Aaron Downie

Low back pain is a major cause of disability and a common symptom for people with arthritis. People with low back pain commonly seek help from their community pharmacist.

This project, supported by Arthritis Australia through the Zimmer Biomet Australia Grant, aims to assist pharmacists to provide high quality care and information for patients who present with low back pain, through creation of customised evidence-based advice. This will be achieved using a decision support tool.

An Apple iPad App has been designed for use in community pharmacy, and is undergoing assessment prior to testing within pharmacies across the Sydney metropolitan area. Sufferers of low back pain in the community often do not receive the best advice to manage their pain effectively. Community pharmacists can play an important role for patients as pharmacists are easily accessible and are well placed to provide effective care for low back pain. However, a recent study found that pharmacists offered inadequate self-care advice, or failed to identify what types of low back pain presentations may require prompt medical review.¹ The aims of this pilot research are to test the acceptability, and potential impact of the latest evidence-based advice as generated by a custom iPad App to assist pharmacists manage low back pain.

To create a decision support tool for pharmacists, multiple and sometimes contrasting design goals had to be met simultaneously. We needed to balance the competing aims of gathering enough information from the patient to provide high quality customised advice, while also ensuring the process was quick enough to be practical for pharmacists to use. The key questions needed to gather the critical information were: have you already consulted a pharmacist for this episode of back pain, what is the pain duration, is the pain is getting better or worse, what current medications are being taken and, questions relating to the possibility of serious disease. As a result, we designed the iPad App to work within the normal flow of a pharmacist-patient interaction. The iPad App has been designed to help pharmacists make the best decisions, not be a substitute for thinking or be overly prescriptive with advice. Finding the right balance has required multiple phases of consultation between health researchers, pharmacists, consumer representatives, and our computer programmer. We also discovered the need to be very careful in language used, in order to optimise patient understanding of the advice generated by the App. The final App has been designed so most of the output advice is generated automatically based on the patient’s responses but the pharmacist can override or modify this advice as they choose. Key messages such as staying active, avoiding bed rest, and using a heat wrap can be conveyed simply and effectively to improve symptoms, empower patients, and potentially decrease medication use. Development and refinement of computer coding has been completed, and the design of the interface for the iPad is in the final stages of usability testing. We will then test the App in the community pharmacy setting. A key barrier to improving the health of patients with musculoskeletal disease is how to offer evidence-based advice that is both accurate and easy to follow. Our research supports the pharmacist to deliver the latest evidence-based advice regarding self-care strategies, medicine choice, and referral advice within a single visit. Empowering patients with this advice will help to reduce the burden of low back pain in society. We will be continuing this project, and will use the results from the current study to further refine the iPad App whilst testing within community pharmacy. Future research can include clinical trials to test the effectiveness of the advice generated by the App, compared to other types of care, when patients present with low back pain.