Improving Back Care in Scotland Fraser Ferguson Project Manager: National Physiotherapy Low Back Pai

1
Improving Back Care in ScotlandFraser
FergusonProject Manager National Physiotherapy
Low Back Pain Audit (NPLBPA)fferguson_at_nhs.net
2
Afternoon session - Next Steps

• (Chair Lesley Holdsworth)
• 1345 - Overview of National clinical audit of
  physiotherapy management of low back pain
• 1415 - Training for participating sites
• 1530 - Coffee break and close

3
Aims

• To provide and overview of the NPLBPA
• To provide an introduction to the audit tool

4
Objectives

• By the end of this session you should be able to
• Discuss the reasons why the audit is taking
  place.
• Be able to demonstrate how to use the audit tool

5
NPLBPA
6
Thanks for getting us this far!
7
Today is about

• Establishing a nationwide basic competency of
  clinical care.
• It is not unreasonable for patients to expect
  that care they receive from physiotherapists
  irrespective of setting is in line with the
  guidelines produced by their professional body.

8
Today is not about
9
Why bother?

• 16780 (?) LBP patients per annum
• 40 of your caseload
• Direct/Indirect costs
• Clinical Guideline after clinical guideline
• Evidence to show how good we are????

10
Clinical Guidelines
1992
2004
2007
1999
2005
1997
Repetition or Reinforcement?
11
But do clinical guidelines make a difference?

• Have they changed your Clinical Practice?
  practice?
• How?
• What do you think are the problems of
  implementing them?

12
Building a Picture
17th March 2008
NPLBPA- Launch
13
A Delphi study investigating consensus among
expertphysiotherapists in relation to the
management of low back pain.Ferguson et al
(2008) Musculoskeletal Care (in press)

• It is possible to establish consensus among
  expert clinicians in relation to the management
  of LBP.
• This consensus conformed to current LBP evidence
  based clinical guidelines.
• Gaps around yellow flag management and post
  spinal surgery rehab.

14
Building a Picture
17th March 2008
NPLBPA- Launch
15
Primary care clinicians use variable methods to
assess acute nonspecific low back pain and
usually focus on impairments.Kent et al (2008)
Manual Therapy (in press)

• 651 primary care clinicians from Physiotherapy,
  Manipulative Physiotherapy, Chiropractic,
  Osteopathy, General Medicine, and Musculoskeletal
  Medicine.
• BPS Assessment was variable, 100 of clinicians
  very frequently or often assess physical
  impairment.
• 99 assess pain, 21 assess activity limitation,
  and 7 assess psychosocial function.

17th March 2008
NPLBPA- Launch
16
Building a Picture
17th March 2008
NPLBPA- Launch
17
Adherence of Irish general practitioners to
European guidelines for acute low back pain A
prospective pilot study.Fullen et al (2007)
European Journal of Pain Vol. 11 614623

• A prospective pilot study was conducted on 54
  consenting patients with a new episode of acute
  LBP (lt3 months).
• Medication prescriptions were consistent with
  European guideline recommendations.
• Referral for further treatment to secondary care
  or discontinuation of work were not consistent.

18
Building a Picture
17th March 2008
NPLBPA- Launch
19
Implementation barriers for General Practice
Guidelines on low back pain. A qualitative study.
Schers et al (2001) Spine Vol. 26E34853.

• GPs were aware of clinical guidelines for LBP but
  adhering to them was often limited due to patient
  demands/expectations

20
Building a Picture
17th March 2008
NPLBPA- Launch
21
Benefits
22
NHS Quality Improvement Scotland

• Provide advice and guidance on effective clinical
  practice.
• Help set clinical and non clinical standards of
  care for LBP.
• Monitor the performance of the NHS against our
  standards.
• Promote patient safety and implementation of
  clinical governance.

23
Individual Physiotherapist Benefits

• Reflective Practice.
• Changing Practice.
• Reinforcing Practice.
• Support staff to make the best use of resources.

24
Physiotherapy Professional Benefits

• National focus first of its kind.
• Justification of increasing physiotherapy role.
• Driver for change?

25
Patient Benefits

• Minimum standard of care.
• Consistently good healthcare which continually
  improves help to ensure that high standards are
  consistently delivered.
• Equity of service.

26
17th March 2008... March 19th 2009
and onwards.
27
Timescale
28
Problems?

• Not got enough time.
• No IT access.
• IT access doesnt work.
• Dont understand the audit form.
• Audit form questions doesnt all relate to my
  clinical practice.
• Cant get audit forms back from areas.

29
Help

• QIS Website
• Flowchart
• FAQ
• Regional Reps
• Feedback regularly
• Education visits
• Staff meetings/rotations/inductions
• Communication

30
Try it out

• Small groups- use data base on laptops
• Questions/feedback

31
How to guide
32
Feedback
33
What Next?

• Data collection plan 15th April
• Complete basic data collection 21st April
• Start keeping LBP stats April 08-April 09??????

34
How are others planning to input data?

• Staple an audit form onto each referral to remind
  them.
• Block off 15 minutes once a week for staff to
  input data.
• Plan to get a clerical officer to input data once
  a fortnight for all their department and will
  contact QIS for some payment towards this.
• Work into CPD
• Involve Students etc
• SHARE IDEAS SOLUTIONS WITH QIS AND WE WILL
  FORWARD IN UPDATES

NPLBPA- Launch
35
What next QIS?

• Within next week or so
• Send out packs
• Respond to glitches etc

36
Take Home Message

• Pilot - Publicise - Communicate!
• Please make the most of his unique opportunity.
• September the 19th!