Banca de DEFESA: Taís Luciana Lacerda

Uma banca de DEFESA de MESTRADO foi cadastrada pelo programa.
STUDENT : Taís Luciana Lacerda
DATE: 23/07/2024
TIME: 09:00
LOCAL: Microsoft Teams
TITLE:

Management of low back pain in Primary Health Care in the Federal District: investigations into the process of referral to a physical therapist and health costs

KEY WORDS:

Physical Therapy, Primary health Care, referral

PAGES: 110
BIG AREA: Ciências da Saúde
AREA: Fisioterapia e Terapia Ocupacional
SUMMARY:

Low back pain (LBP) is a prevalent condition and one of the main causes of years lived with disability worldwide. In Brazil, the prevalence of LBP has increased by approximately 30% in recent decades, generating social impact and high costs for the health system. LBP is one of the main demands of primary health care (PHC), and poses a constant challenge to health professionals. Decision making in the management of low back pain has impacts on resource use and healthcare costs. As such, current clinical guidelines prioritize non-pharmacological treatments as first line, and recommend the use of imaging tests only in the presence of red flags. However, one of the challenges has been the implementation of such recommendations. Therefore, the aim was to investigate whether the PHC interventions and health practices in Brazil are following the recommendations of clinical guidelines for the management of low back pain. Methodology:Retrospective cohort (1 year) with data from electronic medical records of people older than 18 years with LBP treated in 13 PHC units in Brasília, Brazil. We analyzed the compliance with guidelines recommendations based on information available in the records. We performed two main analyses. First, we investigated the procedures adopted during the first PHC consultation. Secondly, the participants were grouped according to care after the first consultation: G0) doctor/nurse care; G1) doctor/nurse and referral to a physiotherapist; G2) physiotherapist as first contact. The records were organized chronologically and information was extracted considering prescribed resources and referral time to physiotherapy. Data was analyzed descriptively. The proportion of participants in each group considered the total number of participants. For x-rays exams (XR) the total number of exams was the denominator. The proportion of emergency visits considered the total number of people in each group. Results: Data from 367 people were included (G0: 245; G1: 66; G2: 56), with an average age of 49 years (SD: 18). The majority was female (70.3%; N: 258), and with secondary education (44 %; N: 124). After the first consultation, only 16 (4%) people were referred to physiotherapists and 6 (2%) to other therapies. Moreover, 102 (28%) people had imaging exams prescribed in the first consultation, contrary to guidelines recommendations. Regarding the grouping analysis, in the G1, 66 (18%) people were referred to physiotherapists, with an average delay of 103 days (median: 53), and 20 (5%) referrals for other therapies (e.g., acupuncture). In total, 287 exams were requested in the sample, with XR being the most requested (62%). Referrals to specialists were frequent, specifically 93 (25%) referrals to orthopedics and 13 (4%) to other specialties, totaling 198 consultations with specialists. Emergency visits were most frequent in the G0 (77%), compared to the other groups (17% in G1, and 7% in G2). Conclusion: Our findings demonstrated that clinical practice in PHC still lacks adherence to recommendations from clinical guidelines. The procedures focused on the management of LBP were mainly centered on imaging tests and specialist consultations. Physiotherapy interventions, and other non-pharmacological treatments, were less frequently adopted. However, when individuals were referred to physiotherapists, a lower frequency of emergency care was found, though the time for referral was long. Our findings suggest further studies to investigate healthcare costs related to the management of low back pain in primary health services in Brazil, to guide decision-makers and health professionals.

COMMITTEE MEMBERS:
Externa à Instituição - FABIANNA RESENDE DE JESUS MORALEIDA - UFC
Externo à Instituição - MARCELO PEDRA MARTINS MACHADO - FIOCRUZ
Presidente - 1724901 - RODRIGO LUIZ CARREGARO
Externa ao Programa - 1710591 - SILVANA SCHWERZ FUNGHETTO - null