Effects of telemedicine triage on efficiency and cost-effectiveness in spinal care

Clinical pathways for the management of low back pain from primary to specialised care: a systematic review

“…Seven Canadian studies related to three separate pathways [24][25][26][27][28][29][30]. Four American studies included two from one centre regarding a telehealth-assisted pathway [31,32]. Four pathways were described as regional, namely the Integrated Spine Assessment and Education Clinics (ISAEC) [30], the Saskatchewan Spine Pathway (SSP) [27][28][29], the NERP [19][20][21] and that of Fleuren et al [33].…”

“…Four pathways were described as regional, namely the Integrated Spine Assessment and Education Clinics (ISAEC) [30], the Saskatchewan Spine Pathway (SSP) [27][28][29], the NERP [19][20][21] and that of Fleuren et al [33]. Eleven papers considered lumbar related conditions [19-21, 24-26, 30, 34-37], eight were specific to radicular leg pain [17,18,22,23,[27][28][29]33], and eight studies included more general spine conditions [31,32,[38][39][40][41][42][43], although half of these stated that most participants had lumbar complaints [38,40,41,43].…”

“…Physiotherapists were the most common professional group in these interface services, working independently [17, 18, 22-29, 35, 38, 40], or alongside other professionals [19-21, 30, 34, 37, 41, 43]. Figure 2 illustrates that interface services were community-based [23-26, 30, 39-42] or hospital-based [19-21, 34-37, 43], although the location was not always clear, and three studies used hospital-led telehealth-assisted triage [31,32,38]. Interface services were principally accessed via direct referral from primary care, although in a small number of pathways the referral was first sent to a secondary care consultant service and subsequently triaged to an interface clinic [31,32,34,36,38,41,43] or both direct and indirect referral was available [24][25][26]35].…”

“…Figure 2 illustrates that interface services were community-based [23-26, 30, 39-42] or hospital-based [19-21, 34-37, 43], although the location was not always clear, and three studies used hospital-led telehealth-assisted triage [31,32,38]. Interface services were principally accessed via direct referral from primary care, although in a small number of pathways the referral was first sent to a secondary care consultant service and subsequently triaged to an interface clinic [31,32,34,36,38,41,43] or both direct and indirect referral was available [24][25][26]35]. Twelve pathways (17 studies) [17-21, 23, 27-30, 34, 35, 37-39, 41, 43] provided guidance regarding referrals appropriate for interface assessment, but this guidance varied considerably from detailed criteria [41] to broad statements, such as 'non-urgent' referrals [38].…”

“…The management of 'red flag' presentations was not documented by all studies. Some authors described direct referral pathways for patients presenting in primary care with red flag symptoms to urgent/emergency specialised review [27-29, 33, 39], or on referral triage in secondary care, these presentations were considered inappropriate for interface assessment [31,32,34,41,43]. In another study, all triage clinicians were trained in red flag identification and these patients were escalated to an appropriate medical appointment at the first level of triage [37].…”