Multidisciplinary Care Setting Research Articles

Nutrition care practices of primary care providers for weight management in multidisciplinary primary care settings in Ontario, Canada - a qualitative study

BackgroundDespite the recommended guidelines on addressing diet for the management and prevention of obesity in primary care, the literature highlights that their implementation has been suboptimal. In this paper, we provide an in-depth understanding of current nutrition-related weight management practices of primary care providers (PCPs) working in relatively new multidisciplinary health care settings in Ontario.MethodsThree types of multidisciplinary primary care settings were included (2 Family Health Teams, 3 Community Health Centres and 1 Nurse Practitioner-Led Clinic). Participants (n = 20) included in this study were nurse practitioners (n = 13) and family physicians (n = 7) supporting care for adult patients (18 years or older). In-depth interviews were transcribed, coded and the content was analyzed using an integrated approach.ResultsOur analysis showed that most PCPs used anthropometric measures such as weight for screening patients who would benefit from nutrition counselling with a dietitian. The topic of nutrition was generally brought up either during physical examinations, when patients were diagnosed with a chronic disease, or when blood markers were out of normal range. Participants also mentioned that physical examinations are no longer occurring annually, with most PCPs offering episodic care. All participants reported utilizing dietetic referrals, noting the enablers for providing the referral, which included access to an on-site dietitian. Nonetheless, dietetic referrals were mostly used when patients had an obesity-related co-morbidity. Participants mentioned that healthy eating advice was reinforced during follow-up visits with patients only when there was enough time to do so. Electronic Health Records (EHRs) were utilized to facilitate message reinforcement by PCPs, who perceived EHRs to be helpful for viewing what was discussed in the session with the dietitian.ConclusionsPCPs mostly used objective measures to screen for patients who would benefit from nutrition counselling rather than diet assessment, which undermines the importance of dietary intake and overemphasizes weight. With physical examinations occurring less frequently, there will be additional missed opportunities for addressing nutrition-related concerns. The presence of a dietitian on site allowed for PCPs to refer patients to nutrition counselling. Having sufficient time during medical visits and EHRs seemed to facilitate message reinforcement by PCPs in follow-up visits with patients.

A Systematic Review of Interprofessional Collaboration for Obesity Management in Primary Care, A Focus on Dietetic Referrals

Background: An interpr ofessional approach is recommended in the managementof obesity.Objectives: To elucidate: 1) dietetic referral practices of primary care providers to prevent and manage obesity, and 2) the factors that enable or disable the use of dietetic referrals.Methods: Inclusion criteria: 1) written in English 2) primary care settings, 3) weight-management approaches, 4) referrals to Dietitians, 5) adult patients, 6) published from 2000 and 2017, and 7) meets standard quality criteria.Findings: Factors hindering the use of dietetic referrals included lack of accessibility to dietetic services and associated cost to patients. Working in proximity and relationship building were considered enabling factors for providing dietetic referrals.Conclusions: Multidisciplinary primary care settings facilitate dietetic referrals through relationship building, accessibility to dietitians, and cost-free dietetic services.

Nutrition and obesity care in multidisciplinary primary care settings in Ontario, Canada: Short duration of visits and complex health problems perceived as barriers.

Nutrition care in the primary care setting is integral in obesity management, but there is a substantial gap between patients who would benefit from this service and those receiving it. This study provides an in-depth understanding of how relatively new multidisciplinary primary care settings may be affecting nutrition care practices of family physicians and nurse practitioners. This qualitative comparative case study sought to assess nutrition care practices in three different types of multidisciplinary clinics (2 Family Health Teams, 3 Community Health Centers, 1 Nurse Practitioner-Led Clinic) in Ontario, Canada. Individual semi-structured interviews were conducted with nurse practitioners (n = 13) and family physicians (n = 7) in fall 2017. Data analysis was conducted using NVivo Software. The integrated approach was used for elucidating codes and themes. Findings suggest that suboptimal duration of medical visits and increasing prevalence of complex patients were reported by most participants and were perceived as barriers for addressing nutrition and obesity. However, improved nutrition care was fostered through Electronic Medical Records, primary care providers' positive attitude towards nutrition and cost-free dietitian services at point of access. Site-specific challenges, such as duration of medical visits, incentive programs, access to dietitians on site, and continued professional development could enhance nutritional care for weight management in these multidisciplinary primary care settings.

