Model of care for the management of low back pain

A 'model of care' broadly defines the way health services are delivered. It outlines best practice care and services for a person as they progress through the stages of a condition, injury or event.

The model is for:

• people with low back pain in NSW, and
• guiding health professionals to provide healthcare that helps people with low back pain to recover.

People with low back pain have been identified as a priority group in SIRA’s implementation of value-based healthcare.

Recent SIRA funded research has found sub optimal outcomes for people with low back pain in WC scheme who receive surgery, including:

• low return to work rates
• high rates of additional surgery
• an ongoing need for pain medicine at two years post-surgery
• and high cost of treatment.

The model is a value-based healthcare initiative that will enable SIRA to support enhanced clinical practice across CTP and WC schemes.

Value-based healthcare is defined as achieving measurable improvements in a patient’s meaningful health outcomes relative to the resources utilised in achieving those improvements.

The model will support people to receive value-based healthcare through the early assessment, management, review and appropriate referral of people with back injury in the NSW personal injury schemes.

Responsibilities of an employer include:

• providing workers with the Managing low back pain: Information for patients fact sheet,
• arranging a case conference for complex cases to set goals, ensure roles and responsibilities are understood and agree on timeframes to recover at or return to work,
• participation in the development and implementation of the worker’s injury management plan, written by the insurer,
• providing suitable work that is (as far as reasonably practicable) the same as or equivalent to the work being performed at the time of the injury.

More information is available in When a worker is injured: A workers compensation guide for employers.

Insurers should expect that people in the CTP & WC schemes receive care according to these pathways, including:

• biopsychosocial risk screening at regular intervals to ensure a holistic and person-centred approach,
• primary care providers using the Standardised outcome measures to determine what pathway is relevant,
• people in pathway A or C who show no improvement by visit 3 (6 week) should be referred by their GP to a musculoskeletal specialist,
• people presenting to primary care with suspected conditions of concern identified in the pathways should have immediate referral to a tertiary hospital or other specialist care.

The model champions best practices and is a guide for practitioners caring for people with low back pain. The model uses 10 key principles to promote best practice for people with low back pain.

Insurers are not required to instruct or direct primary health care providers on how to treat an injured person, or direct a general practitioner to make a referral in accordance with the medical pathways. However, insurers can encourage general practitioners and primary healthcare practitioners to adopt the model.

The primary care practitioner is guided through the model so that people are triaged appropriately and referrals to musculoskeletal specialists or other specialist care is made in line with the model.

Being at work is often the best way to recover from your injury.

Research suggests five key benefits:

1. Get better sooner  - recovering at work with support from your employer means you’re likely to get better sooner.
2. Keep up your connections - recovering at work helps you stay connected with colleagues and workplace friends.
3. Get back to your usual activities - recovering at work also helps you return to the other things you enjoy.
4. Boost your physical and mental health - recovering at work can boost your self esteem and wellbeing according to research.
5. Reduce the chance of long-term effects - recovering at work helps you avoid other health complications following injury.