Models of Care For Musculoskeletal Pain Conditions: Driving Change to Improve Outcomes

Abstract

Keywords• implementation • models of care • pain management musculoskeletal pain & models of care Managing musculoskeletal pain can be challenging at a health systems level, at a service delivery level, at a clinical level and for the consumer experiencing pain. Approaching this complexity to both facilitate person-centered care and respond to the burden associated with musculoskeletal pain in an efficient, effective and sustainable way, requires reform reaching across policy and into clinical practice. In this context, Models of Care (MoCs) are increasingly regarded as a system-level enabler to translate evidence for 'what works' from policy/ systems, across service delivery and into practice. MoCs provide a platform for a reform agenda in health systems by describing not only what care to deliver but also 'how to' deliver care. We have previously comprehensively reviewed the evidence for musculoskeletal MoCs [1]. In the following commentary, rather than a focus on MoCs per se, we use working examples to show how the implementation of musculoskeletal pain MoCs is being enabled to support reform agendas. We make an explicit distinction between a MoC which provides principle-level guidance on what care to deliver and how to implement it, and a Model of Service Delivery (MoSD) which operationalizes these principles into local activity, informed by an implementation plan [2].

Complementary and alternative medicine use among older adults with musculoskeletal pain: findings from the European Social Survey (2014) special module on the social determinants of health

“…8 Despite its prevalence and associated burden, the management of musculoskeletal pain continues to be a major healthcare challenge. 9 Traditional pharmacological approaches, such as the use of opioid analgesics, are no longer recommended, particularly in the longterm, due to the heightened risk of both adverse effects and treatment discontinuation. 10,11 The implementation and use of management strategies, in particular opioid alternatives, for musculoskeletal pain should be evaluated to understand their use, quality and effectiveness.…”

Synthesis of clinical practice guideline recommendations for the primary health care of chronic musculoskeletal pain

“…An important finding is the variety of recommendations focussing on empowering the patient with the knowledge and skills to become a successful self‐manager of their condition in a supportive environment. This supportive environment should ideally involve the healthcare system, clinical teams and community integration 39,40 . The role of the therapeutic process, as well as the healthcare organization in implementing pain care interventions and thereby optimizing CMSP outcomes, is underscored and indicated by the variety of recommendations.…”

The Global Spine Care Initiative: resources to implement a spine care program

“…There is little information in the peer-reviewed literature that addresses the resources necessary to implement a model of care for the management of spinal disorders. Extensive work has been done in Australia to propose a model of care for musculoskeletal disorders that relies on multidisciplinary teams [26]. However, the authors do not describe the resources necessary to implement the model.…”