Developing multidisciplinary clinics for neuromuscular care and research.

ABSTRACTMultidisciplinary care is considered the standard of care for both adult and pediatric neuromuscular disorders and has been associated with improved quality of life, resource utilization, and health outcomes. Multidisciplinary care is delivered in multidisciplinary clinics that coordinate care across multiple specialties by reducing travel burden and streamlining care. In addition, the multidisciplinary care setting facilitates the integration of clinical research, patient advocacy, and care innovation (e.g., telehealth). Yet, multidisciplinary care requires substantial commitment of staff time and resources. We calculated personnel costs in our ALS clinic in 2015 and found an average cost per patient visit of $580, of which only 45% was covered by insurance reimbursement. In this review, we will describe classic and emerging concepts in multidisciplinary care models for adult and pediatric neuromuscular disease. We will then explore the financial impact of multidisciplinary care with emphasis on sustainability and metrics to demonstrate quality and value. Muscle Nerve 56: 848–858, 2017

Satisfaction among lung cancer (LCa) patients (pts) in multidisciplinary (MDC) vs. serial care (SC) settings.

e18254 Background: Coordinated MDC, in which all key specialists concurrently provide early input, develop and execute a consensus plan of care in collaboration with pts and their caregivers, may improve satisfaction with care. We rigorously evaluated this premise. Methods: Prospective clinical cohort study comparing newly-diagnosed LCa pts receiving MDC (n=156) or SC (n=307) in the same healthcare system. Pts were enrolled before treatment onset. At baseline (study entry) and 3 months later, pts and caregivers completed treatment-related measures from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, including perceptions of quality of care, satisfaction with care, and extent of involvement in decision making. Satisfaction indices at 3 months will be compared in multiple linear regression models, adjusting for baseline scores and demographic and treatment-related characteristics. Results: Pt characteristics were similar, except for age and stage (Table). At baseline, MDC pts rated their care more positively than SC pts, but satisfaction with provider communication was similar. Three month data are currently being analyzed. Conclusions: MDC provided greater pt satisfaction in the diagnostic phase of LCa care. Further prospective analyses will test the hypothesis that MDC pts experience greater satisfaction with quality of care and provider communication compared to SC pts. Clinical trial information: NCT02123797. [Table: see text]

The electronic Patient Reported Outcome (ePRO) Tool: Testing usability and feasibility of a mobile app for patients with complex chronic disease and disability in primary care settings

