Low back pain affects up to 4 million Australians, spanning all ages and socioeconomic groups. About 80% of people may experience low back pain at some point in their lives.
Although international guidelines recommend that it is best to receive care in primary or community care settings, low back pain is still the fifth most common cause of emergency department visits in Australia in 2017-2018.
About half of all patients with low back pain seeking treatment in the emergency department are diagnosed with non-musculoskeletal disease at discharge. It is not uncommon for low back pain to be a symptom of an underlying problem.
Investigators including the Newcastle University School of Medicine and Public Health, the Department of Population Health, and Simon Davidson of the Hunter New England Local Health District wanted to know why patients with low back pain appeared in the emergency room and then sent to the hospital; the provider was caring for these patients What are the obstacles and driving factors that are faced at the time? What strategies are there to improve the emergency department’s care for patients with low back pain and related nursing procedures.
In order to optimize service delivery and improve patient care, it is important to explore the perspectives of clinicians. Designing interventions with end users will increase the likelihood of their acceptance and implementation.
Qualitative research has been conducted covering a range of topics related to emergency departments and general chronic pain patients. Nevertheless, no research has specifically addressed the problems that clinicians face when treating low back pain.
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Clinicians in the emergency department can determine the internal and external factors that they believe will cause low back pain to the emergency department. Factors include difficulty in making appointments with general practitioners, and the patient’s assumption that the emergency department provides patients with the highest and fastest level of care.
Some of the obstacles that providers face in caring for patients with low back pain in emergency situations are beyond the patient’s performance and deciding which treatment to provide. Service level requirements, such as the patient’s hospital stay, are important issues that need to be addressed to optimize care.
Clinicians in the emergency department have identified key strategies that can improve the care of patients with low back pain. These strategies include low back pain access in specific departments, modern patient and clinician resources, better post-discharge follow-up options, and optimized communication between the emergency department and primary care.
The researchers conducted a qualitative exploratory study with clinicians (medical staff, nurses and physical therapists) in the emergency department of a tertiary public hospital in New South Wales, Australia. They use focus groups and personal interviews.
Participants included 2 individual interviews with 21 clinicians and 19 focus group members. Investigators use topic analysis to answer pre-defined research questions in response to participants.
In the end, they found that patient perception was suspected to be the driving factor for these patients to seek treatment from the emergency department. In addition, achieving optimal care includes factors such as patients, clinicians, and service levels.
The investigator wrote: “The discussions of each professional group focused on the areas most relevant to them, medical staff, clinical decisions and follow-up options; nurses, who provide care to patients; and physical therapists, who optimize functions.”
The study is titled “Emergency Clinicians’ Views on the Challenge of Addressing Low Back Pain in Emergency Situations: A Qualitative Study”, published in Emergency Medicine Australia.