Tratamento estratificado para indivíduos com dor lombar nos cuidados de saúde primários

The Split Project aims to change GPs` and PTs? LBP practice through the introduction and support of a subgrouping for targeted treatment system based on risk identification. It also aims to investigate the effects of the introduction of this system on health professionals` (HP) attitudes and behaviours, care processes, patients` clinical outcomes and cost-effectiveness. The aforementioned system differs from ?one-size fits all? usual practice as it enables the LBP patients` allocation to one of three subgroups according to key modifiable prognostic indicators for chronicity. This allocation is systematically carried out by the GPs, who base their approach on a sub-grouping tool (?Start Back Tool?). This tool classifies patients into 3 risk categories, based on the presence of potentially modifiable physical and psychological prognostic indicators for persistent and disabling symptoms. The tool also supports clinical decision-making about treatment and onward referral. Patients in each sub-group are then managed according to a targeted treatment system of increasing complexity. The Split Project is based on a prospective, quality improvement study of before and after design. After ethical approval from the local ethical committee, health professionals (GPs and PTs) and LBP patients from 4 health centres and family health units (USFs) of Health Group Centre group of ACES Arrábida will be invited to participate in this study. The project includes 3 phases: the first phase involves the assessment of GPs? and PTs? attitudes and behaviours regarding LBP, care processes, clinical outcomes and costs of LBP treatments; 2) the second phase involves a multicomponent quality improvement intervention; 3) the third phase is focused on the reassessment of GPs? and PTs? attitudes and behaviours regarding LBP and reassessment of care processes, costs and effectiveness following the implementation of the new model of subgrouping for targeted treatment care. The project is based on a collaborative initiative among the School of Health Care of the Polytechnic Institute of Setúbal, Nova Medical School of the Universidade Nova de Lisboa and the ACES Arrábida that aims to improve the quality of health care services for LBP according to a framework of value-based health care delivery. Through this strategic alignment between academia and healthcare units, it is aimed to change practices and optimize the clinical outcomes and cost-effectiveness of health care services via the integration of knowledge produced at an international level. Additionally, it also aims to accomplish social challenges related to the significant impact of LBP, through the implementation of specialised health care as well as associated clinical research. The project aims to add value to health care provided in ACES Arrábida and it is expected that the knowledge and practices developed could be transferred to similar contexts.