A Hospital Avoidance Pathway With Digitally Supported Follow‐Up for Low Back Pain: An Alternative to Emergency Department Care
Joseph F. Orlando, Maria Zucco, Usha Ritchie, Anne L. J. Burke, Matthew Beard, Michelle Guerin, Saravana KumarABSTRACT
Background
Low back pain (LBP) is a common reason for presentation to an emergency department (ED) but LBP‐care in this setting is frequently low‐value, costly and often fails to meet system and patient needs. Other service options are urgently required. This study evaluated a novel care pathway that diverted people with suspected non‐serious LBP seeking ED‐care to a community‐based, hospital avoidance service in a large South Australian health network.
Methods
A retrospective quantitative analysis was conducted on data extracted from electronic medical records (demographics, service activity, subsequent presentations/admissions) for patients seen March–December 2024, and analyzed using descriptive statistics. Repeated measures analysis of selected EQ‐5D‐5L items (pain/discomfort, usual activities, anxiety/depression) was conducted using the Wilcoxon signed‐rank test. Semi‐structured interviews undertaken May‐Nov 2024 with consecutive eligible patients explored experiences of care via qualitative thematic analysis.
Results
There were 143 patients (mean age = 52.1 years, SD = 19.0) managed via this pathway. All received multidisciplinary care and 101 (78%) registered for digitally supported follow‐up. Patients reported significant improvements in pain/discomfort and usual activities ( p < 0.05) 2‐weeks following initial evaluation, but not anxiety/depression. Most patients (90%) did not present to a public hospital ED within 90 days of intervention. Interviews ( n = 20) identified four key themes: faster access and reducing ED pressure, care that meets expectations, digitally supported care assists recovery, and recommendations for improvements in LBP‐care.
Conclusion
This digitally supported hospital avoidance pathway provided an acceptable alternative to ED‐care for patients with LBP with potential to offer significant benefits to the health system.