Within-team Patterns of Communication and Referral in Multimodal Treatment of Chronic Low Back Pain Patients by an Integrative Care Team

Abstract

综合护理小组对慢性腰病患者的多形式治疗之组内沟通和推介模式aBSTracT Background: Nonspecific chronic low back pain (CLBP) is a highly prevalent and costly public health problem with few treatment options that provide consistent and greater than modest benefits. Treatment of CLBP is shifting from unimodal to multimodal and multidisciplinary approaches, including biopsychosocially-based complementary and integrative care. Multidisciplinary approaches require unique levels of communication and coordination amongst clinicians; however, to date few studies have evaluated patterns of communication and decision making amongst clinicians collaborating in the care of challenging patients with CLBP. methods: As part of an observational study evaluating the effectiveness and cost-effectiveness of an integrative, team-based care model for the treatment of CLBP, we used multiple qualitative research methods to characterize within-team cross-referral and communication amongst jointly-trained practitioners representing diverse biomedical and complementary disciplines. Patterns of communication and coordinated care are

Establishing an Integrative Medicine Program Within an Academic Health Center: Essential Considerations

“…27,28 Whether this financial “investment” in team training is an essential predictor of clinical, organizational and/or fiscal success remains unstudied. 22 …”

“…For example, initial positive outcomes of migraine patients referred from a HMS-affiliated hospital headache program led to a collaborative pilot trial evaluating a mind-body program offered at the OCC for managing migraine symptoms. 29 Similarly, a large scale NIH-funded observational study currently underway, evaluating the effectiveness and cost-effectiveness of our clinical care model for chronic low back pain patients, 22 has contributed significantly to OCC infrastructure development and support, and findings will be used to inform the evidence base for referring complex back pain patients to our team in the future.…”

Characteristics of a well-functioning chronic pain team: A systematic review

“…Well-functioning teams had a specific focus (Cartmill, Soklaridis, & David Cassidy, 2011), common ground (Hellman, Jensen, Bergström, & Brämberg, 2016), collective efficacy (Howarth, Warne, & Haigh, 2012) and shared model of care (O'Connor et al, 2015). Shared philosophy embodies an explicit and collective understanding of the values and purpose of the team; team objectives; or theoretical stance, such as a "broad biopsychosocial framework" (O'Connor et al, 2015).…”

“…The described benefits of sharing team office and treatment space included facilitating access to other team members for discussion and decision-making about clients; an opportunity (Cartmill et al, 2011;Howarth et al, 2012;O'Connor et al, 2015). Co-location appeared to support the processes that generated more effective teamwork.…”

“…Benefits to the team of stable staffing included team intelligence (O'Connor et al, 2015); role familiarity and understanding of individual team members (Howarth et al, 2012); and team maturity (Howarth et al, 2012). Patient-specific outcomes were also thought to benefit when a team was together long enough that a feedback loop was created which enabled the team to see "the consequences of previous decisions" (Haig et al, 2006(Haig et al, , p. 1084.…”