Care Pathway for Chronic Low Back Pain
Low Back Pain has a high incidence worldwide with significant impact on physical, psychological and social well-being of patients. Moreover it often evolves into chronicity with impact on quality of life. With this pathway, we focus on patients with chronic low back pain (CLBP) (>3 months), without previous surgical interventions.
Through a standardized screening of the patient’s health complaints, needs and expectations, a multidisciplinary pathway is organized, with efficient deployment of all involved parties. Treatment and follow-up takes place – depending on the severity – in the hospital or in an outpatient setting. By digitalization and mapping of outcomes and experiences, we strive for tailored expert care.
The care pathway is based on the KCE guideline for management of CLBP (KCE, 2017) and on the existing multidisciplinary consultation body “Spine unit”. Both aim to address the medical condition in all its aspects. Besides biomedical causes, the patient’s professional and psychosocial context also has an influence on recovery and/or evolution towards chronicity. The KCE guideline emphasizes the importance of exercise, and the strength of the ‘Spine Unit’- approach is the multidisciplinarity. Both were merged, in combination with the ICHOM set for low back pain (ICHOM, 2017), aiming at optimizing patient’s experiences and outcomes.
At the heart of the pathway is the case manager, called ‘spine coach’: first contact point for the patient, and his ‘compagon-de-route’ for the whole trajectory. The spine coach organizes the intake, initiates the digital pathway, sets up a multidisciplinary diagnosis carousel with the appropriate specialisms, and organizes the follow-up based on the specific patient trajectory.
The multidisciplinary diagnosis carousel involves the team of professionals, including physicians, physiotherapists, psychologists, and other specialists, collaborating to provide comprehensive evaluations and to come to an individualized treatment plan. The carousel allows for a seamless transition of patients between the disciplines, ensuring that each patient is evaluated by the appropriate specialist at the right time.
Such a carousel has several benefits. First, it allows for a more comprehensive assessment of patients, as the team is able to draw on a range of expertise and perspectives to identify underlying causes and contributing factors of each patient’s condition. By using Canadian Occupational Performance Measures (COPM, 2023) treatment plans are tailored to individual needs.
Second, the carousel enables a more efficient and streamlined intake process, reducing the time it takes for patients to receive appropriate care.
Finally, the multidisciplinary approach enhances communication and collaboration between healthcare providers, ensuring patients receive integrated and coordinated care.
In addition to improving outcomes, this project has the potential to increase value by reducing costs. By identifying and eliminating unnecessary or ineffective treatments, healthcare spending can be reduced without compromising patient care. This is achieved through implementation of an evidence-based pathway and the use of cost-effective interventions.
To ensure the success of the project, it is important to engage patients in the design and implementation. This is done through the use of patient-reported outcome measures (PROMs) and patient engagement tools such as shared decision-making. By involving patients in the project, the needs and preferences of patients are better understood and treatments can be tailored accordingly.