Grant: Team Grant: Community-Based Primary Healthcare - LOI

It is estimated that 50-80% of the adult population will experience LBP in their lifetime. Although, generally acknowledged as having a favorable prognosis, growing evidence suggest that LBP is a chronic remitting and relapsing condition for many. It is this group that incurs the largest costs in terms of healthcare utilization and loss of productivity within the LBP population. In Canada, medical expenditures with respect to LBP are estimated between $6 and $12 billion annually. Canadian patients with LBP who seek care are faced with a choice of healthcare and provider options, with little or no collaboration between providers, often leading to fragmented patient care. Treatment results for patients with non-specific LBP in general, when managed as a single group, are suboptimal. Current research suggests that a more specific approach to the management of LBP could lead to tailored treatments and improved outcomes. The Saskatchewan Ministry of Health has recently developed the Saskatchewan Spine Pathway, which involves training primary care providers (family physicians, physiotherapists, and chiropractors) in a systematic pathway of care for all LBP patients who present for treatment. The Ontario Ministry of Health and Long Term Care has recently approved a pilot study to explore the effect of a shared care model using standardized assessment of LBP patients by allied health professionals (physiotherapists, chiropractors, and occupational therapists). Neither model of care has been comprehensively evaluated. We propose to assess the Ontario model with a randomized controlled trial, and the Saskatchewan model, given that it has already been widely implemented, with an observational study. If the use of inter-professional shared care is effective in improving LBP-related outcomes, our research proposal will provide essential evidence to support a fundamental change in the management of LBP in Canada.