CareTrack: Toward Appropriate Care for Low Back Pain.
METHODS
Retrospective medical record review to assess compliance with low back pain (LBP) care indicators.


OBJECTIVE
To establish baseline estimates of the appropriateness of LBP care in the general Australian population provided by a range of healthcare providers in various real-world settings.


BACKGROUND
LBP is a costly condition and accounts for the greatest burden of disease worldwide, yet the care provided is often at variance with guidelines. No baseline estimates of performance are currently available in Australia across various aspects of LBP care, practitioners, and settings.


METHODS
A population-based sample of patients with 22 common conditions was recruited by telephone; consents were obtained to review their medical records against indicators ("CareTrack"). Care for LBP was reviewed against 10 indicators used in a previous study and ratified by experts as representing appropriate LBP care in Australia during 2009 and 2010.


RESULTS
Of the 22 CareTrack conditions, LBP had the highest number of eligible healthcare encounters (6588 of 35,573, 19%), 125 to 884 per indicator among 164 LBP patients. Overall compliance with LBP indicators was 72% (range 42%-98%). Allied health practitioners and hospitals were the most compliant (82%-83% respectively), followed by general practitioners (54%). Some aspects of care were poor, such as documenting a thorough neurological examination, screening for serious diseases such as infection and inappropriate use of drugs such as steroids and treatments such as traction.


CONCLUSIONS
Over a quarter of LBP care was not appropriate despite the availability of guidelines. There is a need for national and, potentially, international agreement on clinical standards, indicators and tools to guide, document and monitor the appropriateness of care for LBP, and for measures to increase their uptake, particularly where deficiencies have been identified.


METHODS
N /A.
Hunter Medical Research Institute and University of Newcastle, Newcastle, Australia.|University of South Australia, Adelaide, Australia.|Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
Shanthi A
SA
Ramanathan
University of South Australia, Adelaide, Australia.|Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
Peter D
PD
Hibbert
The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.
Chris G
CG
Maher
Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.|Clinical Pharmacology and St Vincent's Clinical School, St Vincent's Hospital and University of New South Wales, Sydney, NSW, Australia.
Richard O
RO
Day
Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
Diane M
DM
Hindmarsh
University of South Australia, Adelaide, Australia.
Tamara D
TD
Hooper
University of South Australia, Adelaide, Australia.
Natalie A
NA
Hannaford
University of South Australia, Adelaide, Australia.|Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.|Australian Patient Safety Foundation, Adelaide, Australia.
William B
WB
Runciman
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D019317:Evidence-Based Medicine / Q000379:methods* / Q000639:trends; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D008875:Middle Aged; D005791:Patient Care / Q000379:methods* / Q000639:trends; D012189:Retrospective Studies; D000072140:Rheumatologists / Q000639:trends; D055815:Young Adult