are Patients Different Based on Location of Initial Care Seeking for Low Back Pain? Analysis of Primary, Tertiary, and Emergency Care Settings in the Military Health System Spine Open. 2026;2(4). doi:10.1097/bn9.0000000000000148