Clinical strategies for controlling costs and improving quality in the primary care of low back pain

Richard A. Deyo

Research output: Contribution to journalArticlepeer-review


Back pain is a pervasive problem which ranks only behind cold symptoms as a reason for all physician visits. Among persons with back pain lasting at least two weeks, 85% will seek the care of a health professional. These patients obtain care fromprimary care physicians (Family Medicine, Internal Medicine, and Osteopathic physicians), but also see a variety of specialists, including physiatrists, rheumatologists, orthopedic surgeons, and neurosurgeons. Since any of these specialties may evaluate patients early in their course, it is important to adopt a systematic and rational early approach to back pain. This discussion emphasizes recent data suggesting that such an approach would include a parsimonious diagnostic evaluation, careful attention to patients’ concerns, and careful choice of proven effective treatments. Specifically, we propose five strategies that may help to reduce costs of care while maintaining quality: 1. Avoid premature or unnecessary diagnostic tests. 2. Avoid patient deactivation. 3. Avoid ineffective or unproven remedies. 4. Prescribe effective therapy in a cost-conscious manner, and 5. Emphasize lifestyle changes and patient self-efficacy.

Original languageEnglish (US)
Pages (from-to)1-13
Number of pages13
JournalJournal of Back and Musculoskeletal Rehabilitation
Issue number4
StatePublished - 1993
Externally publishedYes


  • Back pain
  • Diagnosis back pain
  • Lifestyle change
  • Strategies for back pain

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


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