Introduction: People experiencing complex chronic disease and disability (CCDD) face some of the greatest challenges of any patient population. These individuals struggle to manage their many health conditions, which may be exacerbated by psychological and social challenges. Primary care providers working in integrated interdisciplinary teams also find it difficult to manage these patients’ multiple discordant conditions and symptoms, and their often complex social challenges. The electronic Patient Reported Outcome (ePRO) tool is designed to overcome some of these challenges through supporting goal-oriented primary care delivery. Using the tool patients and providers collaboratively develop health care goals on a portal which is linked to a mobile device to help patients track goal progress. Multiple providers on the patients care team can view patient goals and work together to care for patients. Theory/Methods: This study tested the usability and feasibility of adopting the ePRO tool into a single inter-disciplinary primary care practice in Toronto, Canada. We used the Fit between Individuals, Task and Technology (FITT) framework to guide our feasibility and usability assessment to explore whether the ePRO tool is, 1) feasible for adoption in inter-disciplinary primary care practices and, 2) usable from both the patient and provider perspective. This usability and feasibility pilot is part of a broader user-centred design strategy that is guiding development of the ePRO tool. We conducted a 4-week pilot study in which patients and providers used the ePRO tool to collaboratively set health related goals that patients then monitored using a mobile device. Providers and patients were separately trained to use the tool. Patients and providers set up goals on the system during an initial visit, and had at least one follow-up visit at the end of the 4-week pilot to discuss goal progression. Focus groups and interviews were conducted with patients and providers to capture usability and feasibility measures. Data from the ePRO system was extracted to provide information regarding how the tool was used. Results: A total of 6 providers and 11 patients participated in the study. Three patients dropped out within the first two weeks due to health issues, and in one case, due to increased anxiety caused by using the ePRO tool. The tool was used heavily by patients, with 8 individuals completing 210 monitoring protocols, which included over 1300 total questions. Providers and patients accessed the portal an average of 10 and 1.5 times respectively over the course of the pilot. Patients and providers found the system easy to use. Some patients reported that using the tool helped in their ability to self-manage, catalyzed a sense of responsibility over their care, and improved patient-centred care delivery. Some providers saw the tool as helping to focus conversations on goal-setting. However, the tool did not fit well with provider workflows and current processes, in particular the monitoring questions were not adequately tailored to individual patient needs, and monitoring became tedious and time consuming for patients. Discussion: Heavy tool use may be attributable to the ease of use of the tool, the noted impact on patient self-management and patient-centred care delivery, as well as the potential for the tool to improve patients’ sense of responsibility over their care. Providers were equally positive about the potential of the tool to improve efficiency and patient-centredness at the point of care, particularly if suggested changes were to be implemented. However, our assessment indicates that overall usability and feasibility of the ePRO tool was low. Concerns regarding the impact on patient-provider relationships, the repetitive nature of questions, and an inability of the system to connect with other monitoring activities that they were already completing (e.g. physical activity monitoring using other apps/devices), were among the more notable issues identified by patients. For providers they experienced difficulty integrating the ePRO tool into their daily workflow, what was exacerbated by the lack of inter-operability between the ePRO tool and the providers’ electronic medical record, which are common challenges in eHealth tool adoption. Conclusion: While our study suggests relatively low usability and feasibility of the ePRO tool, we are encouraged by the early impact on patient outcomes as well as the generally positive response from patients and providers regarding the importance, and potential of the tool to improve care delivery for patients with CCDD in integrated multi-disciplinary primary care settings. As is consistent with our user-centred design development approach, we have modified the tool based on user feedback to improve usability and feasibility and are now testing the re-developed tool through an exploratory trial.

My memories are important to me: Changes in autobiographical memory in amyotrophic lateral sclerosis.

The loss of autobiographical memories (ABM) is a pervasive feature of neurodegenerative diseases. Studies to date have not investigated ABM retrieval in amyotrophic lateral sclerosis (ALS), a multisystem disorder that may be associated with cognitive dysfunction and dementia. The integrity of autobiographical memory was evaluated in 22 ALS patients compared with 28 age-matched controls using the Autobiographical Interview (AI), a semistructured interview assessing autobiographical events from discrete time periods across the life span. ABM retrieval was preserved in ALS and remained rich in detail for personal events in recent (last 12-months) and remote (teenage years) time epochs. ABM retrieval was positively correlated with months since ALS symptom onset, with a greater number of contextual details being recalled as ALS progressed. A shift in how ABMs were perceived in ALS patients became apparent, with more recurrent reflection of recent life, which was also weighted with greater personal importance. The preservation of ABM in ALS has clinical implications for the use of life review as a therapeutic tool in a multidisciplinary care setting. (PsycINFO Database Record

An Evaluation the Implementation of Evidence-Based Quality Improvement Metrics for Prostate Cancer Management in a Multidisciplinary Tertiary Care Setting

An Evaluation the Implementation of Evidence-Based Quality Improvement Metrics for Prostate Cancer Management in a Multidisciplinary Tertiary Care Setting

Routine use of patient reported outcome measures (PROMs) for improving treatment of common mental health disorders in adults.

