Back pain in a hospital setting: service re-design

Abstract

Hospital outpatient clinics receive a large number of referrals each year for people with back pain. Services should deliver care that is patient-centred, timely and cost effective, and processes should be routinely evaluated. Re-designing services necessitates an understanding of patient needs and current processes. The aim of this thesis was to conduct key aspects of a needs assessment for re-designing services for people with back pain in a hospital setting, and to explore new processes for better directing referrals to these services.

A file review of a hospital neurosurgery clinic was conducted to describe the characteristics of people referred to the clinic and the processes involved from the point of referral. A longitudinal cohort study involving the physiotherapy and neurosurgical clinics investigated changes in patients’ pain and disability over 12-months from time of referral, and explored factors associated with 12-month disability score. It has also provided pre-change outcome data for comparison after re-design. A multi-methods study investigated the utility of a new process for patient assessment in the form of a pre-assessment questionnaire.

This thesis has contributed to a better understanding of the local context, the patient population and service processes in the outpatient clinics. Patients wait months for an appointment and changes to their pain and disability over 12-months are not clinically relevant. Despite moderate to high levels of pain and disability, many people are not formally screened for risk of poor prognosis. The majority of referred patients do not require neurosurgical care and are referred on to another service. Use of the pre-assessment questionnaire appears reliable and feasible, and clinicians indicate that it would be helpful to preliminarily identify destination clinics. The outcomes of current service delivery have been established and can be used for comparison when future service re-design occurs.