COST-EFFECTIVE PROVISION OF SPINAL CARE TO A LARGE URBAN POPULATION.

Abstract

Objective: This was to analyse RLBUHT orthopaedic spinal service’s provision of spinal care and to determine the impact on the need for surgery.

Methods: This was a three-year retrospective cohort study of orthopaedic patients with spinal related problems from January 2003 to January 2006. The sample included all patients referred to the service by general practitioners in Liverpool. Patients were examined by orthopaedic musculoskeletal physiotherapists lead by senior specialist therapists. The latter had autonomy to access imaging investigations and blood tests. Patients were referred to the consultant surgeons for surgical consideration when appropriate or to the physiotherapy department for non-surgical management. Outcome measures used included the Stockport Scale, the Roland and Morris Disability Questionnaire, the Neck Disability Index, the Euroquol Questionnaire and the Visual Analogue Scale.

Results: 17,214 patients were referred to the service from January 2003 to January 2006. 9,896 patients attended, 2,600 failed to attend and 4,718 cancelled their appointments. The number of referrals increased from 4,499 in 2003 to 5,695 in 2004, and 7,020 in 2005. Patients going on for surgery remained 200 to 220 cases per annum. The waiting times to surgery decreased from 3 to 6 months, to within 3 months. An audit of 300 patients discharged from the physiotherapy department using the Stockport Scale from January 2005 to January 2006 revealed that problems were solved / goals achieved in 40.3% of patients, with significant improvement in 42.7%, some improvement in 8.3% and no improvement or no data in 8.7%.

Conclusion: Over the three-year period there has been a significant increase in the number of patients managed by this service. This has not resulted in an increase in patient waiting-time. Surgical intervention per head of population has not altered and has been sooner. Our experience demonstrates an effective model of care for large urban populations.