Two years ago, Belleville Nurse Practitioner Led Clinic (NPLC) was one of seven sites implementing Ontario’s Primary Care Low Back Pain Pilot Program. Since then, the way care is being provided to patients has changed.
Ontario Health had a chance to catch up with Karen Clayton-Babb, Chief Nurse Practitioner/Clinic Director, to get an update on the program and find out how the team is adapting to virtual low back pain care given our “new reality.”
When we spoke to Belleville NPLC two years ago, you were one of seven sites implementing Ontario’s Primary Care Low Back Pain Pilot Program. Can you describe where you are now?
A year ago, the pilot funding we were receiving became part of our base funding and was integrated into our budget, which we’re very delighted about. We continue with our model of inter-professional care to holistically support patients experiencing low back pain.
The patients we see are often complex with four or more chronic conditions and multiple medications. Many patients are also living with mental health and addiction issues and may have challenges with housing and other social determinants of health. This makes our inter-professional care model so critical since it provides the opportunity to address these social determinants of health when they are identified.
Who is part of your inter-professional team?
Our team includes nurse practitioners, a social worker, chiropractor, pharmacist, registered nurses, and a registered dietitian – all of whom support patients with various aspects of care whether it involves weaning off of narcotics, supporting patients with financial or housing challenges, or supporting nutritional health. All of which can affect a person’s ability to cope with their low back pain.
We also partner with our local hospital, pharmacies, and home and community services. We have a relationship with our local YMCA to provide access to an exercise program at a subsidized rate for eligible patients.
Can you describe how your practice has changed due to the pandemic?
Initially when the pandemic hit, we needed to move most of our patients to virtual care, which we provided via telephone. We divided our team into groups and rotated working in the office and at home. We were then able to work with patients that needed to come in for physical assessments.
We had a list of all patients in the Low Back Pain Program and our chiropractor called everyone to check to see how they were doing with pain. Based on the response, the chiropractor would advise on exercises and if needed, would recommend an in-person visit if they were not coping well.
The population we serve has a number of older patients with mental health conditions, and primarily, anxiety was increased in this period, so we called them regularly for wellness checks just so they knew we were here for them. The team would even refer patients to the dietitian who partnered with the local food bank to deliver food hampers if patients could benefit from this.
In April of this year, we implemented video virtual consultation through our EMR, which was pretty easy to use. A link is generated that can be sent to patients via email. Most patients have a phone with a camera so there usually weren’t many issues with access. This was especially helpful for our chiropractor so that he could conduct an assessment while seeing the patient, demonstrate exercises, and request a return demonstration when appropriate
When COVID-19 cases started to decline, we slowly transitioned back into office. Currently 50% of our visits are via teleconference and 50% are face-to-face. Video consults have gone down. The chiropractor is able to see patients with low back pain in person so the need for video or telephone consults declined.
Were there any challenges you faced?
The rate that things were changing was the most challenging. What made things work was our great tight-knit team. Everyone really rose to the challenge.
The team was very flexible and were willing to deal with technical challenges, transitioning to working from home, and rotating into the office for in-person care. Our team did what they had to do and that allowed us to get up and running quickly.
Do you use the Low Back Pain Quality Standard in your practice?
We certainly do. The Low Back Pain Quality Standard informs our low back pain practice. As the quality standard recommends, we ensure that patients receive a comprehensive assessment. We use the CORE Back Tool which is embedded in our EMR as a custom form. The chiropractor will use/review the CORE Back Tool as part of his assessment and follow up.
We also ensure that diagnostic imaging is only ordered when there are red flags suggesting pathological disease. We focus on patient education and self-management while providing psychosocial support and discussing the pros and cons of pharmacological options.
Evidence-based care is the backbone of our work and the Quality Standard helps us to provide this high-quality care.
What other supports or resources do you use?
We use the ISAEC patient tools daily, particularly the patient exercise handouts and videos. Patients find the handouts easy to understand and follow. Having the videos available for the more complicated exercises is invaluable!
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