Back pain outcomes in primary care following a practice improvement intervention:- a prospective cohort study

Abstract

BackgroundBack pain is one of the UK's costliest and least understood health problems, whose prevalence still seems to be increasing. Educational interventions for general practitioners on back pain appear to have had little impact on practice, but these did not include quality improvement learning, involve patients in the learning, record costs or document practice activities as well as patient outcomes.MethodsWe assessed the outcome of providing information about quality improvement techniques and evidence-based practice for back pain using the Clinical Value Compass. This included clinical outcomes (Roland and Morris Disability Questionnaire), functional outcomes, costs of care and patient satisfaction. We provided workshops which used an action learning approach and collected before and after data on routine practice activity from practice electronic databases. In parallel, we studied outcomes in a separate cohort of patients with acute and sub-acute non-specific back pain recruited from the same practices over the same time period. Patient data were analysed as a prospective, split-cohort study with assessments at baseline and eight weeks following the first consultation.ResultsData for 1014 patients were recorded in the practice database study, and 101 patients in the prospective cohort study. We found that practice activities, costs and patient outcomes changed little after the intervention. However, the intervention was associated with a small, but statistically significant reduction in disability in female patients. Additionally, baseline disability, downheartedness, self-rated health and leg pain had small but statistically significant effects (p < 0.05) on follow-up disability scores in some subgroups.ConclusionsGP education for back pain that both includes health improvement methodologies and involves patients may yield additional benefits for some patients without large changes in patterns of practice activity. The effects in this study were small and limited and the reasons for them remain obscure. However, such is the impact of back pain and its frequency of consultation in general practice that this kind of improvement methodology deserves further consideration.Trial registration numberISRCTN: ISRCTN30420389

Clinician education unlikely effective for guideline-adherent medication prescription in low back pain: systematic review and meta-analysis of RCTs

“…RCTs (both cluster 11−17 and individual patient 18−21 designs), as well as prospective 22−31 and retrospective 32−39 studies have investigated the impact of guideline adherence on financial costs 11,12,14,16,17,19,22,24−28,30−40 and patient outcomes. 12,13,15,18,20,21,23,24,29,[33][34][35]37,41 Retrospective studies have shown lower costs 32−36,38−40 when guidelines are followed. Prospective non-randomised studies 22,[24][25][26][27][28]30,31 are less consistent, yet appear dependent on the modality of intervention examined.…”

Implementing Evidence-Informed Policy into Practice for Health Care Professionals Managing People with Low Back Pain in Australian Rural Settings: A Preliminary Prospective Single-Cohort Study

“…Many health care professionals continue to manage consumers with persistent pain within a biomedical reductionist framework [6] and have little or no training to help them address the multidimensional nature of pain [7]. Furthermore, a lack of knowledge by practitioners of best‐practice guidelines [8], a lack of adherence to these guidelines [9], the inconsistent translation of evidence into practice in the primary care setting [10], an inadequately skilled health workforce [11] and emerging workforce [12] contribute to poor consumer outcomes. Additional barriers exist for care providers who work in rural regions where access to professional development opportunities is limited [13,14].…”

Engaging consumers living in remote areas of Western Australia in the self-management of back pain: a prospective cohort study

“…Many factors contribute to this gap in healthcare for consumers with LBP, including the failure of evidence to be translated into best practice [ 5 - 7 ], an inadequately trained and skilled health workforce [ 8 , 9 ] and a lack of co-ordinated interdisciplinary care [ 10 ], the latter being a favoured model for consumers with persistent LBP [ 11 ]. To obtain effective care is difficult because persistent pain is often poorly understood by the general community , by educators, researchers and health professionals [ 3 , 12 ], often resulting in stigmatization and conditions not being legitimized [ 13 , 14 ].…”