Low back pain is the fifth most common reason for all physician visits in the US.  While many patients have self-limited episodes of back pain, one third of these patients have persistent back pain lasting at least one year.  Hundreds of patient visits to SFGH are for back pain.  The good news is that the expertise to treat back pain exists at SFGH; there are there multiple venues to receive care.  However, when patients present with ongoing difficulties or require evaluation for other treatment modalities, the coordination of care between these venues is limited.   Significant wait times (at times, months) for specialty care are problematic.  Repeat referrals for patients lost to follow up compound the problem. The treatment of patients with back pain would be significantly improved by providing an interdisciplinary approach to care that would improve access and coordination of services between expert providers and maximize the appropriate utilization of services and studies. 

Currently, care for back pain is provided by a variety of practitioners that include: primary care physicians, spine surgeons, physiatrists, nurse practitioners and physical therapists.  The patient’s first encounter may take place at any of these clinics sites.  Often, patients are then referred from one clinic to another.    Repeat referrals to Physical Therapy commonly occur as patients are referred from clinic to clinic.  Referrals for interventional or surgical evaluations are delayed when appropriate studies have not been performed at the time of referral.  As patients await appointments with specialists, the venues for general education regarding back pain and techniques for self-management are limited. With the exception of the use of eReferral and notes on the Lifetime Clinical Record (LCR), communication and coordination of care between providers is limited.

The development of integrated approach to back pain management would help to effectively guide patients through a potentially complicated and frustrating disease process.  The ability to fund for staff to oversee the coordination of care would greatly enhance the experience of both the patient and provider.  Key clinician stakeholders would start the process by establishing guidelines and/or an algorithm of care.  A clinician would then be identified to implement this algorithm and continue further program enhancements between services. Resources would be allocated to fund the development of regularly scheduled education and wellness sessions devoted to patients with back pain.  Psychological services would be integrated in wellness sessions as many patients with chronic back pain suffer from adjustment disorders or mood disturbances. 

A coordinated program would greatly improve the care of patients with back pain by: 

• providing practitioners and patients with a roadmap of what to expect during their treatment program,
• providing practitioners and patients with resources and education about the management of back pain,
• minimizing redundant and/or repeat referrals for physical therapy,
• minimizing the unnecessary testing and/or optimizing the ordering of the appropriate studies in a timely fashion, and
• reducing wait times to specialty clinics by routing referrals to the appropriate specialists at the right time.