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PILOT STUDY ON THE IMPLANTATION OF HABITUAL USE OF NRT IN THE NATIONAL HEALTH SYSTEM

Title.

Transfer of research on the use of neuroreflexotherapy (NRT) for the treatment of mechanical pathologies of the spine to the National Health System's routine practice. Results of a Pilot program.

Background.

Previous studies have shown the safety, efficacy and effectiveness of NRT for the treatment of non-specific low back pain, as well as the cost/effectiveness of its implantation in the National Health System when it is organized through referral to Kovacs Back Units, that is, to specialized units subjected to various mechanisms of quality control.

On this basis, it was determined to implant this technology in the setting of the Spanish National Health System and to evaluate the means of implantation and the results this technology obtained when routinely applied (and not in an experimental manner, as had been evaluated up until then). Additionally, to plan the application of this technology to the whole of the Spanish National Health System, it was thought prudent to begin with its implantation in a specific territory, as a pilot experience, and to gather the information needed to be able to plan its extension to the rest in a reasonable manner.

Objectives.

To evaluate the system of implanting NRT referral in Health Centers, quantifying:

1. The demand that the inclusion of neuroreflexotherapy generates among available health technologies to cover the care of patients with mechanical pathologies of the spine. With that aim, to determine:

   1. The number of patients referred to NRT from the Health Centers of the Health Service of the Balearic Islands (Ib-Salut).

   2. The rate of patients sent (proportion between referral patients and the population covered by each Health Center).

2. The functioning of the established referral mechanisms, determining:

   1. The rates of appropriate and inappropriate reference.

   2. The degree of referral patient and referring physician satisfaction.

   3. The rate of rejection of NRT.

3. Gather additional information on the routine use of this technology:

   1. Study the possible side effects that could have been overlooked in the previous studies that were made with smaller samples and under experimental conditions.

   2. Study the clinical outcomes this technology obtains when applied in routine conditions, to determine their consistence with those observed in the evaluation phase.

Methodology.

It was a pilot study in which a technology was introduced in a systematic way in the National Health System and a cohort of referral patients and referring physicians was followed in a prospective manner.

The Primary Care (PC) physicians at 18 Health Centers in Mallorca were authorized to refer patients with back pain or non-specific low back pain to the Kovacs Back Unit in Palma de Mallorca when they met the criteria for referral established in the corresponding protocol.

The monthly rate of referral per quota of 10,000 persons was evaluated, as were the rates of appropriate and inappropriate referrals, the rate of significant and minor side effects, the rate of complaints, the degree of referral patient and referring physician satisfaction, and the clinical evolution of the referred patients, in relation to their pain (measured on the Visual Analog Scale) and disability (determined by the Spanish version of the Roland-Morris scale).

Participants, along with the Foundation's Science Department.

The Office of Primary Care of Ib-Salut, the General Office of Evaluation and Accreditation of the Council on Health and Consumer Protection of the Government of the Balearic Islands, and the following Health Centers in Mallorca: A. Bennassar, Arenal-Xaloc, Calviá/Santa Ponça, Casa del Mar, Coll d`en Rebassa, Inca, Emilio Darder, Escuela Graduada, Tramontana, Marratxí, Rafal Nou, S`Escorxador, Santa Catalina, Son Cladera, Son Gotleu, Son Serra, Trencadors and Valldargent.

Status.

The study was completed and its results have been published. Gac Sanit 2004; 18(4): 275-86.

In short, they show that the referral rate per quota of 10,000 persons covered is 1,07 patient with back pain or low back pain per month, with a rate of appropriate referral of 91.8%. Most of the patients were chronic cases, with intense low back and radiated pain and a notable degree of disability. 7% had already previously undergone surgery.

No significant side effect was observed and the rate of minor side effects was under 5%. The patients' clinical evolution was consistent with that observed in the previous clinical trials on this technology: in general it was satisfactory, with positive clinical outcomes that appeared immediately and in general improved throughout the follow-up period. During the month after the NRT, most of the patients left the rest of the treatments.

The degree of satisfaction was high among referred patients and referring doctors. 98% of the patients and 87% of the doctors would recommend the referral to a family member. Additionally, 89% of the doctors believed that they should continue to be allowed to refer their patients.

In view of these results, NRT has been implanted into the usual treatment plan for neck pain, back pain or low back pain in the Health Service of the Balearic Islands on the conditions of application in which this technology has been evaluated and piloted and is currently being implanted in other Health Services.