• Shanthi A Ramanathan, Peter D Hibbert, Chris G Maher, Richard O Day, Diane M Hindmarsh, Tamara D Hooper, Natalie A Hannaford, and William B Runciman.
• *Hunter Research Foundation, Newcastle, Australia †Australian Institute of Health Innovation, Macquarie University, Sydney, Australia ‡The George Institute for Global Health, Sydney Medical School, University of Sydney, Australia §Clinical Pharmacology & St Vincent's Clinical School, St Vincent's Hospital and University of New South Wales, Sydney, NSW, Australia ¶University of South Australia, Adelaide, Australia ||Australian Patient Safety Foundation, Adelaide, Australia.
• Spine. 2016 Nov 9.

Study DesignRetrospective medical record review to assess compliance with low back pain (LBP) care indicators.ObjectiveTo establish baseline estimates of the appropriateness of LBP care in the general Australian population provided by a range of healthcare providers in various real-world settings.Summary Of Background DataLow back pain (LBP) is a costly condition and accounts for the greatest burden of disease worldwide, yet the care provided is often at variance with guidelines. No baseline estimates of performance are currently available in Australia across various aspects of LBP care, practitioners and settings.MethodsA population-based sample of patients with 22 common conditions was recruited by telephone; consents were obtained to review their medical records against indicators ("CareTrack"). Care for LBP was reviewed against 10 indicators used in a previous study and ratified by experts as representing appropriate LBP care in Australia during 2009 and 2010.ResultsOf the 22 CareTrack conditions, LBP had the highest number of eligible healthcare encounters (6,588 of 35,573, 19%), 125-884 per indicator amongst 164 LBP patients. Overall compliance with LBP indicators was 72% (range 42%-98%). Allied health practitioners and hospitals were the most compliant (82% and 83% respectively), followed by general practitioners (54%). Some aspects of care were poor, such as documenting a thorough neurological examination, screening for serious diseases such as infection and inappropriate use of drugs such as steroids and treatments such as traction.ConclusionsOver a quarter of LBP care was not appropriate in spite of the availability of guidelines. There is a need for national and, potentially, international agreement on clinical standards, indicators and tools to guide, document and monitor the appropriateness of care for LBP, and for measures to increase their uptake, particularly where deficiencies have been identified.Level Of EvidenceN/A.

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