Musculoskeletal (MSK) disorders contribute high burden and costs at individual and health system levels. Lack of streamlined care in Ireland negatively affects the patient journey, resulting in inefficient health resource use. MSK triage led by clinical specialist health and social care professionals (HSCPs) demonstrates that most patients referred to secondary care orthopaedic and rheumatology can be managed in primary care. These HSCPs (physiotherapists/occupational therapists) work at an advanced level of practice, although currently there is no salaried HSCP advanced practice grade in Ireland.
Interface MSK triage clinics aim to shift care into the community and bridge the primary-secondary care divide to provide a more integrated patient journey. These are currently being established nationally, but lack evidence regarding how they will be implemented and embedded in integrated care pathways, including the role of the HSCPs working at an advanced level of practice
This research, to be conducted in three phases, aims to evaluate the implementation, impact and potential for scale-up of three HSCP-led MSK interface services embedded in integrated pathways, using the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework. Activities undertaken by the HSCPs within these interface roles will be assessed to inform Advanced Practice workforce planning.
Phase 1: A 6-month prospective cohort study of 517 patients referred to three interface services will investigate patient characteristics, management, healthcare utilisation and clinical outcomes.
Phase 2: Semi-structured individual interviews will explore barriers and enablers to implementation and future scalability of the interface services embedded within integrated pathways, from the perspective of patients, clinicians, administrative staff, general practitioners, health service managers and manager stakeholders.
Phase 3: Activities undertaken by the HSCPs within these roles will be mapped against Advanced Practice competencies to determine how they align with an Advanced Practice role.
Results will be synthesised to develop evidence-informed recommendations to guide implementation decisions.