System Plasticity and Integrated Care: Informed Consumers Guide Clinical Reorientation and System Reorganization

Davies, Stephanie; Hayes, Chris; Quintner, John

doi:10.1111/j.1526-4637.2010.01016.x

Cited by 18 publications

(14 citation statements)

References 39 publications

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“…Findings from targeted educational programmes for consumers [56] and health professionals [57] using similar evidence-based information appropriately titrated for each cohort, support the effectiveness of this interprofessional approach. Importantly, these approaches should recognise the psychosocial sequelae and comorbidities associated with persistent pain and better equip practitioners to recognise, assess and manage psychosocial contributions to persistent pain.…”

Section: Discussionmentioning

confidence: 96%

Consumers’ experiences of back pain in rural Western Australia: access to information and services, and self-management behaviours

Briggs

Slater

Bunzli

et al. 2012

BMC Health Serv Res

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BackgroundCoordinated, interdisciplinary services, supported by self-management underpin effective management for chronic low back pain (CLBP). However, a combination of system, provider and consumer-based barriers exist which limit the implementation of such models into practice, particularly in rural areas where unique access issues exist. In order to improve health service delivery for consumers with CLBP, policymakers and service providers require a more in depth understanding of these issues. The objective of this qualitative study was to explore barriers experienced by consumers in rural settings in Western Australia (WA) to accessing information and services and implementing effective self-management behaviours for CLBP.MethodsFourteen consumers with a history of CLBP from three rural sites in WA participated. Maximum variation sampling was employed to ensure a range of experiences were captured. An interviewer, blinded to quantitative pain history data, conducted semi-structured telephone interviews using a standardised schedule to explore individuals’ access to information and services for CLBP, and self-management behaviours. Interviews were digitally recorded and transcribed verbatim. Inductive analysis techniques were used to derive and refine key themes.ResultsFive key themes were identified that affected individuals’ experiences of managing CLBP in a rural setting, including: 1) poor access to information and services in rural settings; 2) inadequate knowledge and skills among local practitioners; 3) feelings of isolation and frustration; 4) psychological burden associated with CLBP; and 5) competing lifestyle demands hindering effective self-management for CLBP.ConclusionsConsumers in rural WA experienced difficulties in knowing where to access relevant information for CLBP and expressed frustration with the lack of service delivery options to access interdisciplinary and specialist services for CLBP. Competing lifestyle demands such as work and family commitments were cited as key barriers to adopting regular self-management practices. Consumer expectations for improved health service coordination and a workforce skilled in pain management are relevant to future service planning, particularly in the contexts of workforce capacity, community health services, and enablers to effective service delivery in primary care.

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Section: Discussionmentioning

confidence: 96%

Consumers’ experiences of back pain in rural Western Australia: access to information and services, and self-management behaviours

Briggs

Slater

Bunzli

et al. 2012

BMC Health Serv Res

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“…More research conducted with patients, not just about patients is needed. Some work has already been done in this area (Hogarth et al, 2010;Davies et al, 2011;Darking et al, 2014) but the challenge for the IS community is to consider how those local experiences can inform national initiatives.…”

Section: Discussionmentioning

confidence: 99%

Transforming healthcare: policy discourses of IT and patient-centred care

Klecuń

2016

European Journal of Information Systems

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Information Technology (IT) is increasingly seen in policy and academic literature as key to the modernization of healthcare provision and to making healthcare patient-centred. However, the concept of Patient-Centred Care (PCC) and the role of IT in the transformation of healthcare are not straightforward. Their meanings need unpacking in order to reveal assumptions behind different visions and their implications for IT-enabled healthcare transformation. To this end, this paper reviews literature on PCC and IT and analyses England's health policy between 1989 and 2013. English policy has set out to transform healthcare from organization-centric to patient-centred and has placed IT as central to this process. This policy vision is based on contested conceptualizations of PCC. IT implementation is problematic and this is at least partly because of the underpinning goals and visions of healthcare policy. If this misalignment is not addressed then producing technologically superior systems, or better IT implementation strategies, is unlikely to result in widespread and substantial changes to the way healthcare is delivered and experienced. For IT to support a healthcare service that is truly patient-centred, patients' needs and wants need to be identified and designed into IT-enabled services rather than simply added on afterwards.

