E. Gorgon1,2,3, K. Maka4, A. Kam4, J. Young4, G. Nisbet1, J. Sullivan1, M. Hancock1, A. Leaver1
1The University of Sydney, Faculty of Medicine and Health, Sydney, Australia, 2Neuroscience Research Australia, Spinal Cord Injury Research Centre, Sydney, Australia, 3University of the Philippines Manila, Department of Physical Therapy, Manila, Philippines, 4New South Wales Health, Western Sydney Local Health District, Sydney, Australia
Background: Despite an abundance of current treatments, back pain remains the leading cause of disability globally suggesting that new approaches to care are needed. Clinical practice guidelines typically tell clinicians what to do to provide best practice care, but mostly fail to provide guidance on how to implement the recommendations in routine practice. It is therefore unsurprising that many clinicians do not follow guidelines. Redesigning the way healthcare is structured and delivered is a potentially enduring solution toward promoting best practice care.
Purpose: This paper synthesises the findings of a needs assessment conducted with the aim of redesigning service delivery for people with back pain in a large teaching hospital in a culturally and linguistically diverse (CALD) community in Sydney, Australia. The needs assessment was crucial to define the problem of back pain in this setting and guide the development of fit-for-context solutions.
Methods: Needs assessment is the first step in intervention mapping, our overarching framework for developing a new service. A mixed methods approach was applied to examine current care in the hospital outpatient services. The needs assessment studies included: clinical record reviews of physiotherapy and surgical specialist care, a longitudinal cohort study, focus groups and interviews with patients, and a pilot neurosurgical service. Relevant literature was also reviewed to summarise the impacts of back pain on quality of life. A core clinician-academic leadership group synthesised the needs assessment findings to draft a statement of the problem (i.e., the Logic Model of the Health Problem), which was refined based on feedback from multidisciplinary stakeholders.
Results: The Logic Model of the Health Problem identified service delivery determinants and patient determinants and the consequences of these determinants that underpinned the problem of back pain in this setting. Service delivery determinants included themes of:
(1) primary care challenges in managing back pain;
(2) predominantly discipline-based service structure;
(3) remnants of traditional physiotherapy care processes;
(4) assessment and documentation processes reflecting a biomedical model;
(5) appropriate focus on active interventions; and
(6) teaching hospital setting with allied health and medical student placements.
Patient determinants were themes of:
(1) knowledge and perceptions of how to manage back pain;
(2) pathoanatomical focus;
(3) unmet expectations;
(4) difficulty coping;
(5) high-level psychosocial risk factors;
(6) associated lifestyle-related comorbidities; and
(7) CALD patient population.
There was stakeholder consensus (at least 80% agreement) on the conceptualisation of the health problem as depicted in the logic model.
(1) primary care challenges in managing back pain;
(2) predominantly discipline-based service structure;
(3) remnants of traditional physiotherapy care processes;
(4) assessment and documentation processes reflecting a biomedical model;
(5) appropriate focus on active interventions; and
(6) teaching hospital setting with allied health and medical student placements.
Patient determinants were themes of:
(1) knowledge and perceptions of how to manage back pain;
(2) pathoanatomical focus;
(3) unmet expectations;
(4) difficulty coping;
(5) high-level psychosocial risk factors;
(6) associated lifestyle-related comorbidities; and
(7) CALD patient population.
There was stakeholder consensus (at least 80% agreement) on the conceptualisation of the health problem as depicted in the logic model.
Conclusions: The findings suggest that changes need to be primarily geared toward how service is organised and delivered and not what specific interventions are provided. Good stakeholder agreement signifies high-level acceptance by internal stakeholders of the overall approach to back pain care, which is crucial to secure buy-in from future service implementers.
Implications: The Logic Model of the Health Problem informs the development of a Logic Model for Change to institute healthcare structure changes to support best practice care in this setting. The Logic Model of the Health Problem also identifies important priorities for patient education to challenge unhelpful beliefs about diagnosis and create realistic management expectations.
Funding acknowledgements:
- Western Sydney Local Health District Allied Health Kickstarter Grants
- Australian Government Research Training Program Scholarship (Edward Gorgon)
Keywords:
Health service delivery
Evidence-based practice
Musculoskeletal health
Health service delivery
Evidence-based practice
Musculoskeletal health
Topics:
Research methodology, knowledge translation & implementation science
Musculoskeletal: spine
Service delivery/emerging roles
Research methodology, knowledge translation & implementation science
Musculoskeletal: spine
Service delivery/emerging roles
Did this work require ethics approval? Yes
Institution: Western Sydney Local Health District
Committee: Human Research Ethics Committee
Ethics number: QA 1811-18, QA 1903-05, 2019/ETH09876, 2020/ETH02078
All authors, affiliations and abstracts have been published as submitted.
