Musculoskeletal care stratification Stratification of Treatment in A Community-Based Musculoskeletal Service: A Mixed-Methods Study to Assess Predictors of Requiring Complex Care

Publication date: Available online 29 December 2015
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Christine Comer, Jennie Glover, Jennifer Richardson, Rachel Yaseen, Steven Foster, Neil M. Wolfenden, Gareth J. Hughes
ObjectiveTo explore factors that might be relevant when designing a triage toolDesignA mixed-methods study using multivariable logistic regression analysis to identify significant factors associated with requiring different levels of care and qualitative focus groups exploring views of patients and physiotherapy clinicians regarding case complexity.SettingA community-based adult Musculoskeletal Service delivering Tier One (standard physiotherapy) and Tier Two care (complex care beyond the scope of standard physiotherapy) and providing onward referral to orthopaedic clinics (Tier Three).ParticipantsQuantitative data was extracted from a random sample of 484 patients who had received treatment for musculoskeletal conditions. Patients and physiotherapists who had received care or who worked in the service participated in focus groups.Main outcome measuresThemes which emerged from focus groups were compared against predictors of requiring complex care found to be significant (P<0.05) following quantitative data analysis.Results184 patients (38.0%, 95% confidence interval: 33.8–42.4) received complex care. Peripheral joint problems, unclear diagnosis, and symptoms affecting sleep were significant independent predictors of requiring complex care. These data supported some of the main themes raised at focus groups.ConclusionsA substantial proportion of patients receive Tier Two level complex care. Further studies are needed to evaluate whether the predictive factors found to be significant in our study might be useful for developing a tool for more effective triage to the most appropriate tier of musculoskeletal care.



from #Medicine via ola Kala on Inoreader http://ift.tt/1SmoFuz
via IFTTT