Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association

Improving the coordination of care for low back pain patients by creating better links between acute and community services

Petra K. Staiger A C , Anna Serlachius A , Susie Macfarlane A , Sharron Anderson B , Thomas Chan B and Greg Young B
+ Author Affiliations
- Author Affiliations

A School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia.

B Southern Health Care Network, VIC, Australia.

C Corresponding author. Email:

Australian Health Review 34(2) 139-143
Submitted: 9 March 2008  Accepted: 19 November 2009   Published: 25 May 2010


This paper reports on the development of a care-pathway to improve service linkages between the acute setting and community health services in the treatment of low back pain. The pathway was informed by two processes: (1) a literature review based on best-practice guidelines in the assessment, treatment and continuity of care for low back pain patients; and (2) consultation with staff and key stakeholders. Stakeholders from both the acute and community sectors comprised the Working Group, who identified central areas of concern to be addressed in the care-pathway, with the goal of preventing chronicity of low back pain and reducing emergency department presentations. The main outcomes achieved include: the development of a new care-coordinator role, which would support a greater focus on integration between acute and community sectors for low back pain patients; identifying the need to screen at-risk patients; implementation of the SCTT (Service Coordination Tool Templates) tool as a system of referral across the acute and community settings; and agreement on the need to develop an evidence-based self-management program to be offered to low back pain patients. The benefits and challenges of implementing this care pathway are discussed.


We thank the Working Group participants: Carol Fountain, Jill Walsh, Carol Stephens, Julie Sutherland, Christine Crosby, Marie Gault, Jo House, Jane Cartlin, Erin Lee, Geraldine Millard, Louise Godbehere, and Cornelius Hickey. Funding support was provided by The Community Health-Early Intervention fund, Victorian Department of Human Services.


[1] Malmivaara A,  Hakkinen U,  Aro T,  Heinrichs ML,  Koskenniemi L,  Kuosma E, et al. The treatment of acute low-back-pain – bed rest, exercises, or ordinary activity. N Engl J Med 1995; 332(6): 351–5.
CrossRef | PubMed | CAS |

[2] Hart LG,  Deyo RA,  Cherkin DC. Physician office visits for low-back-pain – frequency, clinical-evaluation, and treatment patterns from a US national survey. Spine 1995; 20(1): 11–9.
PubMed | |  CAS |

[3] Loney PL,  Stratford PW. The prevalence of low back pain in adults: a methodological review of the literature. Phys Ther 1999; 79(4): 384–96.
PubMed | |  CAS |

[4] Australian Bureau of Statistics. National Health Survey: Summary of Results 2004–2005. Canberra, 2006.

[5] Australian Acute Musculoskeletal Pain Guidelines Group. Evidence-based management of acute musculoskeletal pain: a guide for clinicians. QLD, Australia, 2004.

[6] Merskey H , Bogduk N , eds. Classification of chronic pain: description of chronic pain syndromes and definitions of pain terms. 2nd ed. Seattle: IASP Press, 1994.

[7] Atlas SJ,  Nardin RA. Evaluation and treatment of low back pain: an evidence-based approach to clinical care. Muscle Nerve 2003; 27(3): 265–84.
CrossRef | PubMed |

[8] Von Korff M,  Gruman J,  Schaefer J,  Curry SJ,  Wagner EH. Collaborative management of chronic illness. Ann Intern Med 1997; 127(12): 1097–102.
PubMed | |  CAS |

[9] Department of Human Services. Integrated health promotion: a better way to better health. Melbourne, 2005.

[10] Centre for General Practice Integration Studies. GP–Hospital integration: what have we learnt? Sydney, 2001.

[11] Powell DG , Harris M , Perkins D , Roland M , Williams A , Larsen K et al Coordination of care within primary health care and with other sectors: a systematic review. Research Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, UNSW, 2006.

[12] Foster M , Fleming J . The Health Care System in Australia. In: Taylor S, Foster M, Fleming J, editors. Health Care Practice in Australia: Policy, Context and Innovations. Melbourne: Oxford University Press, 2008.

[13] Kodner DL,  Spreeuwenberg C. Integrated care: meaning, logic, applications, and implications – a discussion paper. Int J Integr Care 2002; 2(Oct–Dec): e12.
PubMed |

[14] Gröne O,  Garcia-Barbero M. Integrated care: a position paper of the WHO European office for integrated health care services. Int J Integr Care 2001; 1(3): e21.
PubMed |

[15] Bird SR,  Kurowski W,  Dickman GK,  Kronborg I. Integrated care faciliation for older patients with complex health care needs reduces hospital demand. Aust Health Rev 2007; 31(3): 451–61.
CrossRef | PubMed |

[16] Frampton S , Gilpin L , Charmel PA . Putting patients first: designing and practicing patient-centered care. San Francisco: Jossey-Bass, 2003.

[17] Metropolitan Health and Aged Care Services Division. Better faster emergency care: Improving emergency care and access in Victoria’s hospitals. Melbourne: Victorian Government Department of Human Services, 2007.

[18] Bensberg M,  Kennedy M. A framework for health promoting emergency departments. Health Promot Int 2002; 17(2): 179–88.
CrossRef | PubMed |

[19] Rodriguez RM,  Kreider WJ,  Baraff LJ. Need and desire for preventive care measures in emergency department patients. Ann Emerg Med 1995; 26(5): 615–20.
CrossRef | PubMed | CAS |

[20] EdTrack Data system. Low Back Pain Report May 2007. Casey Hospital, 2007.

[21] Kanter RM , Stein BA , Jick TD . The challenge of organisational change. New York: The Free Press, 1992.

[22] Weil TP. Horizontal mergers in the United States health field: some practical realities. Health Serv Manage Res 2000; 13(3): 137–51.
PubMed | |  CAS |

[23] Vondeling H. Economic evaluation of integrated care: an introduction. Int J Integr Care 2004; 4(Jan–Mar): e20.
PubMed |

[24] Australian Institute of Primary Care. Measuring health promotion impacts: A guide to impact evaluation in integrated health promotion. Melbourne: Rural and Regional Health and Aged Care Services Division, Victorian Government Department of Human Services, 2003.

[25] Werner RM,  Bradlow ET,  Asch DA. Does hospital performance on process measures directly measure high quality care or is it a marker of unmeasured care? Health Serv Res 2008; 43(5p1): 1464–84.
CrossRef |

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