Want To Refer Your Patients To RAC For LBP?

The RAC for LBP Pilot is an initiative funded by Health Canada’s Substance Use and Addiction Program (SUAP). It supports primary care providers to improve low back pain management and screen for risk of substance use, chronic pain, and mental health conditions in the general population and particularly for those who work in the construction, trades and transport sectors. 

‍

It will replicate and enhance a successful care model developed in Ontario that led to a province-wide funded Rapid Access Clinic - Low Back Pain Pilot.

Patients who meet specific referral criteria (outlined below) and whose lower back pain cannot be managed through primary care can be referred to the RAC for LBP Pilot.

‍

Inclusion criteria for the RAC for LBP Pilot:

‍

• Patients with persistent low back pain and/or related symptoms (e.g., sciatica, neurogenic claudication) that are not improving 6 weeks to 12 months from onset, or
• Patients with unmanageable recurrent/episodic low back pain and/or related symptoms of less than 12 months duration post-recurrence.

‍

In addition, it is recommended to consider referral in the scenarios mentioned above before initiating an opioid prescription, imaging referral, or specialist referral.

‍

Exclusion criteria for the RAC for LBP Pilot:

‍

• Patients with specific red flags* (see below)
• Initial low back-related symptoms < 6 weeks post onset
• Constant/persistent low back-related symptoms > 12 months post onset
• < 18 years of age
• Unmanaged established chronic multisite pain disorder
• Active low back pain related to WorkSafeBC and ICBC claim
• Active low back pain-related MVA claim
• Active low back pain-related legal claim
• Pregnant or post-partum (<1 year)
• Known fractures
• Known oncologic condition

‍

*Patients with the following emergent red flags should be referred directly to the closest Emergency Department:

‍

• Possible Cauda Equina Syndrome (saddle anesthesia about anus, perineum, or genitals; urinary retention with overflow incontinence; loss of anal sphincter tone/fecal incontinence)
• Progressive neurologic deficit
• Significant trauma 

‍

• Primary Care Providers must be enrolled in the RAC for LBP Pilot to refer patients.
• If you are a physician or nurse practitioner interested in enrolling in the RAC for LBP Pilot, please click below to register for the online training module:

• Referred patients will be offered an assessment within 4 weeks of referral. They will be matched with an advanced practice provider based on proximity to 4 physiotherapy clinics located in Fraser North (1), Fraser East (1) and Fraser South (2). The advance practice provider’s clinic will contact the patients directly to schedule an appointment.

• The advanced practice provider will provide patients with a thorough standardized assessment and develop a personalized self-management plan with the patient and their primary care provider, based on stratification of presenting mechanical low-back symptoms. The self-management plan (based on the Center for Effective Practice stratified CORE Back Tool) emphasizes education and health promotion strategies to help patients better self-manage their low back pain. Patients identified by the advance practice provders as requiring more advanced assessment and management are referred to a physiotherapy practice leader.

• Patients will be screened for risk of substance use-related harm, chronic pain and mental health conditions. Primary care providers will be notified if the patient screens positive. 

• The practice leader will review complex patients for diagnostic imaging and referral to the Interdisciplinary Consult Clinic for a coordinated review by a spine surgeon, pain specialist, and the physiotherapist practice lead for timely access to interventional procedures, surgical consultation or other specialty interventions as needed. 

• Three spinal surgeons (affiliated with the Pilot) and 2 pain specialists will provide ongoing clinical leadership to the practice leader and advanced practice providers, supporting continuous knowledge transfer and evidence-informed practice.

• The Pilot utilizes a shared-care management approach for referred patients, as no one provider can do it all.

• The RAC for LBP includes the patient’s one-hour initial assessment with an advanced practice provider and up to four follow-up appointments for patients at risk of chronic low back pain.

• The one-hour follow-up appointments typically occur in 6–12-week intervals. This will be arranged directly with the patient and shared with the primary care provider.

• The advanced practice providers and practice leader may recommend that patients see a non-spine specialist (e.g., for possible inflammatory or pain disorder issues). This recommendation will be communicated to the primary care provider responsible for arranging the necessary referral.

• If your patient screens for a mental health or substance use condition, the screening scores of these assessments will be forwarded to you for referral management as you deem appropriate.

• The Pilot will not provide patients with adjunct pharmacological or non-pharmacological therapy. It is an interprofessional shared-care model that provides evidence-informed assessment, education and personalized self-management plans. The self-management plan is to help your patient better manage their low back pain, mobility and overall physical function. Self-management plans include advice on staying active and instruction on exercises and modified activities as needed.

• While the advanced practice providers will not provide patients with treatments, they will educate them on their condition. They may recommend evidence-informed adjunctive hands-on or other available non-pharmacological treatments as indicated to enable self-management.

• As part of the shared-care model, primary care providers will be informed of the recommended course of treatment for management of low back pain for each patient.

• The patient’s referring primary care provider will receive a consultation note post-assessment outlining the patient’s clinical presentation, risk/prognostic factors, individual self-management plan (including activity/work modifications) and next steps, including recommended follow-ups or additional referral recommendations.

• For complex patients, the advanced practice provider, practice leader, and primary care provider are encouraged to initiate further discussions regarding the consultation and any items needing clarification and to address identified concerns.

• Please refer to the RAC for LBP Pilot website for program information and patient and provider resources at www.fhraclbp.org.

If you have any questions concerning the RAC for LBP Pilot, contact the Central Intake Office by calling 778-757-1302 or Mark Joe, operations manager, Initium Centre for Pain Medicine, raclbp@initiumcpm.com.

‍

Mark will ensure that you are connected to the FH Clinical Pain Lead (Brenda Poulton) and the RAC for LBP Pilot Coordinator (Gerry O'Hanley) as required.