Developing a needs-based integrative service delivery model to deliver best practice care for chronic nonspecific low back pain

Introduction: Evidence suggests an integrative, biopsychosocial approach to managing chronic nonspecific low back pain (CLBP) may help address the complex, unmet healthcare needs of people living with CLBP. Notwithstanding, the translation of this approach into primary care settings has been largely overlooked. This study aimed to develop, and reach consensus on, a needs-based integrative service delivery model to provide best practice care for people living with CLBP in a primary care context. 

Methods: The study comprised four stages: (a) translate practice guidelines into competencies; (b) map competencies onto healthcare occupations; (c) align competencies/occupations to an integrative health care framework; and (d) operationalise the framework by defining a high-level clinical pathway. A modified nominal group technique, comprising seven experts from different disciplinary backgrounds, reviewed and provided feedback on the outputs of each stage of the study. Facilitated discussions were undertaken to reach consensus on each output.

Results: Practice guidelines were translated into ten competencies, which were mapped to 25 distinct occupations. The competencies/occupations aligned with all 22 elements of the integrative healthcare framework, which were used to develop a high-level, four-stage clinical pathway. Following minor amendments, the nominal group reached consensus on all outputs of the study. 

Conclusions: This research used a novel design to develop a needs-based integrative service delivery model to facilitate the translation of an integrative, biopsychosocial approach for CLBP management into primary care. The next step of this research will be to test the acceptability and feasibility of the model in a primary care setting.