{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:08:47Z","timestamp":1792789727283,"version":"4.5.0"},"reference-count":65,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,1,5]],"date-time":"2024-01-05T00:00:00Z","timestamp":1704412800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Low back pain (LBP) accounts for a significant proportion of primary care visits. Despite the development of evidence-based guidelines, studies point to the inefficient use of healthcare resources, resulting in over 60.0% of patients with LBP being referred to spine surgeons without any surgical indication. Centralized waiting lists (CWLs) have been implemented to improve access to specialized care by managing asymmetry between supply and demands. To date, no study has provided data on patients\u2019 clinical profiles and referral patterns to medical specialists for LBP in the context of a publicly funded healthcare system operating a prioritization model. The objective of this study was to evaluate the appropriateness of specialized care referrals for LBP after the implementation of a CWL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective cross-sectional analysis of 500 randomly selected electronic health records of patients who attended the outpatient neurosurgery clinic of the administrative Mauricie-et-Centre-du-Qu\u00e9bec region was performed. Inclusion criteria were neurosurgery consultation referrals for adults \u226518\u2009years suffering from a primary complaint of LBP, and performed between September 1st, 2018, and September 1st, 2021. Data relevant for drawing a comprehensive portrait of patients referred to the neurosurgery service and for judging referrals appropriateness were manually extracted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 500 cases analyzed, only 112 (22.4%) were surgical candidates, while 221 (44.2%) were discharge from the neurosurgery service upon initial assessment. Key information was inconsistently documented in medical files, thus preventing the establishment of a comprehensive portrait of patients referred to the neurosurgery service for LBP. Nevertheless, over 80.0% of referrals made during the study period were deemed inappropriate. Inappropriate referrals were characterized by higher proportion of patients symptomatically improved, presenting a back-dominant chief complaint, exhibiting no objective neurological symptoms, and diagnosed with non-specific LBP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study reveals a significant proportion of inappropriate referrals to specialized care for LBP. Further research is needed to better understand the factors that prompt referrals to medical specialists for LBP, and the criteria considered by neurosurgeons when selecting the appropriate management strategy. Recent studies suggest that triaging approaches led by musculoskeletal experts may improve referral appropriateness to specialized care.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2023.1292481","type":"journal-article","created":{"date-parts":[[2024,1,5]],"date-time":"2024-01-05T05:47:17Z","timestamp":1704433637000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Appropriateness of specialized care referrals for LBP: a cross-sectional analysis"],"prefix":"10.3389","volume":"10","author":[{"given":"Janny","family":"Mathieu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-\u00c8ve","family":"Robert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claude-\u00c9douard","family":"Ch\u00e2tillon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Descarreaux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9e-Anne","family":"Marchand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,1,5]]},"reference":[{"key":"ref1","volume-title":"Canada\u2019s Health Care System","year":"2019"},{"key":"ref2","volume-title":"Improving health care","year":"2023"},{"key":"ref3","volume-title":"L\u2019acc\u00e8s prioris\u00e9 aux services sp\u00e9cialis\u00e9s","year":"2022"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1016\/j.healthpol.2020.05.023","article-title":"How the design and implementation of centralized waiting lists influence their use and effect on access to healthcare \u2013 a realist review","volume":"124","author":"Breton","year":"2020","journal-title":"Health Policy"},{"key":"ref5","volume-title":"Tableau de bord de la performance de l\u2019administration publique","year":"2019"},{"key":"ref6","volume-title":"Referral management","author":"Imison","year":"2010"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1789","DOI":"10.1016\/S0140-6736(18)32279-7","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017","volume":"392","year":"2018","journal-title":"Lancet"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"874","DOI":"10.1016\/j.spinee.2020.01.013","article-title":"Healthcare utilization and costs for spinal conditions in Ontario, Canada \u2013 opportunities for funding high-value care: a retrospective cohort study","volume":"20","author":"Rampersaud","year":"2020","journal-title":"Spine J"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2521","DOI":"10.1097\/j.pain.0000000000002239","article-title":"Effect of back problems on healthcare utilization and costs in Ontario, Canada: a population-based matched cohort study","volume":"162","author":"Wong","year":"2021","journal-title":"Pain"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2384","DOI":"10.1016\/S0140-6736(18)30488-4","article-title":"Low back pain: a call for action","volume":"391","author":"Buchbinder","year":"2018","journal-title":"Lancet"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1016\/j.physio.2012.12.011","article-title":"Direct access and patient\/client self-referral to physiotherapy: a review of contemporary practice within the European Union","volume":"99","author":"Bury","year":"2013","journal-title":"Physiotherapy"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1016\/S1529-9430(03)00152-9","article-title":"Compliance with clinical practice guidelines in family physicians managing worker\u2019s compensation board patients with acute lower back pain","volume":"3","author":"Bishop","year":"2003","journal-title":"Spine J"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1097\/j.pain.0000000000001751","article-title":"What is usual care for low back pain? 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