Abstract
Background: Healthcare systems are struggling to deliver high-quality low back pain (LBP) care. In 2012 specialist physiotherapist-led musculoskeletal (MSK) triage services were introduced in Irish hospitals to expedite patient care and alleviate pressure on elective consultant clinics. Specialist physiotherapists, working in triage roles at the primary-secondary care interface, have critical insights to inform MSK service improvement, but failure to consult with clinicians is a common shortcoming in healthcare transformation planning and appraisal. This study aimed to inform the development of LBP care in Ireland through engaging with specialist physiotherapists, profiling the LBP triage service that they deliver and exploring their perspectives on how LBP care can be enhanced in Ireland.
Objectives: Our objectives were to: 1) establish how the MSK triage services function on a daily basis with respect LBP care delivery; 2) capture the current level of integration between MSK triage services and primary care services in LBP care provision; 3) explore the specialist physiotherapists’ perceptions of barriers and facilitators to delivery of quality LBP care; and 4) explore their opinions on the development of MSK triage clinics in primary care.
Design: This study employed a cross-sectional observational design, using an anonymous electronic survey with open- and closed-ended questions. Descriptive statistics were used to analyse and report the data generated by the closed-ended questions. Thematic framework analysis was used to evaluate response data from open-ended questions.
Participants: All clinical specialist physiotherapists working in the national MSK programme triage services were surveyed.
Results: A response rate of 72% (n=38) was achieved. There was considerable site-dependent variation in LBP service provision, with discrepancies in access to triage services, wait times, referral processing and prioritisation, access to clinical investigations and onward referral options. Respondents identified insufficient availability of primary care multidisciplinary services. Almost three-quarters of respondents (71%) were dissatisfied with primary-secondary care service integration. Lack of integration between MSK triage services and community multidisciplinary team (MDT) services was exemplified by many (14 to 49%) respondents reporting that they were unsure on referral mechanisms to primary care MDT services. Thirty-four respondents completed the open-ended questions (response rate 64%). Thematic analysis of responses resulted in six overarching themes, grouped into two categories: LBP healthcare in Ireland (Themes 1-3) and development of community-based MSK interface services (Themes 4-6).
Themes:
1) Inadequate health services for patients with LBP.
2) Need for defined LBP clinical pathways.
3) Need for a multisectoral approach to spine health.
4) Concern regarding isolation from secondary care services.
5) Unrealistic expectations of MSK triage.
6) Improved communication and collaboration with primary care services.
Conclusion: Specialist physiotherapists in Ireland have concerns regarding the lack of integrated LBP services and the persistence of a biomedical, secondary care-led approach. They advocate for investment in primary care MDTs, enhanced integration and communication across primary and secondary care, development of a national clinical pathway and a multisectoral approach. Services would further benefit from improved standardisation of care; national accreditation and a defined scope of advanced physiotherapy practice may reduce unnecessary variation in MSK triage service provision.