The Alberta Back Care Pathway: The feasibility of implementing a novel care pathway to improve low back pain management for family physicians in primary care

by Brandyn Powelske, Alice Kongsted, Allyson Jones, Gregory Kawchuk

Background

Family physicians in Canada’s universal healthcare system often manage low back pain patients using interventions not recommended in clinical guidelines, such as pharmaceuticals, imaging and spinal injections, while guideline-based treatments like education and exercise remain unfunded. The Alberta Back Care pathway was developed to address this gap, offering funded, evidence-based care for low back pain patients in 5 streams (acute, sub-acute, chronic, chronic non-responsive and stable radiculopathy).

Objective

To evaluate the feasibility of implementing the pathway in two urban Primary Care Networks in Alberta, Canada.

Materials and methods

Each of the 5 pathway streams provided physicians with information scripts, no-cost interventions (pharmaceuticals and otherwise) and interventions to avoid. From April 2021 to November 2023, the RE-AIM framework was used to assess implementation feasibility of the pathway.

Results

For the RE-AIM dimension of reach, 25% (n = 41/162) of eligible family physicians in Primary Care Network “A” and 12% (n = 26/221) in Primary Care Network “B” enrolled in the study. Over half of enrolled physicians (n = 21/41 and 21/26) referred at least one patient with most referrals to the GLA:D Back program for chronic low back pain stream (93% in network “A” and 88% in network “B”). Implementation, evaluated as the proportion of referrals by physician compared to their total low back pain caseload, was low (> 0–10% referred) for 52% (n = 11/21) of physicians in network “A”, and medium-low (10–25% referred) for 52% (n = 11/21) of physicians in network “B”. The number of pathway-appropriate patients in each physician’s caseload was unknown. Maintenance at 12 months was 56% (n = 10/18) in network “A” and 39% (n = 7/18) in network “B”.

Conclusion

The Alberta Back Care pathway was feasible to implement during the pandemic and primarily serving patients with chronic low back pain by providing access to a guideline-based education and exercise group program (GLA:D Back).