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Improving the management of musculoskeletal conditions: can an alternative approach to referral management underpinned by quality improvement and behavioural change theories offer a solution and a better patient experience? A mixed-methods study

OBJECTIVES: To assess whether a quality improvement-based approach to referral management can result in better musculoskeletal care within general practice. DESIGN: Prospective cohort study using mixed methodology including random-effects meta-analysis and interrupted time series. SETTING AND PARTIC...

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Autores principales: Tzortziou Brown, Victoria, Underwood, Martin, Westwood, Olwyn M, Morrissey, Dylan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398779/
https://www.ncbi.nlm.nih.gov/pubmed/30782916
http://dx.doi.org/10.1136/bmjopen-2018-024710
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author Tzortziou Brown, Victoria
Underwood, Martin
Westwood, Olwyn M
Morrissey, Dylan
author_facet Tzortziou Brown, Victoria
Underwood, Martin
Westwood, Olwyn M
Morrissey, Dylan
author_sort Tzortziou Brown, Victoria
collection PubMed
description OBJECTIVES: To assess whether a quality improvement-based approach to referral management can result in better musculoskeletal care within general practice. DESIGN: Prospective cohort study using mixed methodology including random-effects meta-analysis and interrupted time series. SETTING AND PARTICIPANTS: 36 general practices in East London. INTERVENTION: Informed by the results of a Cochrane review on educational interventions to improve general practitioners’ (GPs) musculoskeletal care, we developed a multifaceted intervention, underpinned by quality improvement and behavioural change theories. It combined locally agreed clinical pathways, feedback on referral rates, clinical audit and peer review. MAIN OUTCOME MEASURES: Referral letter content, pathway adherence, referral rates, inter-practice variability and patient experience were evaluated before and after the intervention. RESULTS: Referral letter content on suspected diagnosis and prior management improved from a pooled preintervention proportion of 59% (95% CI 53% to 65%) and 67% (95% CI 61% to 73%), respectively, to 77% (95% CI 70% to 84%) and 81% (95% CI 74% to 88%). Pathway adherence improved from a pooled preintervention percentage of 42% (95% CI 35% to 48%) to 66% (95% CI 57% to 76%). The effect was greater across all quality outcomes for practices with baseline performance below or equal to the pooled baseline performance. There were reductions in the variability and rates of orthopaedic referrals at 6, 12 and 18 months (referral rate relative effect 32% (95% CI 14% to 48%), 30% (95% CI 7% to 53%) and 30% (95% CI 0% to 59%), respectively). Patient rating of how well GPs explained the musculoskeletal condition improved by 29% (95% CI 14% to 43%) and patient perception on the usefulness of the GP appointment improved by 24% (95% CI 9% to 38%). CONCLUSIONS: A quality improvement-based approach to referral management which values GPs’ professionalism can result in improvements across a range of outcomes including referral quality, patient experience, referral rates and variability.
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spelling pubmed-63987792019-03-20 Improving the management of musculoskeletal conditions: can an alternative approach to referral management underpinned by quality improvement and behavioural change theories offer a solution and a better patient experience? A mixed-methods study Tzortziou Brown, Victoria Underwood, Martin Westwood, Olwyn M Morrissey, Dylan BMJ Open General practice / Family practice OBJECTIVES: To assess whether a quality improvement-based approach to referral management can result in better musculoskeletal care within general practice. DESIGN: Prospective cohort study using mixed methodology including random-effects meta-analysis and interrupted time series. SETTING AND PARTICIPANTS: 36 general practices in East London. INTERVENTION: Informed by the results of a Cochrane review on educational interventions to improve general practitioners’ (GPs) musculoskeletal care, we developed a multifaceted intervention, underpinned by quality improvement and behavioural change theories. It combined locally agreed clinical pathways, feedback on referral rates, clinical audit and peer review. MAIN OUTCOME MEASURES: Referral letter content, pathway adherence, referral rates, inter-practice variability and patient experience were evaluated before and after the intervention. RESULTS: Referral letter content on suspected diagnosis and prior management improved from a pooled preintervention proportion of 59% (95% CI 53% to 65%) and 67% (95% CI 61% to 73%), respectively, to 77% (95% CI 70% to 84%) and 81% (95% CI 74% to 88%). Pathway adherence improved from a pooled preintervention percentage of 42% (95% CI 35% to 48%) to 66% (95% CI 57% to 76%). The effect was greater across all quality outcomes for practices with baseline performance below or equal to the pooled baseline performance. There were reductions in the variability and rates of orthopaedic referrals at 6, 12 and 18 months (referral rate relative effect 32% (95% CI 14% to 48%), 30% (95% CI 7% to 53%) and 30% (95% CI 0% to 59%), respectively). Patient rating of how well GPs explained the musculoskeletal condition improved by 29% (95% CI 14% to 43%) and patient perception on the usefulness of the GP appointment improved by 24% (95% CI 9% to 38%). CONCLUSIONS: A quality improvement-based approach to referral management which values GPs’ professionalism can result in improvements across a range of outcomes including referral quality, patient experience, referral rates and variability. BMJ Publishing Group 2019-02-09 /pmc/articles/PMC6398779/ /pubmed/30782916 http://dx.doi.org/10.1136/bmjopen-2018-024710 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle General practice / Family practice
Tzortziou Brown, Victoria
Underwood, Martin
Westwood, Olwyn M
Morrissey, Dylan
Improving the management of musculoskeletal conditions: can an alternative approach to referral management underpinned by quality improvement and behavioural change theories offer a solution and a better patient experience? A mixed-methods study
title Improving the management of musculoskeletal conditions: can an alternative approach to referral management underpinned by quality improvement and behavioural change theories offer a solution and a better patient experience? A mixed-methods study
title_full Improving the management of musculoskeletal conditions: can an alternative approach to referral management underpinned by quality improvement and behavioural change theories offer a solution and a better patient experience? A mixed-methods study
title_fullStr Improving the management of musculoskeletal conditions: can an alternative approach to referral management underpinned by quality improvement and behavioural change theories offer a solution and a better patient experience? A mixed-methods study
title_full_unstemmed Improving the management of musculoskeletal conditions: can an alternative approach to referral management underpinned by quality improvement and behavioural change theories offer a solution and a better patient experience? A mixed-methods study
title_short Improving the management of musculoskeletal conditions: can an alternative approach to referral management underpinned by quality improvement and behavioural change theories offer a solution and a better patient experience? A mixed-methods study
title_sort improving the management of musculoskeletal conditions: can an alternative approach to referral management underpinned by quality improvement and behavioural change theories offer a solution and a better patient experience? a mixed-methods study
topic General practice / Family practice
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398779/
https://www.ncbi.nlm.nih.gov/pubmed/30782916
http://dx.doi.org/10.1136/bmjopen-2018-024710
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