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Implementation of a model of care for low back pain produces sustained reduction in opioid use in emergency departments
  1. Caitlin MP Jones1,2,
  2. Danielle Coombs1,2,
  3. Chung-Wei Christine Lin1,2,
  4. Adrian Traeger1,2,
  5. Qiang Li3,
  6. Christina Abdel Shaheed1,2,
  7. Sweekriti Sharma1,2,
  8. Chris G Maher1,2,
  9. Gustavo C Machado1,2
  1. 1 Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  2. 2 Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, New South Wales, Australia
  3. 3 The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Caitlin MP Jones, Level 10N KGV Building Missenden Road, Camperdown, New South Wales, Australia; Caitlin.jones{at}

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Low back pain (LBP) is one of the most common reasons for presentation to emergency departments (EDs) internationally,1 and the majority of people presenting are prescribed an opioid.2 3 Tackling overprescribing of medicines is a health priority.4 We recently completed the SHaPED trial5 that evaluated the implementation of an evidence-based model of care for LBP in four EDs in Sydney, Australia, with 269 clinicians and 4625 patient presentations. The intervention aimed to reduce unnecessary care for LBP and resulted in an absolute reduction in opioid prescribing of 13.4% (from 64.6% to 51.2%) across the three of four original hospitals included in this time series (12.3% in the short-term SHaPED analysis which included four EDs), with no deleterious effect on patient outcomes such as pain, function and satisfaction with care. The follow-up period of SHaPED was short (3 months). In this study, we examined how long the reduction in opioid use was sustained for.

The implementation of the model of care included clinician training, …

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  • Handling editor Steve Rothrock

  • Twitter @Caitlin_Jones_, @SweekritiSharma, @gustavocmachado

  • Contributors CJ: conceptualisation, investigation, project administration, visualisation, writing original draft. CWC-L, CGM and CAS: conceptualisation, investigation, project administration, visualisation, supervision, writing, review, editing. SS and DC: conceptualisation, writing, review, editing. QL and AT: conceptualisation, investigation, formal analysis, validation and writing, review, editing. GM: conceptualisation, investigation, project administration, formal analysis, validation, writing, review, editing.

  • Funding C-WCL (APP1193939) and CGM (APP1194283) are supported by fellowships from Australia’s National Health and Medical Research Council. This was an investigator-initiated study funded by Sydney Health Partners and the NSW Agency for Clinical Innovation.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note Reproducible Research Statement: Statistical code: Available on request from Dr Machado (e-mail, Dataset: Access to the anonymised data is on application to the Sydney Local Health District Human Research Ethics Committee.