Authors (including presenting author) :
Wong SN(1), Chan PF(1), YT Yee(1), Chao DVK(1), Lam KHE(2), HC Cheng(2), WS Tam(3)
Affiliation :
(1)Department of Family Medicine and Primary Health Care, Kowloon East Cluster (KEC)
(2)Department of Orthopaedics and Traumatology, United Christian Hospital
(3)Specialist Out-patient Department, United Christian Hospital
Introduction :
In order to enhance the gatekeeping role of Family Physicians, a pilot Family Medicine Triage Clinic (FMTC) was set up in KEC in August 2017 to manage stable patients with predefined orthopaedics conditions referred to Orthopaedics Specialist Outpatient Clinic (SOPC). Comprehensive assessment and pharmacological treatment by FM specialists according to evidence-based clinical guidelines mutually agreed between FM and Orthopaedics specialists, and early non-pharmacological intervention by physiotherapists and occupational therapists are provided.
Objectives :
To evaluate the diagnoses and outcomes of patients with chronic low back pain referred to FMTC
Methodology :
All patients with chronic low back pain referred to FMTC from 18th August 2017 to 26th October 2017 were reviewed. Relevant clinical data were retrieved from CDARS.
Result & Outcome :
106 patients were referred to FMTC for chronic low back pain, with a mean age of 61.6 years old and 63.2% were female. 69.8% of patients were referred from General Out-patient Clinic while 30.2% were triaged from Orthopaedics SOPC according to the triage criteria. The mean waiting time of the clinic was 2.1 weeks. 83.0% and 20.8% patients were referred for physiotherapy and occupational therapy respectively. 18 patients (17.0%) and 8 patients (7.5%) were referred for private DEXA scan and MRI spine respectively. The most prevalent diagnosis was lumbar disc disorder (34.9%), followed by lumbar spondylosis (28.3%), non-specific back pain (9.4%), vertebral collapse (8.5%) and spondylolisthesis (8.5%). Other less common diagnoses included facet joint disease, back pain due to scoliosis, back muscle pain, sacroiliac joint pain, back sprain, fibromyalgia and piriformis syndrome. For those who had attended the clinic for more than one visit, 69.5% patients reported symptoms improvement after treatment. Concerning the outcome, 41.5% patients were discharged from the clinic, only 29 (27.4%) patients required referrals to the Orthopaedics SOPC for further management. The indications for referrals were prolapsed intervertebral disc with significant neurology, spinal stenosis, neurogenic tumor in thecal sac, multiple vertebral collapses with lower limbs neurology. Family physician led Triage Clinic could manage adult patients with high prevalent orthopaedics conditions successfully, make accurate diagnosis and timely referrals for those with serious diseases and reduce the workload in secondary care.
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