Improving the coordination of care for low back pain patients by creating better links between acute and community services

Abstract

This paper reports on the development of a care-pathway to improve service linkages between the acute setting and community health services in the treatment of low back pain. The pathway was informed by two processes: (1) a literature review based on best-practice guidelines in the assessment, treatment and continuity of care for low back pain patients; and (2) consultation with staff and key stakeholders. Stakeholders from both the acute and community sectors comprised the Working Group, who identified central areas of concern to be addressed in the care-pathway, with the goal of preventing chronicity of low back pain and reducing emergency department presentations. The main outcomes achieved include: the development of a new care-coordinator role, which would support a greater focus on integration between acute and community sectors for low back pain patients; identifying the need to screen at-risk patients; implementation of the SCTT (Service Coordination Tool Templates) tool as a system of referral across the acute and community settings; and agreement on the need to develop an evidence-based self-management program to be offered to low back pain patients. The benefits and challenges of implementing this care pathway are discussed.

Care pathways across the primary-hospital care continuum: using the multi-level framework in explaining care coordination

“…Poor communication between agencies and a lack of understanding of each other’s roles and responsibilities are barriers to coordinating multi-agency practice [39]. Staiger [40] formulates the future challenges in terms of redefining the roles and supporting the staff in their efforts to develop effective strategies to enhance communication, collaboration and coordination between the acute and the community health sectors. The local community projects used a variety of strategies to involve all healthcare professionals.…”

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

“…To encourage appropriate service delivery and facilitate the uptake of active self-management and co-care for consumers with persistent spinal pain, we recommend that policy makers and health professionals address the following key considerations: 1) timely provision of integrated evidence-based interdisciplinary co-care [70,71]; 2) ensuring the availability of supportive health professionals [72] and carers; 3) providing a menu of different self-management strategies allowing better matching of consumer profiles with appropriate resources to optimize health outcomes [66,73]; 4) facilitating adherence to self management [63] and providing reinforcement to help encourage the adoption of positive behavioural change [64,74] with reference to an operationalized stages of change framework [75] and readiness to adopt self management [67]. To address these changes requires system plasticity at the individual level (preferably using a w ho le p erson e ngagement model, which we term the HOPE model), in primary care (appropriately skilled interdisciplinary workforce), at a community level (community-based training programs), and at a tertiary level (integrated interdisciplinary co-care).…”

Reducing psychological distress and obesity in Australian farmers by promoting physical activity

“…Socio-demographic, health conditions and medication data will be collected from the participant including age, gender, country of origin, health care card using the Victorian Department of Health Service Coordination Tool Templates (SCTT) [39]. The type of farming undertaken and residential postcode will also be collected from participants.…”