Authors (including presenting author) :
Choi YK(1), Law SW(2), Wong WL(3), Cheuk C(1), Lee MK(1), Yeung KC(3), Siu HK(3), Hui MT(1), Leung KW(1)
Affiliation :
(1)Department of Family Medicine,Prince of Wales Hospital, (2)Department of Orthopaedics and Traumatology,Tai Po Hospital, (3)Department of Physiotherapy, Prince of Wales Hospital
Introduction :
Spine disorders, especially low back pain is a common and disabling condition with significant socioeconomic burden. Inappropriate or overuse of orthopaedic referrals have led to the long waiting time and delayed the timely care of those who may need early surgical interventions. A spine care delivery model with collaborative input from family medicine (FM) physicians, orthopaedic surgeons and allied health professionals has been implemented in the Prince of Wales hospital since September 2017. We aim to provide risk-matched treatment by triaging low-risk spine cases back to primary care in order to reduce the burden of orthopaedic specialist outpatient clinic (SOPC).
Objectives :
To evaluate the preliminary effectiveness of the FM-ORT spine care model by measuring health service outcomes and patient-specific outcomes.
Methodology :
Spine cases referred to orthopaedics department had initial assessment by physiotherapists and low-risk cases were triaged to FM clinic under the care of FM physicians with trained musculoskeletal skills. All new spine cases seen by FM physicians in 2018 were retrospectively reviewed till 31st Dec 2020 to evaluate the health service outcomes such as the waiting time, discharge rate, and healthcare resources utilization. Patient-specific outcomes was obtained from pre and post physiotherapy questionnaires survey including the Numeric Pain Rating Scale (NPRS), Roland Morris Disability Questionnaire (RMDQ), Northwick Park Neck Pain Questionnaire (NPQ).
Result & Outcome :
490 spine cases were seen in 2018. The overall waiting time of orthopaedic SOPC was reduced from 182 to 121 weeks since commencement of the model. The mean waiting time of FM clinic was 9.2 ± 3.5 weeks. 22% were discharged at the first visit. At 1 year, the discharge rate and default rate were 79.4% and 15.7%. 54.2% received physiotherapy, 27.9% received occupational therapy and 1.8% had MRI ordered. 1.0% were referred back to orthopaedic SOPC. No adverse event from spine problem was reported. After physiotherapy, patients reported improvement of the NPRS (mean difference: 2.99, 95% CI=2.52-3.45, P< .001), RMDQ (mean difference: 5.08, 95% CI=3.79-6.38, P< .001) and NPQ (mean difference: 10.14, 95% CI=4.11-16.18, P=.003), which were all above the minimal clinically important difference (MCID). The FM-ORT model provided effective healthcare with improved clinical outcomes, reduced the waiting time of orthopaedics department and enhanced the overall spine care service delivery.
