Stepped care for musculoskeletal pain is ineffective: a model for utilisation of specialist physiotherapists in primary healthcare management

2021 ◽  
Author(s):  
Darren Beales ◽  
Tim Mitchell ◽  
David Holthouse
Keyword(s):  
Musculoskeletal Pain ◽  
Primary Healthcare ◽  
Healthcare Management ◽  
Stepped Care

Pain and Psychological Outcomes Among Iraq and Afghanistan Veterans with Chronic Pain and PTSD: ESCAPE Trial Longitudinal Results

Pain Medicine ◽  
2020 ◽  
Vol 21 (7) ◽  
pp. 1369-1376
Author(s):  
Matthew J Bair ◽  
Samantha D Outcalt ◽  
Dennis Ang ◽  
Jingwei Wu ◽  
Zhangsheng Yu
Keyword(s):  
Chronic Pain ◽  
Musculoskeletal Pain ◽  
Pain Catastrophizing ◽  
Psychological Outcomes ◽  
Stepped Care ◽  
Chronic Musculoskeletal Pain ◽  
Pain Severity ◽  
Analysis Of Covariance ◽  
Escape Trial ◽  
Care Intervention

Abstract Objective To compare pain and psychological outcomes in veterans with chronic musculoskeletal pain and comorbid post-traumatic stress disorder (PTSD) or pain alone and to determine if veterans with comorbidity respond differently to a stepped-care intervention than those with pain alone. Design Secondary analysis of data from the Evaluation of Stepped Care for Chronic Pain (ESCAPE) trial. Setting Six Veterans Health Affairs clinics. Subjects Iraq and Afghanistan veterans (N = 222) with chronic musculoskeletal pain. Methods Longitudinal analysis of veterans with chronic musculoskeletal pain and PTSD or pain alone and available baseline and nine-month trial data. Participants randomized to either usual care or a stepped-care intervention were analyzed. The pain–PTSD comorbidity group screened positive for PTSD and had a PTSD Checklist–Civilian score ≥41 at baseline. Results T tests demonstrated statistically significant differences and worse outcomes on pain severity, pain cognitions, and psychological outcomes in veterans with comorbid pain and PTSD compared with those with pain alone. Analysis of covariance (ANCOVA) modeling change scores from baseline to nine months indicated no statistically significant differences, controlling for PTSD, on pain severity, pain centrality, or pain self-efficacy. Significant differences emerged for pain catastrophizing (t = 3.10, P < 0.01), depression (t = 3.39, P < 0.001), and anxiety (t = 3.80, P < 0.001). The interaction between PTSD and the stepped-care intervention was not significant. Conclusions Veterans with the pain–PTSD comorbidity demonstrated worse pain and psychological outcomes than those with chronic pain alone. These findings indicate a more intense chronic pain experience for veterans when PTSD co-occurs with pain. PTSD did not lead to a differential response to a stepped-care intervention.

Acceptability of a telecare intervention for persistent musculoskeletal pain

2016 ◽  
Vol 24 (1) ◽  
pp. 44-50 ◽  
Author(s):  
Rebecca E Guilkey ◽  
Claire B Draucker ◽  
Jingwei Wu ◽  
Zhangsheng Yu ◽  
Kurt Kroenke
Keyword(s):  
Musculoskeletal Pain ◽  
Text Messaging ◽  
Pain Treatment ◽  
Median Number ◽  
Stepped Care ◽  
Free Text ◽  
Web Based ◽  
Patient Feedback ◽  
User Friendly ◽  
Patient Use

Introduction Persistent musculoskeletal pain is a prevalent, disabling, and often undertreated condition. This paper examines the acceptability of a telecare intervention for this condition. Methods The Stepped Care to Optimize Pain Care Effectiveness (SCOPE) intervention couples automatic symptom monitoring (ASM) with optimized analgesic care management by a nurse-physician team. Data from participants in the telecare intervention arm (n = 124) of a randomized control trial of SCOPE were analysed to determine the acceptability of the telecare intervention as indicated by patient use and satisfaction. Results Most (93.5%) patients completed at least one ASM report, selecting equally web-based (49%) or interactive voice-recorded (51%) reporting. The median number of ASM reports and nurse contacts per patient was 15 and 12, respectively. Of 12 demographic and clinical factors examined, none predicted the number of ASM reports, whereas nurse contacts were more frequent in patients with higher pain severity or receiving opioids. Only a minority of ASM reports required an expedited nurse call, with the most frequent alerts being for a medication change, a nurse call or side effects. Most (92%) patients rated ASM as easy to use and found the ASM reporting (76%) and nurse contacts (81%) very or moderately helpful. Nearly three-fourths of patients rated their overall pain treatment as good to excellent. The most common suggestions from patient feedback were for a free-text messaging function, more frequent nurse contact and less redundancy in ASM reporting items. Discussion Participants generally found the telecare intervention a user-friendly and helpful approach for treating persistent musculoskeletal pain.

Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) study

2007 ◽  
Vol 29 (6) ◽  
pp. 506-517 ◽  
Author(s):  
Kurt Kroenke ◽  
Matthew Bair ◽  
Teresa Damush ◽  
Shawn Hoke ◽  
Gloria Nicholas ◽  
...  
Keyword(s):  
Musculoskeletal Pain ◽  
Affective Disorders ◽  
Stepped Care

scholarly journals Implementation of the principles of primary health care in a rural area of South Africa

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Surona Visagie ◽  
Marguerite Schneider
Keyword(s):  
South Africa ◽  
Primary Healthcare ◽  
Rural Areas ◽  
Healthcare Service ◽  
Service Providers ◽  
Health Management ◽  
Healthcare Management ◽  
Rural Setting ◽  
Service Managers

Background: The philosophy of primary healthcare forms the basis of South Africa’s health policy and provides guidance for healthcare service delivery in South Africa. Healthcare service provision in South Africa has shown improvement in the past five years. However, it is uncertain as to whether the changes have reached rural areas and if primary healthcare is implemented successfully in these areas.Objectives: The aim of this article is to explore the extent to which the principles of primary healthcare are implemented in a remote, rural setting in South Africa.Method: A descriptive, qualitative design was implemented. Data were collected through interviews and case studies with 36 purposively-sampled participants, then analysed through Interpretative Phenomenological Analysis.Results: Findings indicated challenges with regard to client-centred care, provision of health promotion and rehabilitation, the way care was organised, the role of the doctor, healthworker attitudes, referral services and the management of complex conditions.Conclusion: The principles of primary healthcare were not implemented successfully. The community was not involved in healthcare management, nor were users involved in their personal health management. The initiation of a community-health forum is recommended. Service providers, users and the community should identify and address the determinants of ill health in the community. Other recommendations include the training of service managers in the logistical management of ensuring a constant supply of drugs, using a Kombi-type vehicle to provide user transport for routine visits to secondary- and tertiary healthcareservices and increasing the doctors’ hours.

Case-mix accounting beyond the hospital

2016 ◽  
Vol 28 (4) ◽  
pp. 373-385 ◽  
Author(s):  
Frederick Ng ◽  
Isabella Li
Keyword(s):  
Performance Management ◽  
Primary Healthcare ◽  
Healthcare Management ◽  
Management Tool ◽  
Case Mix ◽  
Content Type ◽  
Learning Machine ◽  
Ideological Tensions ◽  
Conceptual Foundations

Purpose This paper aims to examine how the customer can be better integrated into case-mix systems for primary healthcare. Case-mix is an established performance management tool in hospitals, and there is growing interest in its extensions into out-of-hospital healthcare. Design/methodology/approach Interviews with academics and clinicians are used to explore conceptual foundations for this area. A service-dominant logic perspective is used to problematize the roles of accounting in this complex setting. Findings The findings identify that a customer focus is embedded in current primary healthcare thinking, contrasting with the goods-dominant focus in hospitals. This paper identifies diverse objectives and coordinating networks of care as challenges for case-mix. Research limitations/implications This paper breaks down the complexity of primary healthcare case-mix into two accounting roles: a “dialogue machine” to understand client objectives and a “learning machine” to understand clients’ networks of resources. The infancy of case-mix for primary healthcare means our interview sample is restricted to a small group of pioneers in the area, within a supply perspective. Practical implications Primary healthcare management is a priority area in New Zealand. The findings describe opportunities and challenges for the “dialogue” and “learning” roles of accounting. This paper discusses practical and ideological tensions to be resolved when integrating customers into case-mix systems. Originality/value This paper contributes to the limited literature on the use of case-mix accounting outside of hospitals, discussing the role of customers and networks of care. Findings contribute by describing the customer as both a source of, and a means to resolving, complexity.

scholarly journals KINESIOPHOBIA AMONG PATIENTS WITH MUSCULOSKELETAL PAIN IN PRIMARY HEALTHCARE

2006 ◽  
Vol 38 (1) ◽  
pp. 37-43 ◽  
Author(s):  
Mari Lundberg ◽  
Maria Larsson ◽  
Helene Östlund ◽  
Jorma Styf
Keyword(s):  
Musculoskeletal Pain ◽  
Primary Healthcare
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