My modal reason for contacting the health system is to be reassured that I’m not at large risk of a bad outcome and to be told what to look for that would indicate an increase in such risk. The modal response is a request to come in for testing. Is testing always necessary to achieve the reassurance I seek? This, from a recent paper on low back pain (LBP) by Adrian Traeger and colleagues, suggests not:

Our data suggest that when practitioners are trained to deliver structured patient education interventions, the reassurance this provides to patients is superior to usual care. […] Patient education methods suitable for delivery in primary care have the potential to reduce the burden of LBP. […]

To prevent 1 subsequent visit to primary care the NNT for education was 17. By comparison, the NNT estimated by Rolfe and Burton for diagnostic testing was 20. Kroenke estimated that with an NNT of 20, the cost of diagnostic testing is between $4000 and $16 000 to prevent a $100 primary care visit. Given that patient education can take place in a single visit, the comparable cost estimate for patient education to prevent 1 further visit is $1700. Although these are small effects, when indirectly compared with the reassuring effects of diagnostic testing, patient education might be a more brief, less costly, and equally reassuring option to provide in primary care.


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