News

The ABCp proposal overview

November 23, 2020

A proposal for the Edmonton West, Calgary West Central, Wood Buffalo and Aspen PCNs.

The problem:

Low back pain (LBP) causes more disability than any other health problem globally. As a result, the societal, healthcare, and economic costs of LBP are comparable to other prevalent conditions like cardiovascular disease, cancer and mental illness.

While evidence-based guidelines suggest effective LBP interventions are available for family physicians, they are rarely implemented due a lack of funding. As a result, Albertans experience unnecessary pain, disability, procedures and addictions — all with excessive system cost.

Our proposal:

The Alberta Back Care pathway (ABCp) provides a solution for these problems where back pain patients are seen most often — the Primary Care Network (PCN). The ABCp is a unique care pathway that provides PCN physicians with a common approach to coordinate, assess and manage their LBP patients.

Importantly, all ABCp interventions are evidence-based and provided at no-cost to patients. Our hypothesis is that evidence-based, no-cost interventions for LBP will significantly improve patient outcomes, system costs and opioid safety.

Project details and timeline:

Funding for this project is being sought through the PRIHS 6 competition sponsored by Alberta Innovates. The final application for funding is due in mid-January with notification of funding in mid-March.

If we are successful, the project will begin in the spring of 2021 but start dates are flexible. Funding for the project will be provided for 3 years with plans to sustain the project should our results be favourable. For our final application, we are polling PCN physicians about their interest in ABCp so that we can convey the desire of physicians to improve LBP care for their patients.

Pathway execution:

If you agree to take part in this study, you will be asked to utilize the ABCp in your clinical practice for all patients who present with LBP as their primary complaint. This will require you to assess patients using an established 10-minute exam that will place the patient into one of six categories: acute, subacute, chronic, chronic non-responsive, radiculopathy, or red flag referral.

Each category is derived from existing guidelines and has its own specific prognosis, evidence-based pharmaceutical and non-pharmaceutical interventions, and a list of procedures that should be avoided. In all cases, interventions are provided at no cost to the patient including referral to the GLA:D Back programs (education or education and exercise) for subacute and chronic patients. GLA:D Back programing will be provided in small-group settings at community rehabilitation centres or remotely through an established tele-health platform.

At all times, patient oversight remains with the PCN physician who will receive full reporting.

Training in pathway execution:

Enrolled physicians will be engaged in pre-implementation discussions to identify how ABCp can be adapted to their specific needs. From these discussions, customized training programs will be developed then delivered by the most desirable method (e.g. one-on-one sessions, cloud-based video vignettes). In addition, on-demand phone consultations with ABCp developers will be available 24/7.

What PCN resources are required?

Change to existing staff tasks or charting procedures are minimal and consist of offering a consent-to-contact form to LBP patients. This form requires only a signature.

At the end of each day, signed forms will then be forwarded to our research team who will do all the heavy lifting of consenting, enrolling, surveying and scheduling the patient. Enrolled patients and their physicians will be asked to complete electronic surveys from time to time to capture their ABCp experiences.

Expected gains:

We expect ABCp will create significant improvement in patient outcomes (improved pain, disability and self-efficacy), health resource utilization (reduction in recidivism, imaging and specialist referrals) and patient safety (opioid use).

For more information, please contact greg.kawchuk@ualberta.ca.


Return to News