Routine outcome monitoring of common mental health disorders (CMHDs), using patient reported outcome measures (PROMs), has been promoted across primary care, psychological therapy and multidisciplinary mental health care settings, but is likely to be costly, given the high prevalence of CMHDs. There has been no systematic review of the use of PROMs in routine outcome monitoring of CMHDs across these three settings. To assess the effects of routine measurement and feedback of the results of PROMs during the management of CMHDs in 1) improving the outcome of CMHDs; and 2) in changing the management of CMHDs. We searched the Cochrane Depression Anxiety and Neurosis group specialised controlled trials register (CCDANCTR-Studies and CCDANCTR-References), the Oxford University PROMS Bibliography (2002-5), Ovid PsycINFO, Web of Science, The Cochrane Library, and International trial registries, initially to 30 May 2014, and updated to 18 May 2015. We selected cluster and individually randomised controlled trials (RCTs) including participants with CMHDs aged 18 years and over, in which the results of PROMs were fed back to treating clinicians, or both clinicians and patients. We excluded RCTs in child and adolescent treatment settings, and those in which more than 10% of participants had diagnoses of eating disorders, psychoses, substance use disorders, learning disorders or dementia. At least two authors independently identified eligible trials, assessed trial quality, and extracted data. We conducted meta-analysis across studies, pooling outcome measures which were sufficiently similar to each other to justify pooling. We included 17 studies involving 8787 participants: nine in multidisciplinary mental health care, six in psychological therapy settings, and two in primary care. Pooling of outcome data to provide a summary estimate of effect across studies was possible only for those studies using the compound Outcome Questionnaire (OQ-45) or Outcome Rating System (ORS) PROMs, which were all conducted in multidisciplinary mental health care or psychological therapy settings, because both primary care studies identified used single symptom outcome measures, which were not directly comparable to the OQ-45 or ORS.Meta-analysis of 12 studies including 3696 participants using these PROMs found no evidence of a difference in outcome in terms of symptoms, between feedback and no-feedback groups (standardised mean difference (SMD) -0.07, 95% confidence interval (CI) -0.16 to 0.01; P value = 0.10). The evidence for this comparison was graded as low quality however, as all included studies were considered at high risk of bias, in most cases due to inadequate blinding of assessors and significant attrition at follow-up.Quality of life was reported in only two studies, social functioning in one, and costs in none. Information on adverse events (thoughts of self-harm or suicide) was collected in one study, but differences between arms were not reported.It was not possible to pool data on changes in drug treatment or referrals as only two studies reported these. Meta-analysis of seven studies including 2608 participants found no evidence of a difference in management of CMHDs between feedback and no-feedback groups, in terms of the number of treatment sessions received (mean difference (MD) -0.02 sessions, 95% CI -0.42 to 0.39; P value = 0.93). However, the evidence for this comparison was also graded as low quality. We found insufficient evidence to support the use of routine outcome monitoring using PROMs in the treatment of CMHDs, in terms of improving patient outcomes or in improving management. The findings are subject to considerable uncertainty however, due to the high risk of bias in the large majority of trials meeting the inclusion criteria, which means further research is very likely to have an important impact on the estimate of effect and is likely to change the estimate. More research of better quality is therefore required, particularly in primary care where most CMHDs are treated.Future research should address issues of blinding of assessors and attrition, and measure a range of relevant symptom outcomes, as well as possible harmful effects of monitoring, health-related quality of life, social functioning, and costs. Studies should include people treated with drugs as well as psychological therapies, and should follow them up for longer than six months.

Red flags presented in current low back pain guidelines: a review.

