Better Value Healthcare

The Fourth Atlas of Healthcare Variation was released by the Australian Commission on Safety and Quality in Health Care and the Australian Institute of Health and Welfare a couple of week ago.

This reporting series explores how healthcare use in Australia varies depending on where people live. It investigates reasons why certain treatments and health outcomes are higher or lower than what is expected and outlines what can be done to reduce unwarranted variations.

One area raised in the Atlas relates to lower back pain.

The Fourth Atlas recommends that priority should be given to examining and improving access to services that provide multidisciplinary review and non-surgical treatments for chronic lower back pain. The report also highlights the need for more pain specialists and the importance of multidisciplinary care; raises questions about the long wait times to see a pain specialist; and potential cost savings that could be made from using a best practice approach to pain management for low back pain, rather than low value surgical options.

The Atlas suggests utilising alternative treatment options for lower back pain, over surgical options. The Atlas highlights several factors that could contribute to variations in surgical options for lower back pain:

• potentially low-quality evidence and lack of established guidelines which lead to variations in practice that influence clinical decision making and over utilisation of surgical options.
• patients may not be aware of the uncertainties about the benefit of surgery for treating chronic lower back pain and have expectations that surgery will solve the problem, and
• alternatives to surgery may not be affordable or accessible to some consumers and that private health insurance provides access to spinal fusion but may not cover non-surgical treatments.

One key recommendation in the Atlas is to map the services in the pain space. This may go some way to ensuring that Australians have and are aware of alternative options to surgery and that surgery will only be used when it has a high probability of being effective.