What is the optimal system of care for low back pain?

    The optimal system of care for low back pain is a blueprint for action which proposes the development of a community-based system to optimise the delivery of low back pain care in South Australia. It offers particular benefit to rural and regional areas that are disproportionately disadvantaged under the current models of care.

    The components for improved care highlighted in the system include:

    • Central triage hotline to support service navigation and early assessment, management, and review.
    • Community care hub(s) in areas of most need that are staffed by a multidisciplinary care team (e.g. exercise physiologist, medical practitioner, occupational therapist, pharmacist, physiotherapist, psychologist, specialist nurse etc.).
    • Enhanced patient education through pain coach roles and an emphasis on supported self-management to empower individuals in their care journey.

    What does it look like?

    Refer to the Documents section to view the optimal system of care for low back pain.

    Why do we need it?

    Data from the South Australian electronic medical record indicates that low back pain is the primary pain-related reason that people present to an Emergency Department. This is associated with disproportionately high rates of SA hospital admissions (SA=31%) compared to national (NSW=17%) and international (Canada=<10%) peers. Once patients are in the Emergency Department, the primary treatment was found to be biomedically focused, including provision of opioid medication, which was followed by discharge. Most patients received limited allied health input. This represented an estimated annual economic impact of around $3.5 million across the hospital sites included in the data analysis.

    Best-practice clinical guidelines emphasise that low back pain should be managed in community settings where early intervention (especially from allied health input), patient education, and timely follow-up can be provided, and self-management supported. The lack of community-based options for low back pain care inadvertently directs activity and associated costs to publicly funded hospitals.

    Redesigning a more appropriate and consistent care system for low back pain is needed to optimise health service delivery and improve patient experiences and outcomes, including quality of life.

    What will it do?

    The optimal system of care intends to support delivery of more effective care in the most appropriate clinical setting for people experiencing low back pain. It aims to reduce demand on the acute health sector by providing alternative care for low back pain at the community level, which is informed by contemporary principles of pain management and pain science. This in turn will assist in dealing with the pressures on our hospitals, including ambulance ramping.

    In doing so it will:

    • improve quality of life and wellbeing of people experiencing low back pain, and their families and care-givers,
    • better support our health care professionals and general practitioners, and,
    • better support our hospital systems.

    Who is it for?

    It is for everyone aged 16 years or older who experiences low back pain.

    How will it be implemented?

    This consultation process is the first critical step towards improving the way that care for low back pain is delivered in South Australia. It will articulate the optimal system of care needed to best support people experiencing this condition.

    It is important to note that funding has not yet been allocated. Once the optimal system of care is finalised, implementation will require resourcing and will need to involve a range of stakeholders across the healthcare system.

    To support this process, the optimal system of care has been strategically designed to enable complete or staged implementation, so can be adapted to suit a range of potential funding models.

    This could include, for example:

    • creation of standalone low back pain care services,
    • co-location of low back pain care hubs with existing health services or hospital avoidance centres, and,
    • virtual care options to extend in person services.

    Where can I find information on the clinical care guidelines for low back pain?

    The Australian Commission on Safety and Quality in Health Care released the Low Back Pain Clinical Care Standard in 2022. The standard describes the care that you can expect to receive at a primary healthcare provider or a hospital emergency department with a new episode of low back pain. This could be new pain or a flare-up of an ongoing problem.

    The standard provides a road map for healthcare practitioners to help patients manage low back pain episodes early and reduce their chance of ongoing problems. The package of information includes a guide for consumers.

    The Low Back Pain Clinical Care Standard contains eight quality statements:

    1. Initial clinical assessment
    2. Psychosocial assessment
    3. Reserve imaging for suspected serious pathology
    4. Patient education and advice
    5. Encourage self-management and physical activity
    6. Physical and/or psychological interventions
    7. Judicious use of pain medicines
    8. Review and referral.

    What does it mean for the role of the general practitioner (GP)?

    The proposed optimal system of care for low back pain is not intended to replace existing services. It is intended that the GP will remain the central point of coordination for care.

    Who developed the draft proposal?

    Broad consultation has occurred across the sector. Three sector workshops were held in 2021-22 to support the initial conceptualisation of the model. This included more than 100 participants across the three sessions, including representatives with lived experience, clinicians, researchers, and health system leaders.

    The draft proposal was then informed and developed by a diverse working group that included consumers, clinicians, healthcare professionals, researchers, and industry experts from across the public and private healthcare sector.

    How can I provide feedback?

    There are a number of ways you can provide feedback on the proposed optimal system of care for low back pain:

    • Take our survey and answer some short questions. The survey should take about 10 - 15 minutes to complete, depending on how you choose to answer the questions. 
    • Provide a comment in the guest book.
    • Share your story about your experience with accessing and/or receiving care for low back pain in South Australia.