The purpose of this study was to identify and descriptively compare the red flags endorsed in guidelines for the detection of serious pathology in patients presenting with low back pain to primary care. We searched databases, the World Wide Web and contacted experts aiming to find the multidisciplinary clinical guideline in low back pain in primary care, and selected the most recent one per country. We extracted data on the number and type of red flags for identifying patients with higher likelihood of serious pathology. Furthermore, we extracted data on whether or not accuracy data (sensitivity/specificity, predictive values, etc.) were presented to support the endorsement of specific red flags. We found 21 discrete guidelines all published between 2000 and 2015. One guideline could not be retrieved and after selecting one guideline per country we included 16 guidelines in our analysis from 15 different countries and one for Europe as a whole. All guidelines focused on the management of patients with low back pain in a primary care or multidisciplinary care setting. Five guidelines presented red flags in general, i.e., not related to any specific disease. Overall, we found 46 discrete red flags related to the four main categories of serious pathology: malignancy, fracture, cauda equina syndrome and infection. The majority of guidelines presented two red flags for fracture ('major or significant trauma' and 'use of steroids or immunosuppressors') and two for malignancy ('history of cancer' and 'unintentional weight loss'). Most often pain at night or at rest was also considered as a red flag for various underlying pathologies. Eight guidelines based their choice of red flags on consensus or previous guidelines; five did not provide any reference to support the choice of red flags, three guidelines presented a reference in general, and data on diagnostic accuracy was rarely provided. A wide variety of red flags was presented in guidelines for low back pain, with a lack of consensus between guidelines for which red flags to endorse. Evidence for the accuracy of recommended red flags was lacking.

Risk Assessment and Strengths Based Case Management in Elderly Care– Scope of Social Work Practice

Social workers have a significant role in ensuring the wellbeing of older people. Social work brings a range of specialized skills and methods of interventions in improving the quality of life of older adults. Conducting proper assessment is an important task of social workers while engaging in the provision of support services. In contrast to the ubiquitous deficit-based assessments, strengths-based assessments provide social work practitioners with methods to assess strengths and abilities and thereby develop strengths-based interventions. Though risk-assessment is necessary to prevent problems occurring, understanding clients’ strengths is an integral resource in the helping process. Assessments giving equal importance to risks and strengths are inevitable in formulating and implementing specific activities to facilitate their independent living in the community. This paper highlights the significance of biopsychosocial assessment, risks/strengths assessment and strengths-based case management of older adults. This paper also presents an inventory of risks and strengths reported by older adults who attended case work and counselling sessions with the author during her role as a social worker in a multidisciplinary community health care setting in Australia.

Reconstructive algorithms in the pediatric population.

Reconstruction of oncologic defects in the pediatric population is a unique challenge. Differences in patient comorbidities, size of the reconstructive components, response of the skeletally immature body to surgery and radiation, compliance, and overall recovery potential make the pediatric patient cohort distinct from the adult population. Considering that patients are enjoying longer life spans, it behooves the surgeon to reconstruct oncologic defects with durable and long-lasting tissue. Determining when to implement each of the reconstructive tools is based upon principles embodied by the reconstructive ladder and taking into account the defect-specific characteristics, including location and type of tissues involved. Within the setting of multi-disciplinary care, reconstruction can be associated with good long-term functional and aesthetic outcomes. J. Surg. Oncol. 2016;113:940-945. © 2016 Wiley Periodicals, Inc.

Amyotrophic Lateral Sclerosis: Review.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease primarily affecting the upper and lower motor neurons. The lifetime risk of developing ALS is estimated at 1:350 for men and 1:500 for women, higher for those who have served in the military. The diagnosis remains clinical with electrodiagnostic support. Alternative diagnoses can usually be ruled out by the use of neuroimaging studies and laboratory evaluation. Perhaps because ALS is a diagnosis of exclusion, there is a substantial delay in diagnosis, upward of 12 months after the onset of symptoms, and most patients see three or more providers in the course of the diagnostic process. Once diagnosed, patients are best medically managed in a multidisciplinary care setting, an approach that has been shown to prolong survival and improve quality of life. Riluzole is the only disease-modifying therapy approved by the Food and Drug Administration, but numerous symptomatic therapies exist. In the past 20 years, ALS has become the focus of intense investigation by a worldwide community of basic scientists, and for clinical investigators the disease is an active area of research, with stem cell therapies, gene therapies, and a host of small molecule agents under investigation at various stages of clinical and preclinical development.

