Abstract
Background
The national back pain pathway sets out the gold standard pathway for patients with back and radicular pain. To improve implementation we needed to understand current practice and identify divergences from the pathway.
Objectives
1) What patient is referred into the surgical clinic?
2) What treatments had they tried?
3) How many had spinal interventions.
4) Consider ways to improve the appropriateness of referrals.
Method
100 new patients attending the Spinal Orthopaedic Clinic from December 2018 to February 2019 were asked to complete a questionnaire asking about previous interventions and benefit gained. Symptoms and outcomes were recorded from the clinical entries and MRI's reviewed.
Results
Over 90 had tried analgesics with only 60 reporting more than 50% benefit. Only 6 had tried neuromodulators all with poor results. 82 attended physiotherapy with 62 reporting some benefit. 84 tried exercises and 31 found it helpful whereas 17 had acupuncture and 8 of those reported benefit.
65 had consistent findings on their MRI and 31 elected to have an intervention. 8 were better, 22 wanted to self-manage and 4 went to other providers.
Conclusion
82% of our patients had tried analgesics and physical therapy before being referred to secondary care. Few opted to have an intervention and could possibly have been managed in a non-surgical clinic. If appropriate training and management is put into primary care settings, secondary care referrals could be reduced. Only 1/3 of the patients were right patient right place right time.
Conflicts of interest: No conflicts of interest
Sources of funding: No funding obtained
