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Although it may appear that the results reported by Dr Gutierrez and colleagues contradict our findings, we actually believe they are quite similar. Our study involved only primary care physicians, whereas theirs also included internists, surgeons, and chiropractors. In their health insurance company, Gutierrez et al report that lumbar radiograph utilization by family practitioners was 16%, which is similar to the utilization rate in our study (13%). Higher rates were observed for surgeons and chiropractors. After implementing the AHCPR guidelines to educate clinicians in their health insurance company, utilization in the overall group was reduced by 20%, but it is unclear whether this decrease occurred in all groups of clinicians or just those with prior high utilization (especially surgeons). In this group, a decrease of only 20% still would result in substantial use.
We agree that prospective studies are necessary to evaluate fully the effect of these (and other) clinical
Suarez-Almazor ME, Russell AS, Belseck E. Clinical Guidelines for Lumbar Radiographs for Patients With Low Back Pain-Reply. JAMA. 1997;278(21):1742. doi:10.1001/jama.1997.03550210040029