Many people have painful musculoskeletal conditions like back pain and osteoarthritis. In case of severe pain, surgery is performed to alleviate some of the pain and restore some functional ability. There is a lack of information at the national level on the proportion of people who undergo surgery and who need surgery. This information is very important for healthcare professionals and policymakers in order to determine fairness in healthcare utilisation.
We will take the examples of shoulder and back surgeries to describe disparities in the provision of surgical care between geographical regions. Most people seeking health care for musculoskeletal pain will see a GP. Routinely recorded primary care data such as that in the Clinical Practice Research Datalink (CPRD) can provide information on the health of people with musculoskeletal pain, hence determine an estimate of need for surgery. Hospital data can provide an estimate on the surgical rate. By comparing provision versus need for surgery estimates per geographic area would better understand disparities at the national level.
These data will become a key source of information for the monitoring of care, and related equity in access to surgery.
The objective is to compare the provision of care for back and shoulder pain with estimates of need to map variation in shoulder and back surgical procedures across geographical regions and by level of neighbourhood deviation
In related work (ISAC protocol number 18_014R), we are developing a model to estimate the need for musculoskeletal (MSK) care using CPRD information such as age, gender, number of consultations for musculoskeletal problems, time since first consultation, pain medications prescribed, other management, and other illnesses.
In this work, we will first extract rates of surgery provision from HES data in a pre-defined 12-month period, then will compare the provision rate to the rate of need using the model identified in the related work. This measure will be calculated for each geographical region, and a map of regions in the UK will be populated. This map will demonstrate wherever there is disparity between provision and need, and the degree of the disparity at the national level. Finally, we will also look at the overall trend of rates of surgery over time since 2000.
Back surgery
Shoulder surgery
Daniel Prieto-Alhambra - Chief Investigator - University of Oxford
Daniel Prieto-Alhambra - Corresponding Applicant - University of Oxford
Alan Silman - Collaborator - University of Oxford
Andrew Judge - Collaborator - University of Oxford
Dahai Yu - Collaborator - Keele University
George Peat - Collaborator - Keele University
Joanne Protheroe - Collaborator - Keele University
Kelvin Jordan - Collaborator - Keele University
Ross Wilkie - Collaborator - Keele University
Sara Khalid - Collaborator - University of Oxford
Victoria Y Strauss - Collaborator - University of Oxford
HES Admitted Patient Care;Patient Level Index of Multiple Deprivation