Abstract: Learning to improve the management of back pain in general practice: collaboration between service users and service providers.

Abstract

Purpose: There are difficulties in implementing evidence into practice, in particular, incorporating meaningful service user involvement. This study sought to evaluate an interprofessional and service user approach to the evidence-based management of low back pain in the community using established health care improvement principles and methods to introduce change. Relevance: Back pain is a common yet complex condition posing a challenge to both service users and service providers. Service users may start their back pain journey to recovery by visiting their GP but studies show that general practice is not well organised to manage back pain due to other competing priorities. For service users this gives rise to feelings of unmet needs and frustration at not being able to access appropriate services. This study aimed to learn from the experiences of service users and service providers. Participants: Participants were self selected interprofessional teams comprising a GP, practice nurse, physical therapist, administrator and a self selected service user from 9 General Practice teams in southern England. Methods: The study used a mixed method design. Each Practice team attended 8 half day workshops to familiarise service users and service providers with current evidence for the management of back pain and principles relating to quality improvement. Topics for specific study were identified by participants, notably through individual service user “stories”. During the workshops discussions were held between the learning teams and were tailored to a specific purpose. These were organised either within uniprofessional groups, in interprofessional groups across all Practices or as individual Practice teams. The latter worked together to create small scale improvement plans using a Plan-Do-Study-Act (PDSA) cycle. When the first workshops commenced two of the Practice teams had been unable to recruit a service user. During the workshops the Practices developed an initial process map for back pain. Between workshops communication was facilitated through a wiki and through Practice visits from a Quality Improvement Facilitator to support the learning teams. Analysis: Thematic analysis of the aims and ideas for each Practice team and how they were to achieve their first improvement plan. Results: Practice teams which included a service user prioritised the need for patient advice and education. Those without a service user focused on the need for process change. More broadly, there appeared to be a shared vision that the methodological approach taken in this study could be employed in the management of other conditions in primary care. Conclusions: These preliminary results suggest that meaningful patient input can be a powerful, influential and essential component in the management of back pain. Implications: This study highlights how service users and service providers can work together, and the importance of the role of service users in highlighting key barriers and solutions. Listening to the concerns and solutions put forward by service users in the future may provide a more cost effective way for physical therapists to manage back pain. This might extend the length of each consultation but reduce the number of follow up appointments.