Improving spine surgical access, appropriateness and efficiency in metropolitan, urban and rural settings

2017 
BACKGROUND: The Inter-professional Spine Assessment and Education Clinics (ISAEC) were developed to improve primary care assessment, education and management of patients with persistent or recurrent low back pain-related symptoms. This study aims to determine the effect of ISAEC on access for surgical assessment, referral appropriateness and efficiency for patients meeting a priori referral criteria in rural, urban and metropolitan settings. METHODS: We conducted a retrospective review of prospective data from networked ISAEC clinics in Thunder Bay, Hamilton and Toronto, Ontario. For patients meeting surgical referral criteria, wait times for surgical assessment, surgical referral-related magnetic resonance imaging (MRI) scans and appropriateness of referral were recorded. RESULTS: Overall 422 patients, representing 10% of all ISAEC patients in the study period, were referred for surgical assessment. The average wait times for surgical assessment were 5.4, 4.3 and 2.2 weeks at the metropolitan, urban and rural centres, respectively. Referral MRI usage for the group decreased by 31%. Of the patients referred for formal surgical assessment, 80% had leg-dominant pain and 96% were deemed appropriate surgical referrals. CONCLUSION: Meme si les ressources en soins de sante sont concentrees en milieu metropolitain, c’est le milieu rural qui a connu la plus grande baisse du temps d’attente. La mise sur pied d’un modele de soins partages en reseau pour les patients aux prises avec des symptomes de lombalgie a ameliore l’acces aux evaluations chirurgicales de facon significative, malgre la variete geographique des milieux de pratique et les divers obstacles rencontres. Les baisses les plus importantes ont ete observees en milieu rural. De plus, des ameliorations significatives de la pertinence et de l’efficacite des references ont ete observees lors de la comparaison avec les rapports anterieurs, pour tous les sites de l’etude.
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