Around 50,000 patients turn up to New South Wales emergency departments every year suffering from lower back pain, 70 percent of whom are given addictive opioids to treat the pain despite well-known harms.
Now, the Sydney Local Health District (SLHD), in an effort to provide better long term care to patients with back pain, has launched a new app to wean healthcare professionals off the easy pain killer option through locally-relevant data to inform their course of treatment.
The STARS (SLHD Targeted Activity and Reporting System) Back Pain App provides emrgency department clinicians with key information relevant to the management of lower back pain, while also efficiently providing a mechanism to identify and explore any clinical variation.
Through audit and continuous feedback, the app is also helping to reduce the number of patients who receive unnecessary tests and imaging services (think MRI and CT scans) which is estimated to include 30 percent of all patients who present with lower back pain.
SLHD developed the app on Qlik’s data visualisation platform, collating a strong dataset of existing options for lower back pain management coupled with patient data that typically exists in siloed datasets.
The STARS app links and displays information including demographics, diagnoses, allied health service review, pain medicines used, pathology tests, diagnostic imaging, costs of care and patients’ admission status in near-real time.
Dr Bethan Richards, director of Rheumatology at Royal Prince Alfred (RPA) Hospital and team leader for the development of the STARS app, said the multidisciplinary approach lets physicians can easily see from the data which interventions worked, which didn’t, and what can be done moving forward.
“One of the best things about this app is that each individual can ask their own questions, interrogate the data, and arrive at conclusions without doing extensive and time-consuming audits,” Richards said.
So far the app has been used at RPA, Concord Repatriation General Hospital, and Canterbury Hospital, providing clinicians with a summary of patients with lower back pain that highlights clinical variations.
It also allows healthcare professionals to compare data across hospitals, generating conversations about trends, opioid prescription rates, and overall patient care.
To reinforce the insights provided by the data, SLHD developed a set of tools to help doctors act on the information and trends they were identifying.
A new model of care was implemented, with educational resources for both doctors and patients to encourage the use of other effective and safe strategies, rather than simply using strong opioid pain-killers.
Dr Gustavo Machado, who led the emergency department trial of the app, said clinicians have so far been more likely to use the STARS app than other resources “because it gives them a view on their own real-world data”.
“The data is in front of them and ready to be leveraged. The app has already changed the way clinicians in our trial are treating patients.”
SLHD is now working on expanding the app to all NSW emergency departments with the state’s Agency for Clinical Innovation, and has commenced work with Monash University to kick off a similar project in Victoria.
A study by Monash indicated that Australia spends $4.8 billion a year managing lower back pain, and that back pain reduces Australia’s GDP by $3.2 billion each year by keeping people out of the workforce.
