Negative Health Impacts of Navigating the Healthcare System for Musculoskeletal Conditions: Healthcare User Perspectives

Background: Musculoskeletal (MSK) disorders represent a significant public health challenge in Alberta, impacting patient quality of life, productivity, and healthcare costs. Although the challenges and negative health outcomes of living with chronic MSK conditions are well-documented, there is limited attention paid to the negative impacts of navigating the system on an individual health.

Approach: A qualitative inquiry using the interpretive description methodology was leveraged to explore patients experiences of the MSK healthcare system for knee, shoulder, and low back problems. Recruitment, using a multi-pronged approach, and data collection spanned from November 2022 to December 2023. Semi-structured one-on-one telephone interviews were conducted with participants. Each interview was transcribed verbatim and analyzed using the framework analysis approach. To enhance the credibility of the analysis, data was analyzed by two researchers and strategies such as bracketing were employed. This study received ethics approval from the University of Calgary Conjoint Health Research Ethics Board (REB22-088).

Results: Interviews were completed with 73 participants who ranged in age from 20 to 78 years and sought care for MSK issues related to the knee (2), shoulder (), low back (20), or multiple joints (2). The sample included 45 females and 28 males (self-identified), drawn from Calgary (4), Central (3), North (5), South (8) and Edmonton zones (6), enabling a broad representation of the population affected by MSK conditions. An emergent and unexpected finding was the negative health impacts experienced by approximately one-third of participants due to navigating the MSK healthcare system. Participants described physical decline (debilitation, pain) and psychological distress, characterized by depression, anxiety, frustration, and despair, as direct consequences of navigating a healthcare system. Additionally, the participants experienced disruptions in personal relationships and economic stability. Several participants reported job losses directly linked to the inefficiencies and demands of managing their healthcare pathways. Causes of decline and distress were attributed to uncertainty regarding the next steps in their care pathway, a lack of access to effective treatments, poor interpersonal relationships with providers (i.e., feeling dismissed, ageism), lack of care continuity, and healthcare costs. These were compounded by systemic inefficiencies including wait times, lack of primary physicians, disconnects across care contexts, and length of time to diagnosis.

Implications: These emergent findings indicate systemic issues exacerbating patient ill-health and hindering well-being. Our results underscore the urgent need for comprehensive reforms of Alberta MSK healthcare system. There is a need for a well-integrated, patient-centred system that is designed to optimize delivery across the care continuum (from primary care to allied health to specialists) and empower patients as active partners in managing their MSK health. Policymakers, healthcare providers, and administrators must consider these insights to develop and implement strategic reforms to enhance accessibility, integration, and care continuity. Such improvements are crucial for aligning MSK healthcare delivery with patient needs, thereby not only enhancing patient satisfaction and health outcomes but also mitigating unintended consequences of a fragmented system. Future work should measure the systemic impacts healthcare imposes on those it aims to serve in addition to disease outcomes or patient satisfaction. Keywords: Musculoskeletal care, patient experience, health system, qualitative research, systemic barriers, patient-centered care.