Rebbeck T1, Evans K1, Simic M1, Ferreira P1, Sterling M2, Beales D3, Bennell K4
1University of Sydney, Faculty of Health Sciences, Lidcombe, Australia, 2University of Queensland, Brisbane, Australia, 3Curtin University, Perth, Australia, 4University of Melbourne, Melbourne, Australia
Background: Musculoskeletal disorders such as low back pain, neck pain and knee osteoarthritis are the highest disease burden in Australia. These disorders are largely managed by primary health care professionals. Costs escalate when people with these disorders don't recover and are sent for unnecessary investigations and referrals. To address this burden, guideline-based health messages need to be conveyed effectively, using a more efficient model of service delivery.
Purpose: To develop and pilot a novel clinical pathway of care that aims to improve health service delivery and health outcomes for common musculoskeletal disorders in primary care.
Methods: We followed a translation framework to develop the clinical pathway. Framework processes followed included stakeholder consultation, feasibility and preliminary efficacy. During the stakeholder consultation phase, we convened meetings with target professions including physiotherapy, rehabilitation medicine, psychology, rheumatology and orthopaedic surgery. Industry stakeholders consulted included government insurance regulators, consumer organisations (eg Arthritis Australia). Finally leading national and international researchers in each musculoskeletal disorder were consulted. Feasibility and preliminary efficacy was determined using semi-structured interviews and piloting in primary care.
Results: The result was a novel risk-based clinical pathway of care, deemed feasible to scale for wider implementation in primary care in Australia. People presenting to primary health care professionals (HCP) are assessed for risk of poor prognosis using an automated version of validated risk assessment tools including the short-form Orebro and the Start MSK tool. Those at low risk are directed to a musculoskeletal e-hub, a one-stop portal that houses existing guideline-based resources and links to websites developed for common musculoskeletal conditions (eg low back pain, whiplash, knee OA). Their nominated HCP, advised of the risk status, also has access to these e-education resources with advice not to over treat. Medium/high patients are referred to a specialist physiotherapist who provides a more complex assessment of the presenting physical and psychological modifiable risk factors. They then liaise with the primary HCP and advise on further care. Feasibility outcomes demonstrated that the pathway was acceptable. Of the 80 primary HCP's using the pathway and the associated resources, most (88%) agreed that they improved knowledge of appropriate risk management. Compared with usual care, pilot data (n=10) demonstrated improvement in health practise with care appropriately matched to risk (eg average number of treatments low risk was 3 in the clinical pathway, and 8 in the usual care).
Conclusion(s): The novel clinical pathway of care was developed following a translation framework including stakeholder consultation , feasibility and preliminary efficacy. The pathway was found to be acceptable, resulted in improved knowledge and improved practise consistent with risk based management for common musculoskeletal conditions.
Implications: The pathway will be scaled for national implementation in Australia. Implementation should reduce disability associated with musculoskeletal disorders, be cost-effective and improve the efficiency of the current health care system, by reducing unnecessary imaging and referrals, and providing timely access to appropriate care when needed.
Keywords: Risk stratification, clinical pathway, musculoskeletal pain
Funding acknowledgements: National Health and Medical Research Council of Australia (NHMRC)
University of Sydney SOAR Fellowship
Purpose: To develop and pilot a novel clinical pathway of care that aims to improve health service delivery and health outcomes for common musculoskeletal disorders in primary care.
Methods: We followed a translation framework to develop the clinical pathway. Framework processes followed included stakeholder consultation, feasibility and preliminary efficacy. During the stakeholder consultation phase, we convened meetings with target professions including physiotherapy, rehabilitation medicine, psychology, rheumatology and orthopaedic surgery. Industry stakeholders consulted included government insurance regulators, consumer organisations (eg Arthritis Australia). Finally leading national and international researchers in each musculoskeletal disorder were consulted. Feasibility and preliminary efficacy was determined using semi-structured interviews and piloting in primary care.
Results: The result was a novel risk-based clinical pathway of care, deemed feasible to scale for wider implementation in primary care in Australia. People presenting to primary health care professionals (HCP) are assessed for risk of poor prognosis using an automated version of validated risk assessment tools including the short-form Orebro and the Start MSK tool. Those at low risk are directed to a musculoskeletal e-hub, a one-stop portal that houses existing guideline-based resources and links to websites developed for common musculoskeletal conditions (eg low back pain, whiplash, knee OA). Their nominated HCP, advised of the risk status, also has access to these e-education resources with advice not to over treat. Medium/high patients are referred to a specialist physiotherapist who provides a more complex assessment of the presenting physical and psychological modifiable risk factors. They then liaise with the primary HCP and advise on further care. Feasibility outcomes demonstrated that the pathway was acceptable. Of the 80 primary HCP's using the pathway and the associated resources, most (88%) agreed that they improved knowledge of appropriate risk management. Compared with usual care, pilot data (n=10) demonstrated improvement in health practise with care appropriately matched to risk (eg average number of treatments low risk was 3 in the clinical pathway, and 8 in the usual care).
Conclusion(s): The novel clinical pathway of care was developed following a translation framework including stakeholder consultation , feasibility and preliminary efficacy. The pathway was found to be acceptable, resulted in improved knowledge and improved practise consistent with risk based management for common musculoskeletal conditions.
Implications: The pathway will be scaled for national implementation in Australia. Implementation should reduce disability associated with musculoskeletal disorders, be cost-effective and improve the efficiency of the current health care system, by reducing unnecessary imaging and referrals, and providing timely access to appropriate care when needed.
Keywords: Risk stratification, clinical pathway, musculoskeletal pain
Funding acknowledgements: National Health and Medical Research Council of Australia (NHMRC)
University of Sydney SOAR Fellowship
Topic: Musculoskeletal; Musculoskeletal; Pain & pain management
Ethics approval required: Yes
Institution: University of Sydney
Ethics committee: University of Sydney Human Ethics Comimttee
Ethics number: 2017/789
All authors, affiliations and abstracts have been published as submitted.
