A Hospital Avoidance Pathway With Digitally Supported Follow-Up for Low Back Pain: An Alternative to Emergency Department Care.

Abstract

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. 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. 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. 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.