School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
Physiotherapy Department, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.
BMJ Open. 2024 Mar 12;14(3):e082668. doi: 10.1136/bmjopen-2023-082668.
Management guidelines for low back pain (LBP) recommend exclusion of serious pathology, followed by simple analgesics, superficial heat therapy, early mobilisation and patient education. An audit in a large metropolitan hospital emergency department (ED) revealed high rates of non-recommended medication prescription for LBP (65% of patients prescribed opioids, 17% prescribed benzodiazepines), high inpatient admission rates (20% of ED LBP patients), delayed patient mobilisation (on average 6 hours) and inadequate patient education (48% of patients). This study aims to improve medication prescription for LBP in this ED by implementing an intervention shown previously to improve guideline-based management of LBP in other Australian EDs.
A controlled interrupted time series study will evaluate the intervention in the ED before (24 weeks; 20 March 2023-3 September 2023) and after (24 weeks; 27 November 2024-12 May 2024) implementation (12 weeks; 4 September 2023-26 November 2023), additionally comparing findings with another ED in the same health service. The multicomponent implementation strategy uses a formalised clinical flow chart to support clinical decision-making and aims to change clinician behaviour, through clinician education, provision of alternative treatments, educational resources, audit and feedback, supported by implementation champions. The primary outcome is the percentage of LBP patients prescribed non-recommended medications (opioids, benzodiazepines and/or gabapentinoids), assessed via routinely collected ED data. Anticipated sample size is 2000 patients (n=1000 intervention, n=1000 control) based on average monthly admissions of LBP presentations in the EDs. Secondary outcomes include inpatient admission rate, time to mobilisation, provision of patient education, imaging requests, representation to the ED within 6 months and healthcare costs. In nested qualitative research, we will study ED clinicians' perceptions of the implementation and identify how benefits can be sustained over time.
This study received ethical approval from the Metro North Human Research Ethics Committee (HREC/2022/MNHA/87995). Study findings will be published in peer-reviewed journals and presented at international conferences and educational workshops.
ACTRN12622001536752.
针对腰痛（LBP）的管理指南建议排除严重的病理情况，然后采用简单的镇痛药、浅表热疗、早期活动和患者教育。在一家大型都市医院急诊部（ED）进行的审计显示，LBP 药物处方推荐率高（65%的患者开了阿片类药物，17%的患者开了苯二氮䓬类药物），住院率高（20%的 ED LBP 患者），患者活动延迟（平均 6 小时），以及患者教育不足（48%的患者）。本研究旨在通过实施一项先前已被证明能改善澳大利亚其他 ED 中 LBP 管理的指南的干预措施，来改善 ED 中 LBP 的药物处方。
一项对照性中断时间序列研究将在实施前（24 周；2023 年 3 月 20 日至 2023 年 9 月 3 日）和实施后（24 周；2024 年 11 月 27 日至 2024 年 5 月 12 日）评估 ED 中的干预措施，另外还将与同一卫生服务机构的另一家 ED 进行比较。该多组分实施策略使用正式的临床流程图来支持临床决策，并通过临床医生教育、提供替代治疗方法、教育资源、审核和反馈来改变临床医生的行为，由实施冠军提供支持。主要结局指标是通过常规收集的 ED 数据评估的开具非推荐药物（阿片类药物、苯二氮䓬类药物和/或加巴喷丁类药物）的 LBP 患者的百分比。根据 ED 中 LBP 就诊的平均每月入院人数，预计样本量为 2000 名患者（n=1000 名干预组，n=1000 名对照组）。次要结局指标包括住院率、活动时间、患者教育提供情况、影像学检查请求、6 个月内到 ED 的就诊情况以及医疗保健费用。在嵌套的定性研究中，我们将研究 ED 临床医生对实施的看法，并确定如何随着时间的推移维持效益。
这项研究得到了 Metro North 人类研究伦理委员会（HREC/2022/MNHA/87995）的伦理批准。研究结果将发表在同行评议的期刊上，并在国际会议和教育研讨会上展示。
ACTRN12622001536752。