Assessing the Quality and Comparative Effectiveness of Team-Based Care for Heart Failure

Team-based or multidisciplinary care may be a potential way to positively impact outcomes for heart failure (HF) patients by improving clinical outcomes, managing patient symptoms, and reducing costs. The multidisciplinary team includes the HF cardiologist, HF nurses, clinical pharmacists, dieticians, exercise specialists, mental health providers, social workers, primary care providers, and additional subspecialty providers. The timing and setting of multidisciplinary care depends on the needs of the patient and the resources available. Multidisciplinary HF teams should be evaluated based on their ability to achieve goals, as well as their potential for sustainability over time.

Abstract P1-01-11: The impact of a critical look at the consequences of preoperative MRI in breast cancer patients

Abstract BACKGROUND: Despite the fact that routine use of preoperative breast MRI for breast cancer has not been shown to improve oncologic outcomes, it is still an exceedingly popular test. Due to low MRI specificity, patients may be subjected to additional invasive test. There have been few studies specifically evaluating the outcomes from these additional tests and its implications on the health care system. The objective of this study was to critically evaluate the impact of performing a preoperative MRI on breast cancer patients at our institution. METHODS: A retrospective chart review was performed on all female breast cancer patients diagnosed and awaiting surgery (2010-2012). Based on extracted data, indications for preoperative breast MRI were established for our institution (2013). Adherence to these guidelines was then assessed over the next year. RESULTS: In 2010-2012, 1159/1674 breast cancer patients underwent a preoperative breast MRI. The MRI group was younger (p<0.0001), but not different in histologic subtype (p=0.06) or biomarker status (0.61). 421/1159 (36%) of MRI patients underwent at least one additional MRI induced imaging test (ultrasound, mammogram, 6 month MRI) following the MRI. 35% (415/1159) of patients underwent an additional MRI-induced biopsies, 52% of which were benign in the breast and 62% of which were benign in the axilla. Post-MRI biopsies resulted in upstaging (DCIS to invasive cancer; node negative to node positive) in 25/1159 (2%) of patients. Preliminary data assessing local guideline adherence demonstrated that 188/349 (54%) of new breast cancer patients underwent a preoperative MRI. Locally accepted indications for MRI use included: dense breast (26%); assessment of tumor extent; (19%); lobular carcinoma (16%); assessment of locally advanced cancer (16%). 71% of MRI studies were ordered by the radiologist. 22% of patients had no obvious indication for MRI according to our local guidelines. MRI-induced biopsies occurred in 76/189 (40.2%) of patients, 60% of which were benign in the breast and 71% of which were benign in the axilla. CONCLUSION: We have critically evaluated the impact of preoperative breast MRI on a large volume of patients. Often, MRI results did not result in significant treatment change. Barriers to guideline evidence based care implementation continue to exist in the setting of multidisciplinary breast cancer care. We must continue to work together to best counsel our patients and effectively manage our health care cost, in keeping with the Choosing Wisely Campaign Canada. Citation Format: I Ching Yeung, Mehrzad Namazi, Valerie Deslauriers, Fatima Haggar, Angel Arnaout. The impact of a critical look at the consequences of preoperative MRI in breast cancer patients [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-01-11.

Rates of appropriate genetic testing referral for breast cancer patients treated in a multidisciplinary cancer care setting.

