Variability of clinical practice in Spain.

Title.

Study of the clinical practice variability in low back pain in Spain.

Background.

Although lumbar pain ("low back pain") is the main cause for sick leave and health costs in industrialized countries, there is scarce scientific evidence to support how physicians conduct these cases. Moreover, there are data suggesting that physicians do not base their decisions on the available evidence. Consequently, different physicians have different attitudes concerning which diagnostic tests should be ordered, and what treatments should be prescribed or recommended for the same patient.

There is still no knowledge of the attitude of Spanish physicians with regard to patients with low back pain (For example, which diagnostic tests are requested, what treatments are prescribed and on what criteria they base their decisions).

Objectives.

1) To describe the conduct of Spanish physicians with patients suffering from low back pain, by recording the diagnostic tests and the treatments prescribed for one year.

2) To describe the evolution of patients during this period of time (recording their pain evolution, their quality of life limitation and their occupational activity).

3) To calculate the health and labor costs that these patients generate during this period.

4) To describe the results ("effectiveness") of each type of treatment and its efficiency (cost-effectiveness, and cost and quality of life relationship).

Methodology.

The subjects of this study are 80 physicians, from 30 Health Centers throughout Spain, who attend to 1,240 patients of 18 or more years of age (without an upper age limit) with low back pain.

The measurement tools used are: The Visual Analog Scale (to measure pain intensity), the COOP-WONCA tables (to measure quality of life), the Kovacs' version of the Roland-Morris scale (to measure quality of life limitation due to low back pain), case record forms for socio-demographic and clinical data, as well as economical case record sheets (direct health and labor costs).

The clinical evolution and the services used are recorded when a patient is included in the study, on day 15, on day 60, and at demand from then on until the end of the study.

Participants jointly with the Foundation's Scientific Department.

Primary Care Centers in:

Badajoz: Health Center (HC) Albuquerque.

Balearic Islands: Ca'n Misses, HC de Inca, CA A. Bennàssar, HC Coll d'en Rabassa, HC de S'Escorxador, HC Santa Catalina, HC Son Serra/La Vileta, HC de Valldargent.

Cáceres: HC Pza. de Angel.

Castilla León: HC San Agustín..

Cuenca: HC Carrascosa del Campo.

Guadalajara: HC Alcolea del Pinar, HC Balconcillo.

Huesca: HC Perpetuo Socorro.

Madrid: HC Cenicientos, HC Pintores, HC Isabel II, HC Los Castilllos, HC Las Ciudades, HC Guayaba, HC Perales del Río,, HC Jazmín.

Murcia: HC Abanilla, HC Lorqui.

Palencia: HC Eras del Bosque.

Valencia: HC Salvador Allende, HC de Paterna.

Vizcaya: HC Albia and HC Casco Viejo.

Units of Primary Care Research in the Balearic Islands, Cáceres, Madrid (area 10), and Seville, Research Units of Hospital 12 de Octubre and Hospital Ramón y Cajal (Madrid), Health Services Research Unit of the Carlos III Institute (Madrid).

Co-financed by the Kovacs Foundation and the Health Research Fund of the Spanish Ministry of Health and Consumption.

Status.

On-going.