E.J. Gorgon1,2, K. Maka3, G. Regan3, J. Sullivan1, G. Nisbet1, M. Hancock1, A. Leaver1
1The University of Sydney, Faculty of Medicine and Health, Sydney, Australia, 2University of the Philippines Manila, Department of Physical Therapy, Manila, Philippines, 3New South Wales Health, Western Sydney Local Health District, Sydney, Australia
Background: Spinal pain is the number one cause of disability in the world and current healthcare approaches have failed to reduce its associated disability and population burden. Numerous clinical practice guidelines have been developed over the past two decades to address failures in spinal pain management and encourage evidence-based care. However, there is evidence that these guidelines are not being followed by practitioners. Without robust frameworks and strategies for integrating key guideline messages into practice, it is likely that practitioners will keep doing more of the same and therefore the burden of spinal pain will not be abated. For guidelines to have a positive impact on practice, redesigning current processes of care is necessary.
Purpose: This study examined processes of clinical care for adults with spinal pain as the first step in a needs assessment, with the view of redesigning service delivery in a large teaching hospital serving a multicultural community in Sydney, Australia. The needs assessment is crucial as it defines the service delivery problem and therefore feeds into the “idea generation” for innovative solutions, the first step in redesigning care using a translational research framework.
Methods: A retrospective service evaluation was conducted in the physiotherapy outpatient department by reviewing patient clinical records over a 6-month period. All adults referred and managed for spinal pain (n = 252) were included. Clinical data on demographics, referrals, episode of care, and processes of care were extracted and coded using a well-defined protocol and customized electronic form. Researchers met fortnightly to ensure consistency of data extraction and coding, and to resolve disagreements through discussion and consensus.
Results: Patients (median age = 56 years; 72% born outside of Australia) were referred from various internal and external sources, with 80% having chronic spinal pain. Active interventions (i.e., physical activity and exercise) were almost universally used (98% of records), whilst passive interventions (i.e., manual therapies) were provided in 43% of records and almost entirely in conjunction with active interventions. The number of treatments provided was small (median, IQR = 3, 2-5). Important items of assessment were frequently recorded (83-100% of records), but psychosocial risk assessment did not routinely feature. Aspects of longitudinal management planning (i.e., goal setting, outcome assessment, and long-term self-management) were also not routinely found.
Conclusion(s): Key aspects of clinical care were consistent with best practice, particularly in relation to choice of interventions and number of treatments. However, there was less consistency with implementing a modern biopsychosocial approach and recording of patient-centered long-term management plans. There is a need to streamline care delivery, with service redesign tailored to the multiple and culturally-diverse stakeholders.
Implications: Examining processes of care using actual patient care data provides a useful starting point for mapping the problem with current models of service delivery for spinal pain and for identifying service redesign needs. Stakeholder input is crucial to complete the needs assessment and allow in-depth understanding of current barriers to best practice within the idea generation phase of the translational research framework.
Funding, acknowledgements: No direct funding was received for this study. Edward Gorgon was supported by an Australian Government Research Training Program Scholarship.
Keywords: evidence-based practice, health service delivery, musculoskeletal health
Topic: Musculoskeletal: spine
Did this work require ethics approval? Yes
Institution: Western Sydney Local Health District
Committee: Human Research Ethics Committee
Ethics number: QA 1811-18
All authors, affiliations and abstracts have been published as submitted.
