Staff experiences of integrating community and secondary care musculoskeletal services: A qualitative investigation

Introduction Integrated models of care intend to provide seamless and timely access to health and social care services. This study investigated the integration of musculoskeletal services across community and secondary care boundaries, including the introduction of a single point of access from whic...

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Veröffentlicht in:Musculoskeletal care 2023-12, Vol.21 (4), p.1279-1287
Hauptverfasser: Alvarado, Natasha, Hargreaves, Gerard, Storey, Karen, Montague, Jane, Broughton, Rowena, Randell, Rebecca
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container_end_page 1287
container_issue 4
container_start_page 1279
container_title Musculoskeletal care
container_volume 21
creator Alvarado, Natasha
Hargreaves, Gerard
Storey, Karen
Montague, Jane
Broughton, Rowena
Randell, Rebecca
description Introduction Integrated models of care intend to provide seamless and timely access to health and social care services. This study investigated the integration of musculoskeletal services across community and secondary care boundaries, including the introduction of a single point of access from which patients were triaged. Methods Staff (n = 15) involved in service development and delivery were interviewed about how, why and to what extent integration impacted service delivery. The analysis focused on staff experiences of using an on‐line patient self‐referral form and co‐located clinics to enhance decision‐making in triage, and on the provision of educational materials and de‐medicalising language in patient consultations to support self‐management. Results Single point of access, including online self‐referral, were operationalised during data collection, but co‐located clinics were not. Triage staff explained that the volume of referrals and quality of information provided in online self‐referrals sometimes constrained decision‐making in triage. Secondary care staff discussed concerns that the single point of access might not consistently identify patients with hard to diagnose conditions that require timely surgical intervention. This concern appeared to constrain staff engagement with integration, potentially inhibiting the delivery of co‐located clinics. However, triage staff accessed support to inform secondary care referral via alternate modes. Patient circumstances, for example, need for reassurance, necessitated multiple self‐management strategies and innovative approaches were developed to provide patients ongoing and professionally led support. Conclusion Findings emphasise that restructuring services requires engagement from diverse stakeholders. Collaborating with stakeholders to address their concerns about the impact of restructures on well‐established pathways may help cultivate this engagement.
doi_str_mv 10.1002/msc.1809
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This study investigated the integration of musculoskeletal services across community and secondary care boundaries, including the introduction of a single point of access from which patients were triaged. Methods Staff (n = 15) involved in service development and delivery were interviewed about how, why and to what extent integration impacted service delivery. The analysis focused on staff experiences of using an on‐line patient self‐referral form and co‐located clinics to enhance decision‐making in triage, and on the provision of educational materials and de‐medicalising language in patient consultations to support self‐management. Results Single point of access, including online self‐referral, were operationalised during data collection, but co‐located clinics were not. Triage staff explained that the volume of referrals and quality of information provided in online self‐referrals sometimes constrained decision‐making in triage. Secondary care staff discussed concerns that the single point of access might not consistently identify patients with hard to diagnose conditions that require timely surgical intervention. This concern appeared to constrain staff engagement with integration, potentially inhibiting the delivery of co‐located clinics. However, triage staff accessed support to inform secondary care referral via alternate modes. Patient circumstances, for example, need for reassurance, necessitated multiple self‐management strategies and innovative approaches were developed to provide patients ongoing and professionally led support. Conclusion Findings emphasise that restructuring services requires engagement from diverse stakeholders. 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This study investigated the integration of musculoskeletal services across community and secondary care boundaries, including the introduction of a single point of access from which patients were triaged. Methods Staff (n = 15) involved in service development and delivery were interviewed about how, why and to what extent integration impacted service delivery. The analysis focused on staff experiences of using an on‐line patient self‐referral form and co‐located clinics to enhance decision‐making in triage, and on the provision of educational materials and de‐medicalising language in patient consultations to support self‐management. Results Single point of access, including online self‐referral, were operationalised during data collection, but co‐located clinics were not. Triage staff explained that the volume of referrals and quality of information provided in online self‐referrals sometimes constrained decision‐making in triage. Secondary care staff discussed concerns that the single point of access might not consistently identify patients with hard to diagnose conditions that require timely surgical intervention. This concern appeared to constrain staff engagement with integration, potentially inhibiting the delivery of co‐located clinics. However, triage staff accessed support to inform secondary care referral via alternate modes. Patient circumstances, for example, need for reassurance, necessitated multiple self‐management strategies and innovative approaches were developed to provide patients ongoing and professionally led support. Conclusion Findings emphasise that restructuring services requires engagement from diverse stakeholders. 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Secondary care staff discussed concerns that the single point of access might not consistently identify patients with hard to diagnose conditions that require timely surgical intervention. This concern appeared to constrain staff engagement with integration, potentially inhibiting the delivery of co‐located clinics. However, triage staff accessed support to inform secondary care referral via alternate modes. Patient circumstances, for example, need for reassurance, necessitated multiple self‐management strategies and innovative approaches were developed to provide patients ongoing and professionally led support. Conclusion Findings emphasise that restructuring services requires engagement from diverse stakeholders. 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source MEDLINE; Wiley Online Library Journals Frontfile Complete
subjects Humans
implementation
integrated care
musculoskeletal conditions
Patients
Referral and Consultation
Secondary Care
service delivery
Triage
title Staff experiences of integrating community and secondary care musculoskeletal services: A qualitative investigation
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