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“…Different systems of health care delivery complicate data comparisons and interpretation of trial outcomes is dogged by a lack of standardised pain assessment measures [27]. System inefficiencies exist due to inadequate use of validated screening criteria designed to match patient complexity with an appropriate level of resource allocation [28]. Furthermore, as there is no simple biomarker for pain and the lived experience cannot be inferred from imaging studies of the spine, including computed and functional magnetic resonance tomography, consistent adoption of evidence-based practice appears even more critical in achieving positive health and economic outcomes [22].…”

Section: Introductionmentioning

confidence: 99%

“…By contrast, the adherence to guidelines by practitioners and the adoption of appropriate self management practices by patients are currently considered rational strategies to reduce the burden of spinal pain [28], [29], [30] and to deliver cost effective patient outcomes [18], [22]. Previously we have demonstrated reduced wait-times and costs at a public pain medicine unit and increased use of active pain management strategies [30] following a system redesign from a traditional model to one that delivers interprofessional patient group education sessions prior to individual appointments [28].…”

Section: Introductionmentioning

confidence: 99%

A Policy-into-Practice Intervention to Increase the Uptake of Evidence-Based Management of Low Back Pain in Primary Care: A Prospective Cohort Study

et al. 2012

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BackgroundPersistent non-specific low back pain (nsLBP) is poorly understood by the general community, by educators, researchers and health professionals, making effective care problematic. This study evaluated the effectiveness of a policy-into-practice intervention developed for primary care physicians (PCPs).MethodsTo encourage PCPs to adopt practical evidence-based approaches and facilitate time-efficient, integrated management of patients with nsLBP, we developed an interdisciplinary evidence-based, practical pain education program (gPEP) based on a contemporary biopsychosocial framework. One hundred and twenty six PCPs from primary care settings in Western Australia were recruited. PCPs participated in a 6.5-hour gPEP. Self-report measures recorded at baseline and at 2 months post-intervention included PCPs' attitudes, beliefs (modified Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS), evidence-based clinical practices (knowledge and skills regarding nsLBP management: 5-point Likert scale with 1 = nil and 5 = excellent) and practice behaviours (recommendations based on a patient vignette; 5-point Likert scale).ResultsNinety one PCPs participated (attendance rate of 72%; post-intervention response rate 88%). PCP-responders adopted more positive, guideline-consistent beliefs, evidenced by clinically significant HC-PAIRS score differences (mean change = −5.6±8.2, p<0.0001; 95% confidence interval: −7.6 to −3.6) and significant positive shifts on all measures of clinical knowledge and skills (p<0.0001 for all questions). Self management strategies were recommended more frequently post-intervention. The majority of responders who were guideline-inconsistent for work and bed rest recommendations (82% and 62% respectively) at pre-intervention, gave guideline-consistent responses at post-intervention.ConclusionAn interprofessional pain education program set within a framework that aligns health policy and practice, encourages PCPs to adopt more self-reported evidence-based attitudes, beliefs and clinical behaviours in their management of patients with nsLBP. However, further research is required to determine cost effectiveness of this approach when compared with other modes of educational delivery and to examine PCP behaviours in actual clinical practice.

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System Plasticity and Integrated Care: Informed Consumers Guide Clinical Reorientation and System Reorganization

Cited by 18 publications

References 39 publications

Consumers’ experiences of back pain in rural Western Australia: access to information and services, and self-management behaviours

Consumers’ experiences of back pain in rural Western Australia: access to information and services, and self-management behaviours

Transforming healthcare: policy discourses of IT and patient-centred care

A Policy-into-Practice Intervention to Increase the Uptake of Evidence-Based Management of Low Back Pain in Primary Care: A Prospective Cohort Study

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