Prof. Trudy Rebbeck1,2, Mr Kwangil Kang1, Dr Darren Beales4, Prof Kim Bennell5, Prof Michele Sterling6, E/Prof Gwendolen Jull7, Dr Julia Treleaven7, Prof Nadine Foster8, Prof Paulo Ferreira1, A/Prof Milena Simic1, Prof Michael Nicholas1,2, Prof Ian Cameron1,2, A/Prof Kerrie Evans1,3
1Faculty of Medicine and Health, University Of Sydney, Sydney, Australia, 2Kolling Institute, Northern Sydney Local Health District, St Leonards, Australia, 3Healthia Limited , Brisbane, Australia, 4School of Allied Health, Curtin University, Perth, Australia, 5University of Melbourne, Melboune, Australia, 6RECOVER Injury Research Centre, University of Queensland, Brisbane, Australia, 7School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia , 8Surgical, Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland, Brisbane, Australia
Biography:
Conjoint Professor of Allied Health, Faculty of Medicine and Health, University of Sydney, and Northern Sydney Local Health District. Trudy is also a Specialist Musculoskeletal Physiotherapist. She leads national programmes of research; i) Implementation of models of care for whiplash and musculoskeletal (MSK) pain conditions more broadly and, ii) Discovery of new mechanism underpinning headache and MSK pain conditions. She has 95+ publications and attracted $20m in research funding in past 5 years. Prof Rebbeck has supervised 16 HDR students and mentored 50+ clinical specialists in physiotherapy. She also works as a clinical specialist in musculoskeletal physiotherapy in primary care.
Abstract:
Background:
Traditional care pathways for musculoskeletal (MSK) conditions in Australia are inefficient and follow a stepped-care model. When initial care fails, people are often referred for unnecessary, ineffective care (e.g imaging, surgery and medications). This delays provision of guideline-based care (e.g exercise) which can be effectively delivered by allied-health clinicians.
Purpose:
This presentation will report on the implementation outcomes (e.g acceptance and adoption) of a new PAthway of CarE for MSK conditions in Australian primary care. PACE-MSK involves early referral of people at high risk of poor outcome to allied-health specialists as an alternative to traditional models of care.
Methods:
Participants were primary care clinicians (n=146) and allied-health specialists (n=50), providing care to 500+ patients in a multi-centre RCT. Clinicians providing care in the “usual care group” received a passive implementation strategy (phone call + written information). Those in the PACE-MSK group received a multi-faceted strategy including interactive education focused on the key behaviours to change.
Results:
Clinicians in the PACE-MSK group referred fewer patients for imaging (MD: -14.5 % (95% CI -26.7 to -1.9) and to medical specialists (MD: -8.1% (95%CI -18.3 to -2.1) compared with usual care. Both groups provided the recommended care (e.g., advice, exercise) in similar proportions (>80% of the time). Specialists chose collaborative care pathways less frequently than anticipated (35% of the time), citing barriers including complexity of patient presentations.
Conclusion:
Implementation of PACE-MSK reduced low value care (imaging and surgical referrals) whilst retaining high value care (advice and exercise). Collaborative care could be improved.