Sheffield spinal pathway audit cycle - pathways, mountains and the view from the top

Area of Science:

• Health Services Research
• Musculoskeletal Health
• Primary Care Management

Background:

• Spinal pain management requires a comprehensive approach, integrating biological and psychosocial factors.
• Existing referral pathways in primary care may not be optimal for efficient patient flow and quality of care.
• The need for evidence-based decision aids in primary care for spinal pain management is recognized.

Purpose of the Study:

• To evaluate the impact of mandated changes in primary care referral pathways on spinal pain management.
• To assess improvements in quality of care and patient flow following pathway modifications.
• To determine the effectiveness of implementing the STarT tool as a decision aid.

Main Methods:

• An audit cycle comparing data before and after pathway changes.
• Introduction of a simplified, one-sided referral proforma.
• Implementation of a 'bounce back' system for inappropriate secondary care referrals to physiotherapy.
• Integration of the STarT tool (Subgroup-Analysis of Treatment Effect) for decision support in primary care.

Main Results:

• The implemented changes led to improvements in the quality of care for spinal pain patients.
• Patient flow within the healthcare system was positively affected by the revised referral pathways.
• The STarT tool facilitated better decision-making in primary care management of spinal pain.

Conclusions:

• A proactive, stratified approach to spinal pain management, incorporating psychosocial elements, is effective.
• Reforming primary care referral pathways can enhance efficiency and patient outcomes.
• The STarT tool is a valuable aid for stratifying spinal pain patients in primary care settings.