Authors (including presenting author) :
Law SW1 , Ko SY 1 , Jack Chau 1, Wong WL2, Chun YWE1
Affiliation :
1 Department of Orthopaedics & Traumatology, Tai Po Hospital 2 Physiotherapy Department, Prince of Wales Hospital 3Department of Family Medicine, Prince of Wales Hospital
Introduction :
Low back pain is a substantial health issue that put pressure on Orthopedics Specialists Outpatient clinics (SOPC) , disequilibrium between demand and supply result in long waiting time for Orthopedic SPOC . Accessibility to care is a key measure for quality health care. Long waiting time not only dissatisfy patients but also affect clinical outcome and increase health care costs. Access management is therefore important to enhance patient safety, increase satisfaction and reduce service inefficiency. There is ample evidence that a triage program and stratification of care is required to put patients into appropriate level of care at appropriate time to prevent chronicity of low back pain. Those non-specific low back pain can be seen and managed by FM rather than putting in long waiting list of Orthopedic SOPC . To rectify this problem ,a conjoined effort from three departments (Orthopedics and Traumatology , Physiotherapy PT and Family Medicine FM ) through a systematic algorithm to triage patients with spinal pain has been launched since December 2017 . With FM input a co-care spinal program to provide early medical and physiotherapy interventions for patients was established .
Objectives :
Spinal cases referred to O&T Department were triage in PT Department , with a standardized protocol with stratification of care accordingly.
Methodology :
After O&T doctor endorsement, stratification of care select suitable case to FM instead of putting into routine O&T waiting list. Cases would then be reviewed and assessed by Specialist in FM; physiotherapy referral would be given if indicated.
Result & Outcome :
From October 2017 to Nov 2018, 509 cases were selected for co-care. This accounted for 25.5 % of all routine O&T spinal cases in the period. Among all cases, only one case required O&T follow-up after FM consultation. 231 cases (males 33.3% and females 66.7%) have been discharged from FM consultation and were reviewed Time to first FM consultation was 4 to 17 weeks;. The average consultation sessions are 2.48±1.06. 53.7% of patients were discharged in the first or second consultations. Time to discharge from FM consultation was 3.85±3.19 months. The waiting time for physiotherapy was 2 to 8 weeks. The Numeric Pain Rating Scale improved from 5.0 to 2.2 (P< 0.05). For low back pain cases, the score of the Roland Morris Disability Questionnaire improved from 11 to 7 (P< 0.05). Conclusion The implementation of such processes not only provide timely care but also allow Orthopedics to restrict their practices to patients who are more likely to benefit from their services, thereby reducing wait times and potentially reducing costs.
Co-location with:
