Back pain questionnaire cuts GP workload, study finds

A stratified back pain tool could overhaul the way GPs assess patients and reduce pressure on workload, according to research.

Back pain leads 6-9% of the working population to visit their GP each year (photo: Jason Heath Lancy)
Back pain leads 6-9% of the working population to visit their GP each year (photo: Jason Heath Lancy)

The questionnaire-based tool reduced the number of patients requesting sick notes from GPs by a third and cut levels of disability in extreme cases.

Researchers said the approach could help to reduce pressure on GPs and the NHS, as well as saving the economy millions of pounds a year.

In the study, from the Arthritis Research UK Primary Care Centre at Keele University, GPs used a prognostic screening approach called the Subgroups for Targeted Treatment (STarT) Back tool, a nine-item questionnaire to give to patients during a consultation.

Patients are then stratified to different treatments according to need, based on low, medium or high risk of persistent disabling back pain. Those at greatest risk can be swiftly referred to physiotherapists, while less serious complaints can be supported to self-mange symptoms.

Researchers found GPs prescribed fewer NSAIDs and patients reported greater satisfaction with the results of their care.

Tool challenges 'one size fits all' approach

Professor Alan Silman, medical director of Arthritis Research UK, said: ‘This exciting research shows that stratified or targeted approach to managing back pain in primary care is effective, and challenges the ‘one size fits all’ strategy that is currently recommended by national guidelines in which everyone with non-specific back pain is offered the same treatment, irrespective of their risk of persistent problems.’

Figures show 6-9% of the working population consults their GP with back pain each year, accounting for 14% of all consultations. The stratified approach could save £400 per working adult through reduced sickness absence, fewer benefit claims and cuts to health and social care costs, the researchers calculated. This amasses to a potential £700m in ‘societal savings’.

Professor Nadine Foster, lead author on the study, said: ‘This new way of managing back pain in patients will mean that healthcare resources are used more effectively, with those patients who are suitable for support to self-manage being clearly identified and those that need more in the way of treatment and support getting access to physiotherapy care earlier on.

‘This would boost the economy overall, and the financial pressures faced by the NHS are well-known, so we hope GPs and NHS commissioners take up this opportunity to improve patient care and ease that burden.’

Last year, GP reported on a programme in Sheffield that used the STarT Back tool to improve the management of back pain in general practice, which led to a 50% drop in referrals to orthopaedic surgeons.

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