Wednesday, May 18, 2011

Better care for patients with back and neck pain - an appropriateness success story. With a Saskatchewan flavour.

Here's a great story about the potential to improve care and reduce waste through system redesign.  And, it recognizes a Saskatchewan initiative as leading the way.

The traditional approach to wait times has been to throw resources at the problem.  If people are waiting too long for surgery, we open more ORs, train more nurses and recruit more surgeons.  There's a superficial appeal to this method: Let's do more of what we already know how to do.

The problem is that this solution deals with the supply of services but ignores the demand.  Specifically, it ignores whether or not the demand for a service is appropriate.  As reported in last week's Globe and Mail, a new way of thinking about treatment of back pain takes the bold step of addressing appropriateness of care.

The problem:

Patients with severe back and neck pain wait a long time to see spine surgeons
Many patients don't need to see the surgeon in the first place.  They need exercise, physiotherapy or back supports.
Millions of dollars are spent on unnecessary imaging (CT and MRI)

Quotes from Hamilton Hall, executive director of the Canadian Spine Society:

In an unscreened practice, where the surgeon sees 100 patients, no more than 10 would be surgical candidates.
As a screening tool for back pain, MRIs are worse than useless.

The solution:

Establish a multidisciplinary screening/triage program to evaluate patients
Refer to appropriate treatment without unnecessary waiting for MRIs and surgical consultations

The benefits

Quicker access to appropriate treatment
Shorter wait times to see surgeons for patients who will benefit from surgery
Fewer unnecessary MRIs
Shorter wait times for MRIs for patients who will benefit from this testing

As the Globe and Mail story points out, Saskatchewan is leading the way by training family doctors to assess which patients need referral to a back surgeon, and providing the trained physicians special access to the multidisciplinary clinic, appropriate imaging and surgical referrals.

The Globe and Mail followed up with this editorial earlier this week.

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