Differences in the clinical management of shoulder pain by physician specialty: data from the 2007–2019 National Ambulatory Medical Care Survey

Abstract

Abstract Objectives The aim of this study was to identify the differences in the clinical management of shoulder pain by primary care physicians (PCPs) and non-primary care physicians (non-PCPs) from the National Ambulatory Medical Care Survey (NAMCS) dataset. Methods This cross-sectional study included ambulatory care visits for shoulder pain by using NAMCS data from 2007 to 2019. Descriptive statistics were presented to assess patient-level and visit-level characteristics of the sampled visits. By controlling for patient-level and visit-level covariates, we conducted a multivariable logistic regression to evaluate the influence of primary care physician status on the utilization of health services (pain medications, PT referral, health education/counseling, and diagnostic imaging) for shoulder pain. Results There were 74.43 million ambulatory care visits by adults with shoulder pain during the study period, and nearly one-third of these shoulder visits were made to PCPs. As compared with non-PCPs, PCPs had higher adjusted odds of prescribing narcotic analgesics (adjusted odds ratio [OR] = 1.62, 95% confidence interval [CI]: 1.04–2.51), skeletal muscle relaxants (adjusted OR = 2.71, 95% CI: 1.65–4.45), other pain medications (adjusted OR = 1.87, 95% CI: 1.13–3.07), and lower odds of prescribing PT (adjusted OR = 0.34, 95% CI: 0.21–0.55) and MRI (adjusted OR = 0.46, 95% CI: 0.25–0.84). Conclusion We observed significant differences in the services ordered or provided by PCPs versus non-PCPs for shoulder pain in ambulatory care settings. These results may reveal the higher reliance of pharmacological approaches, coupled with the potential under-utilization of PT during the ambulatory shoulder care provided by PCPs compared to non-PCPs in the United States.