Models of care for musculoskeletal health in Australia: now more than ever to drive evidence into health policy and practice

Abstract

Abstract.Musculoskeletal health conditions such as arthritis, osteoporosis and pain syndromes impart a profound socioeconomic burden worldwide, particularly in developed nations such as Australia. Despite the identified burden, substantial evidence-practice and care disparity gaps remain in service delivery and access that limit the potential for improved consumer outcomes and system efficiencies. Addressing these gaps requires a whole-of-sector response, supported by evidence-informed health policy. Models of care (MoCs) serve as a policy vehicle to embed evidence into health policy and guide practice through changes in service delivery systems and clinician behaviour. In Australia, MoCs for musculoskeletal health have been developed by networks of multidisciplinary stakeholders and are incrementally being implemented across health services, facilitated by dedicated policy units and clinical champions. A web of evidence is now emerging to support this approach to driving evidence into health policy and practice. Understanding the vernacular of MoCs and the development and implementation of MoCs is important to embracing this approach to health policy.What is known about the topic? The impact of musculoskeletal health conditions is profound. As the awareness around the magnitude of the impact of these conditions increases, the importance of system-wide policy responses and platforms for health service improvements is now recognised. The term 'models of care' is not new. It has been used for many years, mainly at the hospital level, for planning and delivering clinical services. However, over the past 8 years an alternative approach using health networks has been adopted for the development and implementation of models of care to achieve broad engagement and a wider and more sustainable scope for implementation. What does this paper add? Here, we provide a rationale for the development of models of care for musculoskeletal health and draw on experience in their development and implementation using a health network model, referring to an emerging web of evidence to support this approach. We describe what models of care are, how they are developed and question whether they make a difference and what the future may hold. What are the implications for practitioners? All indications suggest that models of care are here to stay. Therefore, this paper provides practitioners with a contemporary overview of models of care in Australia, their relevance to musculoskeletal healthcare, particularly related to closing evidence-practice gaps, and opportunities for sector engagement.

Commonalities and differences in the implementation of models of care for arthritis: key informant interviews from Canada

“…As such, our paper describes modifications to the existing, traditional models of care, rather than unique models of care for arthritis. This argument highlights the challenges with the term “models of care” that have been identified elsewhere [12]. Issues of terminology notwithstanding, our findings demonstrate commonalities and differences in the ways that different locations of service delivery have modified traditional models of care for persons with arthritis that have implications for health policy and service delivery.…”

“…The term “models of care” is used with many different meanings encompassing condition-specific care to service delivery [12]. It has been defined as “an evidence-informed policy or framework that outlines the optimal manner in which condition specific care should be made available and delivered to consumers” [12].…”

“…It has been defined as “an evidence-informed policy or framework that outlines the optimal manner in which condition specific care should be made available and delivered to consumers” [12]. This definition and approach suggests a top-down approach to the development of models of care yet at the time of this research the range of models of care for arthritis in Canada have most often been developed at the local level [13]; however, these local contextual factors have not been examined in-depth.…”

Time to bust common osteoarthritis myths

“…The term "model of care" refers to an evidence-informed framework or policy that outlines the ideal development and delivery of principles of care within a health system. A model of care goes one step further than clinical guidelines by not only outlining what the care components should be, but also how to deliver them within a particular health system (Briggs, Towler, Speerin, & March, 2014). An osteoarthritis model of care would incorporate chronic care principles such as multi-disciplinary management, collaborative care planning and self-management strategies.…”

Hospitalisations, admission costs and re‐fracture risk related to osteoporosis in Western Australia are substantial: a 10‐year review

“…3,10,12 The principal recommendation from these Models of Care is to establish fracture liaison services (FLSs) within health systems, consistent with recent international position statements. [13][14][15] The role of FLSs is to coordinate the timely identification, assessment and appropriate multidisciplinary management of people who sustain incident osteoporotic fractures as a means to reduce the risk of recurrent fracture.…”