Shanthi A Ramanathan1,2,3, Peter D Hibbert2,3, Chris G Maher4, Richard O Day3,5, Diane M Hindmarsh3, Tamara D Hooper2, Natalie A Hannaford2, William B Runciman2,3,6. 1. Hunter Medical Research Institute and University of Newcastle, Newcastle, Australia. 2. University of South Australia, Adelaide, Australia. 3. Australian Institute of Health Innovation, Macquarie University, Sydney, Australia. 4. The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia. 5. Clinical Pharmacology and St Vincent's Clinical School, St Vincent's Hospital and University of New South Wales, Sydney, NSW, Australia. 6. Australian Patient Safety Foundation, Adelaide, Australia.
Abstract
STUDY DESIGN: Retrospective medical record review to assess compliance with low back pain (LBP) care indicators. OBJECTIVE: To establish baseline estimates of the appropriateness of LBP care in the general Australian population provided by a range of healthcare providers in various real-world settings. SUMMARY OF BACKGROUND DATA: LBP is a costly condition and accounts for the greatest burden of disease worldwide, yet the care provided is often at variance with guidelines. No baseline estimates of performance are currently available in Australia across various aspects of LBP care, practitioners, and settings. METHODS: A population-based sample of patients with 22 common conditions was recruited by telephone; consents were obtained to review their medical records against indicators ("CareTrack"). Care for LBP was reviewed against 10 indicators used in a previous study and ratified by experts as representing appropriate LBP care in Australia during 2009 and 2010. RESULTS: Of the 22 CareTrack conditions, LBP had the highest number of eligible healthcare encounters (6588 of 35,573, 19%), 125 to 884 per indicator among 164 LBP patients. Overall compliance with LBP indicators was 72% (range 42%-98%). Allied health practitioners and hospitals were the most compliant (82%-83% respectively), followed by general practitioners (54%). Some aspects of care were poor, such as documenting a thorough neurological examination, screening for serious diseases such as infection and inappropriate use of drugs such as steroids and treatments such as traction. CONCLUSION: Over a quarter of LBP care was not appropriate despite the availability of guidelines. There is a need for national and, potentially, international agreement on clinical standards, indicators and tools to guide, document and monitor the appropriateness of care for LBP, and for measures to increase their uptake, particularly where deficiencies have been identified. LEVEL OF EVIDENCE: N /A.
STUDY DESIGN: Retrospective medical record review to assess compliance with low back pain (LBP) care indicators. OBJECTIVE: To establish baseline estimates of the appropriateness of LBP care in the general Australian population provided by a range of healthcare providers in various real-world settings. SUMMARY OF BACKGROUND DATA: LBP is a costly condition and accounts for the greatest burden of disease worldwide, yet the care provided is often at variance with guidelines. No baseline estimates of performance are currently available in Australia across various aspects of LBP care, practitioners, and settings. METHODS: A population-based sample of patients with 22 common conditions was recruited by telephone; consents were obtained to review their medical records against indicators ("CareTrack"). Care for LBP was reviewed against 10 indicators used in a previous study and ratified by experts as representing appropriate LBP care in Australia during 2009 and 2010. RESULTS: Of the 22 CareTrack conditions, LBP had the highest number of eligible healthcare encounters (6588 of 35,573, 19%), 125 to 884 per indicator among 164 LBP patients. Overall compliance with LBP indicators was 72% (range 42%-98%). Allied health practitioners and hospitals were the most compliant (82%-83% respectively), followed by general practitioners (54%). Some aspects of care were poor, such as documenting a thorough neurological examination, screening for serious diseases such as infection and inappropriate use of drugs such as steroids and treatments such as traction. CONCLUSION: Over a quarter of LBP care was not appropriate despite the availability of guidelines. There is a need for national and, potentially, international agreement on clinical standards, indicators and tools to guide, document and monitor the appropriateness of care for LBP, and for measures to increase their uptake, particularly where deficiencies have been identified. LEVEL OF EVIDENCE: N /A.
Authors: Shanthi Ramanathan; Peter Hibbert; Louise Wiles; Christopher G Maher; William Runciman Journal: BMC Musculoskelet Disord Date: 2018-11-06 Impact factor: 2.362
Authors: Louisa Chou; Tom A Ranger; Waruna Peiris; Flavia M Cicuttini; Donna M Urquhart; Kaye Sullivan; Maheeka Seneviwickrama; Andrew M Briggs; Anita E Wluka Journal: PLoS One Date: 2018-11-08 Impact factor: 3.240
Authors: Louise K Wiles; Tamara D Hooper; Peter D Hibbert; Charlotte Molloy; Les White; Adam Jaffe; Christopher T Cowell; Mark F Harris; William B Runciman; Annette Schmiede; Chris Dalton; Andrew R Hallahan; Sarah Dalton; Helena Williams; Gavin Wheaton; Elisabeth Murphy; Jeffrey Braithwaite Journal: PLoS One Date: 2019-01-09 Impact factor: 3.240
Authors: Mary O'Keeffe; Adrian C Traeger; Tammy Hoffmann; Giovanni Esteves Ferreira; Jason Soon; Christopher Maher Journal: BMJ Open Date: 2019-06-24 Impact factor: 2.692