Abstract
Summary
Each patient received Cognitive Reassurance appropriate for and proportionate to his/her capacity through evidence informed explanation/education to enhance effective self-care and realistic self-management.
Background and pathway
Changes to back and neck pain commissioning by our CCG required GPs not to refer to manual therapy until six weeks and upgrade GP care beyond that previous.
100 consecutive patients requesting GP appointment reporting back/neck pain were directed to a pragmatic service provided by an experienced manual therapy practitioner. Cognitive Reassurance reflecting evidenced informed biopsychosocial and salutogenic thinking was given at initial consultation/assessment. Patients were contacted at 10 and 20 days to ascertain their status. One sub-group suggested an opportunity for long-term follow-up.
Pilot Objectives
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Providing Cognitive Reassurance for achieving greater levels of patient engagement with self-management
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Demonstrate full clinical triage by primary care providers is effective/practical
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Demonstrate a need for appropriate contracting models
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Outcomes 100 patients
| Wait time | 2d |
| Inappropriate self-referral directed to GPs | 25% |
| DNAs | 7% |
| Referral for medication – | 28% |
| Prescribed AQP manual therapy | 35% |
Outcomes 36 patients decided at 20 days no further treatment needed
| Treatments averaged | 1.8/pt (Range 0–4) |
| Patients deciding no treatment needed beyond initial consultation | 4% |
| Patients requesting further consultation during the 12 months following: | 4% |
Conclusion
Patient experience measured by an external moderator showed 94% highly satisfied or satisfied.
Clinical triage was acceptable to patients and GPs.
Adapting to the needs of each patient requires a more pragmatic model of contracting to be created
The opportunity for a further pilot are considered.
