Improving general practice management of patients with chronic musculoskeletal pain: Interdisciplinarity, coherence, and concerns

Formål:Håndtering af patienter med kroniske muskuloskeletale smerter (KMS) forbliver en udfordring i almen praksis. Den praktiserende læge (GP) oplever ofte diagnostisk usikkerhed, på trods af hyppige henvisninger af patienter med KMS til specialiserede afdelinger. Derfor er det fortsat afgørende at få indsigt i, hvordan man kan optimere og omstrukturere den nuværende ordning for håndtering af patienter med KMS. Formålet var at udforske GP'ers perspektiver på udfordringer, behov og visioner for at forbedre håndteringen af patienter med KMS.Metoder:En kvalitativ undersøgelse med co-design ved hjælp af fremtidens værkstedsmetode. Otte GP'er deltog i værkstedet (fem kvinder). Indsigter og visioner opstod fra GP'ernes diskussioner og deling af deres erfaringer med håndtering af patienter med KMS. De lydoptagne data blev underlagt tematisk tekstanalyse.Resultater:Den tematiske analyse afslørede fire hovedtemaer, herunder (1) udfordringer ved nuværende smertebehandling, (2) barrierer for smertebehandling, (3) behovet for en biopsychosocial perspektiv og (4) løsninger og visioner. Alle udfordringer er relateret til kompleksiteten og diagnostisk usikkerhed for denne patientgruppe. GPerne oplevede, at patienternes biomedicinske forståelse af deres smerte var en barriere for behandling og understregede behovet for en biopsychosocial tilgang ved håndtering af patienterne. GPerne beskrev at påtage sig rollen som koordinatorer for deres patienter med KMS, men følte sig undertiden utilstrækkeligt rustet til at håndtere diagnostisk usikkerhed. En tværfaglig enhed blev anbefalet som en mulig løsning for at introducere en biopsychosocial tilgang til undersøgelse, diagnose og behandling af patientens KMS.KonklusionKompleksiteten og diagnostisk usikkerhed ved patienter med KMS kræver en revision af den nuværende ordning. Etablering af en tværfaglig enhed ved hjælp af en biopsychosocial tilgang blev anbefalet som en mulighed for at forbedre den nuværende håndtering af patienter med KMSObjectives ‒ Management of patients with chronic musculoskeletal pain (CMP) remains a challenge in general practice. The general practitioner (GP) often experiences diagnostic uncertainty despite frequently referring patients with CMP to specialized departments. Therefore, it remains imperative to gain insights on how to optimize and reframe the current setup for the management of patients with CMP. The objective was to explore GP's perspectives on the challenges, needs, and visions for improving the management of patients with CMP. Methods ‒ A qualitative study with co-design using the future workshop approach. Eight GPs participated in the future workshop (five females). Insights and visions emerged from the GP's discussions and sharing of their experiences in managing patients with CMP. The audio-recorded data were subjected to thematic text analysis. Results ‒ The thematic analysis revealed four main themes, including (1) challenges with current pain management, (2) barriers to pain management, (3) the need for a biopsychosocial perspective, and (4) solutions and visions. All challenges are related to the complexity and diagnostic uncertainty for this patient population. GPs experienced that the patients' biomedical understanding of their pain was a barrier for management and underlined the need for a biopsychosocial approach when managing the patients. The GPs described taking on the role of coordinators for their patients with CMP but could feel ill-equipped to handle diagnostic uncertainty. An interdisciplinary unit was recommended as a possible solution to introduce a biopsychosocial approach for the examination, diagnosis, and management of the patient's CMP. Conclusions ‒ The complexity and diagnostic uncertainty of patients with CMP warrants a revision of the current setup. Establishing an interdisciplinary unit using a biopsychosocial approach was recommended as an option to improve the current management for patients with CMP.</p

Care pathways for patients with chronic musculoskeletal pain in general practice

Background and aims: The general practitioner (GP) is often the first-point of contact into the healthcare sector for patients with chronic musculoskeletal pain. The GP can refer patients towards additional diagnostic examinations and/or treatments in the secondary sector. The current care pathway is heterogenous and patients are in risk of receiving suboptimal care due to a fragmented and non-coherent care pathway. The objective was to investigate GP perspectives concerning challenges and possible solutions for the care pathways for chronic musculoskeletal pain patients.Methods: We conducted a future workshop with 8 GPs to uncover current challenges and potentials for improving the care pathway. The workshop included a critiquing-, an ideation-, and an implementation phase. A case vignette and inspiration cards were designed and included to facilitate workshop discussions. Audio recordings were transcribed, and data was analyzed via thematic text analysis.Results: The GPs highlighted patient’s expectations of anatomical explanations as challenging. Therefore, GPs were concerned that increased focus on psychosocial factors would make patients feel that their pain is not taken seriously. Proposed solutions were emphasis on pain management and early focus on biomedical and psychosocial factors. The GPs emphasize the need for a multidisciplinary examination to support patients. The GPs envisioned having the possibility to refer patients that does not respond to initiated treatments to a multidisciplinary setup, focusing on biopsychosocial factors.Conclusions: It remains a challenge that patients focus on finding biomedical reasons for their chronic musculoskeletal pain. The GPs envisioned that a multidisciplinary setup, addressing the biopsychosocial factors could optimize future care pathways.</div