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

Jesper Bie Larsen; Pernille Borregaard; Janus Laust Thomsen; Michael Skovdal Rathleff; Simon Kristoffer Johansen

doi:10.1515/sjpain-2023-0070

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

Bidragets oversatte titel: "Forbedring af almen praksis' håndtering af patienter med kronisk muskuloskeletal smerte: Interdisciplinaritet, sammenhæng og bekymringer

Jesper Bie Larsen^*, Pernille Borregaard, Janus Laust Thomsen, Michael Skovdal Rathleff, Simon Kristoffer Johansen

^*Kontaktforfatter

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Abstract

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.

Konklusion
Kompleksiteten 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 KMS

Bidragets oversatte titel	"Forbedring af almen praksis' håndtering af patienter med kronisk muskuloskeletal smerte: Interdisciplinaritet, sammenhæng og bekymringer
Originalsprog	Engelsk
Artikelnummer	20230070
Tidsskrift	Scandinavian Journal of Pain
Vol/bind	24
Udgave nummer	1
Antal sider	13
ISSN	1877-8860
DOI	https://doi.org/10.1515/sjpain-2023-0070
Status	Udgivet - 7 mar. 2024

Emneord

Chronic Pain
Musculoskeletal Pain
General Practice
Pain management
General practice
Care pathways
Future workshop
Qualitative research

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10.1515/sjpain-2023-0070Licens: CC BY 4.0

Open Access articleForlagets udgivne version, 1,07 MBLicens: CC BY 4.0

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@article{23d87f45d0234a9fa16e61f437a6cfe0,

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

abstract = "Objectives ‒ 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.",

keywords = "Chronic Pain, Musculoskeletal Pain, General Practice, Pain management, General practice, Care pathways, Future workshop, Qualitative research, Chronic musculoskeletal pain, pain management, general practice, qualitative research, future workshop",

author = "Larsen, {Jesper Bie} and Pernille Borregaard and {Laust Thomsen}, Janus and Rathleff, {Michael Skovdal} and Johansen, {Simon Kristoffer}",

year = "2024",

month = mar,

day = "7",

doi = "10.1515/sjpain-2023-0070",

language = "English",

volume = "24",

journal = "Scandinavian Journal of Pain",

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AU - Larsen, Jesper Bie

AU - Borregaard, Pernille

AU - Laust Thomsen, Janus

AU - Rathleff, Michael Skovdal

AU - Johansen, Simon Kristoffer

PY - 2024/3/7

Y1 - 2024/3/7

N2 - Objectives ‒ 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.

AB - Objectives ‒ 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.

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KW - General practice

KW - Care pathways

KW - Future workshop

KW - Qualitative research

KW - Chronic musculoskeletal pain

KW - pain management

KW - general practice

KW - qualitative research

KW - future workshop

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DO - 10.1515/sjpain-2023-0070

M3 - Journal article

SN - 1877-8860

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JO - Scandinavian Journal of Pain

JF - Scandinavian Journal of Pain

IS - 1

M1 - 20230070

ER -

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

Abstract

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