Primary care physicians that had access to return to work guidelines in an electronic record-integrated tool were more likely to make such recommendations to their patients with lower back pain than those without the tool, according to a study published in the Journal of Family Medicine and Primary Care.
“The main take away message from the study is that with the proper practice-based interventions through we are able to introduce a practice change within the primary care provider practice, assisting them with the return to work recommendations for their patients with lower back pain,” Ismail Nabeel, MD, MPH, of the department of environmental medicine and public health at Icahn School of Medicine, Mount Sinai Hospital, told Healio Primary Care Today. “Such recommendations are not commonly provided in the primary care setting at the point-of-care level [but] need to be considered as part of treatment and management of lower back pain.”
To conduct a nonblinded, randomized, controlled trial, researchers recruited physicians, residents, nurse practitioners and physician assistants who saw patients 18 years presented with lower back pain from the primary care offices affiliated with the study hospital system between November 2016 and March 2017.
Researchers then randomly assigned participants to either the intervention group (n = 44) or the control group (n =37). Primary care physicians in the intervention group were provided with return to work guidelines in an -integrated tool, based on an algorithm and questionnaire that assessed the patient’s level of disability.
The primary outcome of the study was whether physicians used the ER-integrated return to work tool during treatment, with 301 cases of lower back pain in the intervention group and 256 in the control group included in the analysis.
Primary care physicians that had access to return to work guidelines in an electronic record-integrated tool were more likely to make such recommendations to their patients with lower back pain than those without the tool.
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Researchers found that, in the intervention group, physicians used return to work recommendations in 7.3% of encounters. For the control group, return to work recommendations were used in 1.6% of encounters (P < .001).
“The learning point from the study is how to construct a tailored practice-based intervention for primary care providers easily implemented through at the point-of-care level,” Nabeel said. “We also need to better understand the individual provider practices and more research is needed to incorporate the return to work recommendations in primary care practice as such recommendations are almost nonexistent and more primary care providers are seeing a relatively high volume of musculoskeletal conditions. Further research is needed to develop effective solutions for the evidence-based practice guidelines to be incorporated effectively into the day to day practice.” – by Melissa J. Webb
For more information:
Ismail Nabeel, MD, MPH, can be reached at firstname.lastname@example.org.
Disclosures: The authors report no relevant financial disclosures.