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Stevenson K.1,2, Duffy H.1, Sowden G.1, Chudyk A.1, Somerville S.1, Wathall S.1, Evans N.1, Bradbury H.3, Oxtoby J.1, Dziedzic K.1
1Keele University, Primary Care and Health Sciences, Newcastle under Lyme, United Kingdom, 2Staffordshire and Stoke-on-Trent Partnership NHS Trust, Rheumatology, Stoke on Trent, United Kingdom, 3Staffordshire and Stoke-on-Trent Partnership NHS Trust, Professional Lead, Newcastle under Lyme, United Kingdom
Background: Back pain is common, distressing and costly for the UK National Health Service (NHS). It accounts for the largest number of years lived with disability worldwide1 and in 2013, 131 million days lost to sickness absences in the UK.2
High quality evidence suggested that clinical outcomes are improved and health care costs reduced by using stratified care (STarT Back) 3,4. It uses a 9 item screening tool to match patients to treatment depending on their risk of disability: low risk are managed by the family practitioners (FP), medium risk receive physiotherapy and high risk patients receive psychologically informed physiotherapy. However uptake of this evidence has been inconsistent.
High quality evidence suggested that clinical outcomes are improved and health care costs reduced by using stratified care (STarT Back) 3,4. It uses a 9 item screening tool to match patients to treatment depending on their risk of disability: low risk are managed by the family practitioners (FP), medium risk receive physiotherapy and high risk patients receive psychologically informed physiotherapy. However uptake of this evidence has been inconsistent.
Purpose: · To understand the barriers and enablers to a STarT Back approach being implemented into clinical practice
· To design solutions to assist the uptake of this approach in clinical practice
· To design solutions to assist the uptake of this approach in clinical practice
Methods: A Community of Practice (CoP) model was used to facilitate two stakeholder meetings where barriers, enablers and solutions to implementation were highlighted. CoP 1: consisted of FPs, physiotherapists, rheumatologists, educators and patients. CoP 2: included clinical physiotherapists and educators.
The underpinning research was highlighted followed by a facilitated discussion.
Results: Enablers and solutions identified by CoP 1 (21 stakeholders) included: designing technology to make it easy to do the right thing; use of audit and research data to assist change; and the use of the patient voices.
Subsequently:
an electronic STarT Back template has been designed, tested and embedded in 30 Family Practices, with over 40 physiotherapists trained to deliver the matched treatments in that geographical area.
Local audit data (n=100 patients) demonstrated that waiting time for physiotherapy reduced if this approach was used
Patient groups designed bespoke patient information housed on FP systems (patient.info.uk). 20% of patents now receive this information in their consultation in this pilot region
Issues identified in CoP 2 (21 stakeholders) included the need for training in communication and listening skills, training in motivational interviewing skills, development of central online resource, such as a web site and mentorship.
Subsequently:
Over 199 physiotherapist have been trained regionally to deliver matched treatments
A dedicated website has been developed (http://www.keele.ac.uk/sbst/) which has received 274,687 views
Practice based support sessions have been designed and the materials to set up and run these are freely available
http://www.keele.ac.uk/sbst/learning/practicebasedsupportsessions/
Conclusion(s): Two CoP meetings allowed a detailed understanding of the barriers and enablers to implementation of a stratified care approach (STarT Back) for low back pain in a UK primary care setting. The recommended solutions ranged from technological innovations, high quality patient information generated for patients written by patients, website development and supported training and mentorship.
Implications: This project has the potential to reduce the inconsistent care for patients with low back pain and to reduce the burden on the NHS National Health Service. The programme has been rolled out across the West Midlands region (5.6 million) with 15 CCGs and Provider Trusts engaging with STarT Back. Strategic national roll-out is now being supported through further national and regional initiatives.
Funding acknowledgements: National Institute Health Research: Knowledge Mobilisation Fellowship 2013-15
West Midland Academic Health Science Network
West Midland Academic Health Science Network
Topic: Musculoskeletal: spine
Ethics approval: Ethical approval was not required for the implementation aspect of this research.
All authors, affiliations and abstracts have been published as submitted.
