Home Treatment: Changes to Mental Healthcare in Northern Ireland

Age, gender and duration of symptoms were determined, together with all treatment options/information provided to patients. 50 consecutive patients were questioned. The mean duration of LBP was 8.7 months. Average age was 45 years. The percentage of patients attending each modality is shown in table 1. No patients received all the treatment modalities, and 4% had failed to receive any prior to consultation. 78% had received two modalities at time of referral. The NICE guidelines provide evidence-based best practice for managing acute persistent LBP. They offer a strategy for primary care management prior to spinal outpatients referral. Surgery is considered only after other modalities have failed. Appropriate management of this complex patient group has the potential to minimize those with disabling long-term back pain, and reduce the personal, social and economic impact of LBP. 2 NICE identifies various multidisciplinary treatments including promoting patient self-management through advice and information. They aim to reduce the impact on a patient's day-today life, even if the pain cannot be relieved completely. 2 Only 18% of patients had received written information or advice. NICE advise referral to a combined physical and psychological treatment programme but such a service is not provided by healthcare trusts within Northern Ireland. NICE recommends acupuncture. Systematic reviews have found it a useful adjunct to conventional care. 4 In this cohort, only 12% received acupuncture. Availability of NHS acupuncture is limited in our region. Referral to a surgeon may be for advice and reassurance, and the assumption that all patients being referred should have undertaken all modalities would be unfair. Referral pathways may reflect longstanding traditional routes, possibly explaining the large percentage receiving physiotherapy compared to complementary therapies. Despite a full complement of treatments there will always be patients refractory to conservative management who may benefit from spinal outpatients referral. Further studies may determine whether greater awareness and adherence to such guidelines improves clinical outcome. At present the adherence to the guidelines is inconsistent. New guidance must be effectively disseminated among healthcare professionals to offer patients the best evidence based care and ultimately reduced the morbidity and economic impact of the condition. Treatment options proposed need to be available to the primary care physician, perhaps explaining why, within our region, such guidelines cannot be fully observed. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. home treatment: …