PPatients' and general practitioners' views and experiences of stratified primary care for patients with musculoskeletal pain: qualitative findings from the STarT MSK feasibility and pilot trial.

Saunders, B; Hill, JC; Foster, NE; Cooper, V; Protheroe, J; Chudyk, A; Chew-Graham, C; Campbell, P; Bartlam, B

Abstract

Background
Improving primary care management of musculoskeletal (MSK) pain is a priority. A pilot cluster RCT tested prognostic stratified care for patients with common MSK pain presentations, including low back pain, in 8 UK general practices (4 stratified care; 4 usual care) with 524 patients. GPs in stratified care practices were asked to use i) the Keele STarT MSK tool for risk-stratification and ii) matched treatment options for patients at low-, medium- and high-risk of persistent pain. A linked qualitative process evaluation explored patients' and GPs' views and experiences of stratified care.

Methods
Individual ‘stimulated-recall’ interviews with patients and GPs in the stratified care arm (n=10 patients; 10 GPs), prompted by consultation-recordings. Data were analysed thematically and mapped onto the COM-B behaviour change model; exploring the Opportunity, Capability and Motivation GPs and patients had to engage with stratified care.

Results
Patients reported positive views that stratified care enabled a more ‘structured’ consultation. GPs identified difficulties integrating the STarT MSK tool in their consultation timeframe (Opportunity), but found this easier as it became more familiar. Both groups saw the tool as having added-value, but identified ‘cumbersome’ items which made it more difficult to use (Capability). GPs reported the matched treatment options aided their clinical decision-making, identified several that were not available to them (e.g. pain-management clinics) and suggested additional options (e.g. GP-management of psychosocial issues (Motivation).

Conclusion
Changes to the STarT MSK tool and matched treatment options, targeting the COM-B model constructs, were identified and have been implemented in the current main trial.

Citation

Saunders, B., Hill, J., Foster, N., Cooper, V., Protheroe, J., Chudyk, A., …Bartlam, B. (2019). PPatients' and general practitioners' views and experiences of stratified primary care for patients with musculoskeletal pain: qualitative findings from the STarT MSK feasibility and pilot trial. . https://doi.org/10.1302/1358-992X.2019.10.025

• Conference Name: The Society for Back Pain Research (SBPR) Annual General Meeting 2019, ‘From Bench to Bedside’
• Conference Location: Sheffield, England
• Start Date: Sep 5, 2019
• End Date: Sep 6, 2019
• Online Publication Date: Oct 1, 2019
• Publication Date: 2019
• Deposit Date: Feb 8, 2024
• Publisher: Bone & Joint
• DOI: https://doi.org/10.1302/1358-992X.2019.10.025
• Publisher URL: https://boneandjoint.org.uk/Article/10.1302/1358-992X.2019.10.025