Effectiveness of a multifaceted intervention to improve emergency department care of low back pain: a stepped-wedge, cluster-randomised trial
| Autor: | Eileen Rogan, Laurent Billot, Danielle Coombs, James Edwards, Kirsten McCaffery, Gustavo C Machado, Rachelle Buchbinder, Bethan Richards, Kirsten Howard, Qiang Li, Christopher G. Maher, Chris Needs, Ian A. Harris, Rochelle Facer |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
business.industry Health Policy Pain medicine Psychological intervention 030208 emergency & critical care medicine Emergency department Guideline Low back pain Hospitalization 03 medical and health sciences 0302 clinical medicine Quality of life (healthcare) Health care Physical therapy Quality of Life Medicine Humans 030212 general & internal medicine medicine.symptom Medical prescription business Emergency Service Hospital Emergency Treatment Low Back Pain |
| Zdroj: | BMJ qualitysafety. 30(10) |
| ISSN: | 2044-5423 |
| Popis: | BackgroundOveruse of lumbar imaging is common in the emergency department (ED). Few trials have examined interventions to address this. We evaluated the effectiveness of a multifaceted intervention to implement guideline recommendations for low back pain in the emergency department.MethodsWe conducted a stepped-wedge, cluster-randomised trial in four EDs in New South Wales, Australia. After a 13-month control phase of usual care, the EDs received a multifaceted intervention to support guideline-endorsed care in a random order, based on a computer-generated random sequence, every 4 weeks over a 4-month period. All sites were followed up for at least 3 months. The primary outcome was the proportion of low back pain presentations receiving lumbar imaging. Secondary healthcare utilisation outcomes included prescriptions of opioid and non-opioid pain medicines, inpatient admissions, length of ED stay, specialist referrals and re-presentations. Clinician beliefs and knowledge about low back pain care were measured before and after the intervention. Patient-reported pain, disability, quality of life and satisfaction were measured at 1, 2 and 4 weeks post ED presentation.ResultsA total of 269 ED clinicians and 4625 episodes of care for low back pain (4491 patients) were included. The data did not provide clear evidence that the intervention reduced lumbar imaging (OR 0.77; 95% CI 0.47 to 1.26; p=0.29). It did reduce opioid use (OR 0.57; 95% CI 0.38 to 0.85; p=0.006) and improved clinicians’ beliefs (mean difference (MD), 2.85; 95% CI 1.85 to 3.85; pConclusionIt is uncertain if a multifaceted intervention to implement guideline recommendations for low back pain care decreased lumbar imaging in the ED; however, it did reduce opioid prescriptions without adversely affecting patient outcomes.Trial registration number ACTRN12617001160325. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|