'I'm not in GP pain, I'm in hospital pain': Qualitative study regarding patient decision-making factors in seeking care in the emergency department with non-specific low back pain

Objective: To investigate factors contributing to the decision for a working age adult experiencing non-specific low back pain (NSLBP) to seek care at an Australian metropolitan tertiary ED.

Methods: Participants triaged with NSLBP were recruited from one metropolitan tertiary Australian ED. We employed a qualitative descriptive methodology using semi-structured interviews to collect data. The short-form Orebro musculoskeletal pain screening questionnaire was administered pre-interview and used to inform discussion of psychosocial factors in the interview.

Results: Patient perception and interpretation of their low back pain symptoms was the most important participant decision-making factor. This was part of the care-seeking decision for all participants. Convenience of care accessed in the ED was also important with many participants aiming to avoid multiple appointments in primary care settings while in pain or attending ED because it was close to home. Participants expected high-quality care in the ED and often did not identify an alternative in primary care they believed could provide an equivalent standard of care. Few participants were advised to attend ED by a GP or physiotherapist, but when given, this advice was a critical factor.

Conclusions: Patient beliefs about NSLBP are important drivers of ED care seeking. Evidence-based guidelines recommend screening for red flags and then addressing pain and disability through engagement with patient concerns and providing a management plan/pathway. In the ED setting, addressing the anxieties of these patients and re-interpreting the significance of their pain may be a path to providing time efficient high-value care.