There’s a new way to deal with back pain, thanks to Trillium Health Partners’ interprofessional team-based model at the Kingsway Financial Spine Centre. The Spine Centre is the first of its kind in Canada, where an interprofessional team, including orthopaedic surgeons, neurosurgeons, occupational therapists, psychologists, an advanced practice physiotherapist and a chiropractic specialist work together to identify the best treatment for patients suffering from back pain.
With 80 per cent of Canadians experiencing some type of back pain in their lives, institutions such as the Kingsway Financial Spine Centre are of value to the Canadian health care system. In fact, back problems are the most common cause of disability for people under 45, whether the result of a car accident, sports injury or basic wear and tear.
Having no shortage of patients with spine-related disorders, the centre opened its doors at Queensway Health Centre in 2005. Rather than being referred to a single surgeon, patients are referred to the centre, where they are triaged based on urgency. The most appropriate health professional or team of professionals is then identified, offering patients access to a variety of care providers all in one location. This model ensures patients receive the right care, in the right place, at the right time.
Before this unique triage approach, patients were placed on long waiting lists for a one-time consultation with a surgeon or spine physician. Patients identified as needing surgery were fast-tracked, leaving those that did not require surgery on the wait list. “Back complaints in particular are very common, and the number of referrals that we were receiving for back-related problems was almost insurmountable,” says Dr. Nigel Clements, an orthopaedic surgeon and spine specialist at the centre. Dr. Clements, who is also the medical director of the centre says: “My skill set is focused on doing surgery, but I was spending a lot of my time wading through consultations. That imbalance created barriers for those patients who do need surgery from seeing me and put patients on a waiting list where they were not receiving any recommendations about what treatment may be beneficial to them.”
The new triage model was initiated two years ago, allowing the advanced practice physiotherapist or chiropractor to review each patient profile and determine the best treatment plan for that patient, whether surgery or a more conservative form of care. Diagnostic imaging is ordered only if required—the advanced practice physiotherapist and chiropractor have medical directives in place for ordering CT scans and MRIs—and it is then determined whether or not the patient is a candidate to see a surgeon. This decreases system pressures by reducing the number of CTs and MRIs ordered, thus freeing up resources for other patients. Since the inception of this model, unnecessary referrals to surgeons have been diverted, with over 400 patients having been assessed and treated by the advanced practitioners.
“Our role is to assess the patient and recommend effective, evidence-based treatment,” explains the Spine Centre’s advanced practice physiotherapist Anna Lee. “If the patient will not benefit from surgical intervention then we can provide an alternative treatment plan. This model allows us to expedite patients to the right care providers, while communicating the findings and recommendations back to the family physician. As a result, both the patient’s time and clinical resources are utilized more efficiently.”
The advanced practice physiotherapist and chiropractor have several years of clinical experience working with patients with spine problems, as well as months of hands-on training with the neurosurgeons, orthopaedic surgeons and radiologists in preparation for taking on this role. As a critical component of the training process, they shadowed both an orthopaedic surgeon and a neurosurgeon over the course of a year. This type of learning within an interprofessional setting provides insight into how surgical professionals approach treatment planning.
One of the key measures of success of the triage model is reduced wait times for urgent spine referrals. Approximately 90 per cent of the patients triaged at the Spine Centre do not require surgery. This lessens the burden on physicians, who can then focus on patients in immediate need of their intervention. The process is thus simplified for patients and health care providers alike, leading to improved health outcomes.
“There is great potential that this can be taken and utilized as a model across Canada to streamline the process and ensure patients are seeing the appropriate health care professional,” says the Spine Centre’s Chiropractor, Dr. David Dos Santos. “The silos of care that we’ve had in the past do not fit in the new world of health care. The system is evolving towards interdisciplinary care. Working this way improves patient diagnostics, wait times, accessibility to care and quality of life for patients. Every health care practitioner has a skill set — it’s about utilizing those skill sets for maximum benefit to the patient and the health care system.”