Factors used by general practitioners for referring patients with chronic musculoskeletal pain: a qualitative study

Abstract

Around 20% of the Dutch population is living with chronic musculoskeletal pain (CMP), which is a complex and multifactorial problem. This complexity makes it hard to define a classification system, which results in non-satisfactory referring from the general practitioner (GP). CMP is often explained using the biopsychosocial model in which biological, psychological and social factors cause and maintain the pain. The presented study investigated the factors related to the GPs’ referral for patients with CMP to further treatment.Using convenience sampling, semi-structured interviews and a focus group were conducted among 14 GPs. The interviews were iteratively analyzed using inductive conventional content analysis.Analysis of the interviews demonstrated that there were 28 referral factors that were mentioned by more than 50% of the interviewed GPs. The results showed that the GPs were mostly focussing on the physical (e.g. pain location) and psychological (e.g. acceptation of pain) factors, indicating that they lack focus on the social factors. Furthermore, unfamiliarity of GPs with treatment options was a noteworthy finding.The referral of patients with CMP by GPs is complex and based on multiple factors. To improve referral, it is recommended to include social factors in the decision-making process and to increase the familiarity of the GPs with available treatments.

How Do Physiotherapists Explain Influencing Factors to Chronic Low Back Pain? A Qualitative Study Using a Fictive Case of Chronic Non-Specific Low Back Pain

“…Physiotherapists used very brief explanations when reporting contributing factors to chronic pain with a median of 13 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) words. When exploring which themes were most frequently mentioned (Figure 1), approximatively two thirds of the physiotherapists mentioned "Beliefs" or "Emotions" as contributing factors to the pain.…”

“…The second step is the identification of unhelpful beliefs, attitudes, emotions, behaviour, social factors, etc., of the patient (i.e., psychosocial factors often referred to as "Yellow Flags"), as these are indicative of poor outcomes [18][19][20][21]. However, research has shown that health care practitioners (HCPs) working in first-line care such as general practitioners and physiotherapists do not sufficiently assess these "Yellow flags" [22][23][24]. Moreover, many HCPs still have biomedical beliefs that pain can be reduced to a degeneration or anomaly of a body structure, independent of psychosocial factors, leading to biomedically-oriented advice restricting the patient in work or activities [25][26][27][28][29].…”