Defense Date

2006

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Health Related Sciences

First Advisor

Dr. Dolores G. Clement

Abstract

Low back and neck pain are frequent reasons for adults to seek healthcare. Three types of practitioners are commonly used in the United States: physicians, chiropractors and physical therapists. In this study, Andersen's "Behavioral Model of Health Services Utilization" is used to examine care seeking and provider selection. Estimates of back and neck pain prevalence in the United States are presented as well as care seeking rates and care consumption estimates for patients who used the three providers of interest. Multivariate regression analyses are presented that model the variables that most influence care seeking and provider selection.Cases with the conditions of low back pain and neck pain were drawn from the Medical Expenditure Panel Survey Panel 6 participants. Episodes of care and non-care were defined and the provider used during an episode was identified.Determinants of care seeking for low back pain included MSA status, insurance coverage, perceived health status, number of comorbidities and number of episodes. Determinants of care seeking for neck pain included insurance coverage and number of episodes. When condition was included in the analysis, it was a determinant of care seeking. All of these variables are enabling factors or need factors in Andersen's model.In the analysis of provider selection for low back pain, variables that determined the provider from whom care was sought included patient age, gender, race, ethnicity, marital status, MSA status, insurance coverage, perceived health status, if the condition was disabling and number of episodes. In the analysis of provider selection for neck pain, variables that determined the provider from whom care was sought included patient ethnicity, marital status, and if the condition was disabling.Andersen's Behavioral Model adequately predicts care seeking in LBP and NP with enabling and need factors playing a predominant role. In terms of equity of access this finding indicates a problem of access to care for persons who were uninsured. In the case of provider selection, all the constructs from the model were found to have a role in prediction indicating that access may be inequitable in the case of some providers.

Rights

© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

6-13-2008

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