Primary Care Provider Frequently Asked Questions

You can refer to the program by completing a one-time registration that collects the information needed to register you to a provincial digital platform for managing low back pain care. The platform streamlines referrals, coordinates care with community-based Advanced Practice Providers (APPs), and escalates cases to specialists when necessary.

With early management and mitigation of chronic lower back pain as its main goals, this proven shared-care model is designed for patients and reinforces their relationship with their Primary Care Provider.

This pathway is appropriate for patients with a wide variety of non-emergent lumbar diagnoses and presentations (< 1 year in duration or those with recurrent episodic low back pain) and addresses issues ranging from most non-urgent disc conditions, spinal stenosis, and axial / non-specific back pain.

Inclusion criteria for RAC-LBP program:

• Patients with persistent lower back pain and/or related symptoms (e.g., sciatica, neurogenic claudication) that are not improving 6 weeks to 12 months from onset

OR

• Patients with unmanageable recurrent episodic lower back pain and/or related symptoms of less than 12 months duration post-recurrence.

In addition, it is recommended to consider referral in the above-mentioned scenarios prior to initiation of an opioid prescription, imaging referral, or specialist referral.

Exclusion Criteria for RAC-LBP program:

• Patient with RED FLAGS*
• Initial low back related symptoms <6 weeks post onset
• Constant/persistent LBP-related symptoms >12 months post onset
  <18 years of age
• Unmanaged established chronic multisite pain disorder
• Unmanaged established narcotic dependency
• Active LBP-related WSIB claim
• Active LBP-related motor vehicle accident claim
• Active LBP-related legal claim
• Pregnant/post-partum patients (<1 year)

* Patients with the following emergent red flags should be referred directly to the closest Emergency Department:

• Possible Cauda Equina Syndrome (saddle anesthesia about anus, perineum or genitals; urinary retention with overflow incontinence; loss of anal sphincter tone/fecal incontinence)
• Progressive neurologic deficit
• Significant trauma

Rapid Access Clinics for Low Back Pain follow an inter-professional shared-care model where patients may be seen by one or more providers, who are part of the care team, based on the patient’s presentation and clinical needs.

Patients will be initially assessed by an Advanced Practice Provider (specially trained community-based physiotherapists or chiropractors) in the community close to their home. The APP will provide your patient with a thorough standardized assessment as well as create a personalized self-management plan to help them better manage their low back pain.

Those patients deemed potential surgical candidates will be referred by the APP to a Practice Leader for further assessment and management. Practice Leaders are hospital-based health professionals (chiropractors, physiotherapist or nurse practitioners) who receive advanced training from spine surgeons to manage potential surgical candidates.

The Practice Lead will order diagnostic imaging (e.g. MRI), recommend appropriate advanced interventions (e.g. spinal injections), and refer patients for a consultation with a spine surgeon when indicated. The Practice Lead is typically more centrally co-located at the surgeon(s)’ institution and acts as regional clinical program manager who: (1) oversees the community-based aspects of the program performance and quality; and (2) works closely with the spine surgeon(s) who are part of the RAC-LBP pathway.

A Surgeon Sponsor (a physician spine specialist) supports the management of surgically appropriate patients identified by the Practice Lead and provides ongoing clinical leadership for the Practice Lead and APPs supporting ongoing knowledge transfer and evidence-informed practice.

The program utilizes a shared-care management approach for referred patients as no one provider can do it all. The patient’s Primary Care Provider plays an integral part in the management of their patient’s progress in relation to the treatment goals. If no clinical improvements are realized, the RAC-LBP care team will be there to further evaluate and manage patients.

Advanced Practice Providers will provide one or more follow-up appointments for patients identified as being at risk of chronic low back pain (e.g., those with complex presentation including yellow flags or opioid dependency).

If there is an indication for referral to a non-spine specialist (e.g. for possible inflammatory or pain disorder issue), the Primary Care Provider will receive this recommendation from the APP or Practice Lead to arrange the necessary referral.​ ​

The program will not provide patients with adjunct pharmacological or non-pharmacological therapy. It is an interprofessional shared care model that provides evidence informed assessment, education and personalized self-management plan. The self-management plan is to help your patient better manage their low back pain, improve their mobility and improve their overall physical function. Self-management plans include advice on the importance of staying active as well as instruction on exercises and modified activities as needed.
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While the Advanced Practice Providers will not provide your patients with treatment, they will educate them on their condition and may recommend evidence informed adjunctive hands-on or other available non-pharmacological treatments as indicated to enable self-management.

Primary Care Providers will complete and submit a standardized Rapid Access Clinics for Low Back Pain referral form to the Central Intake office in their Local Health Integrated Network.

Referred patients will be offered an assessment in approximately four weeks and will be matched with an Advanced Practice Provider based on location proximity and availability. The APPs office will contact the patient directly to schedule an appointment.

The referral process is automated using an electronic Case Management System and patients are automatically matched with the closest APP via their home postal code. Auto-matching patients with APPs helps minimize both travel time and wait time for the first appointment. In some circumstances, patients may be manually matched to a different provider due to a specific preference (e.g., closer to work or provider gender). These specific preferences should be noted on the referral form.

​The patient’s referring Primary Care Provider will receive a consultation note post-assessment outlining the patient’s clinical presentation, risk/prognostic factors, individual self-management plan (including activity/work modifications) and next steps, including any recommended follow-ups or additional referral recommendations.
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In this shared-care model it is important to maintain good communication between all providers involved in the patient’s care. For complex patients, the Advanced Practice Provider, Practice Lead, and the Primary Care Provider are encouraged to initiate further discussions regarding the consultation, any items needing clarification, and to address identified concerns.

Only primary care providers can currently refer into this program (Family Medicine Physician, Sports Medicine Physician or Nurse Practitioner in a family practice in Ontario).

If you are a community Physiotherapist, Chiropractor or Physician Specialist with a patient who would benefit from further LBP assessment and management, there is a form you can use to communicate with the patients’ primary care provider regarding registration and referral to the RAC-LBP program. The form can be found on the “Refer to RAC-LBP” page of the website.