45 Background: Approximately 5% to 10% of women diagnosed with breast cancer have a genetic predisposition, which can affect management recommendations. The National Comprehensive Cancer Network (NCCN) has established guidelines for genetics referral and testing, however recent publications have indicated low rates of family history documentation and appropriate genetics referral. We sought to assess the impact of standardized family history documentation on rates of appropriate genetics referral in a multidisciplinary breast clinic (MDC) setting. Methods: In advance of MDC consultation, women with newly diagnosed breast cancer complete an intake questionnaire which includes documentation of Ashkenazi Jewish ancestry along with a thorough family history. We retrospectively analyzed family history documentation to inform eligibility for genetic testing and rates of appropriate genetics referral. Results: Between June 2012 and April 2014, 202 women with newly diagnosed, nonmetastatic breast cancer were seen in MDC. We noted 100% compliance with family history documentation. Per NCCN Guidelines, genetic testing was indicated in 52% (106 patients), of which 77% were appropriately referred to a genetic counselor for evaluation. All patients who met criteria based on personal history factors including age ≤ 45, triple-negative disease under age 60, or two or more breast primaries under age 50 were appropriately referred. Patients who were eligible but not referred ranged in age from 46 to 93 and were eligible for testing based on Ashkenzi Jewish ancestry (3 patients) or family history factors including a relative with ovarian cancer (3 patients), ≥2 relatives with breast cancer (5 patients), or a relative with breast cancer < age 50 (7 patients). Conclusions: Compared with recently published national averages, rates of appropriate family history documentation and genetic testing referrals are significantly higher in our MDC setting. However, this analysis has identified significant opportunity for improvement via identification of overlooked referral indications. Initiatives are underway to improve future compliance.

Barriers and facilitators to implement shared decision making in multidisciplinary sciatica care: a qualitative study.

BackgroundThe Dutch multidisciplinary sciatica guideline recommends that the team of professionals involved in sciatica care and the patient together decide on surgical or prolonged conservative treatment (shared decision making [SDM]). Despite this recommendation, SDM is not yet integrated in sciatica care. Existing literature concerning barriers and facilitators to SDM implementation mainly focuses on one discipline only, whereas multidisciplinary care may involve other barriers and facilitators, or make these more complex for both professionals and patients. Therefore, this qualitative study aims to identify barriers and facilitators perceived by patients and professionals for SDM implementation in multidisciplinary sciatica care.MethodsWe conducted 40 semi-structured interviews with professionals involved in sciatica care (general practitioners, physical therapists, neurologists, neurosurgeons, and orthopedic surgeons) and three focus groups among patients (six to eight per group). The interviews and focus groups were audiotaped and transcribed in full. Reported barriers and facilitators were classified according to the framework of Grol and Wensing. The software package Atlas.ti 7.0 was used for analysis.ResultsProfessionals reported 53 barriers and 5 facilitators, and patients 35 barriers and 18 facilitators for SDM in sciatica care. Professionals perceived most barriers at the level of the organizational context, and facilitators at the level of the individual professional. Patients reported most barriers and facilitators at the level of the individual professional. Several barriers and facilitators correspond with barriers and facilitators found in the literature (e.g., lack of time, motivation) but also new barriers and facilitators were identified. Many of these new barriers mentioned by both professionals and patients were related to the multidisciplinary setting, such as lack of visibility, lack of trust in expertise of other disciplines, and lack of communication between disciplines.ConclusionsThis study identified barriers and facilitators for SDM in the multidisciplinary sciatica setting, by both professionals and patients. It is clear that more barriers than facilitators are perceived for implementation of SDM in sciatica care. Newly identified barriers and facilitators are related to the multidisciplinary care setting. Therefore, an effective implementation strategy of SDM in a multidisciplinary setting such as in sciatica care should focus on these barriers and facilitators.

SAT0409 Multidisciplinary Care in the Management of Fibromyalgia: A Randomized Controlled Trial

BackgroundChronic musculoskeletal pain disorders such as fibromyalgia (FM) have an impact on all aspects of well-being.ObjectivesTo evaluate the effectiveness of a multidisciplinary care setting for the management of FM in...

The International Classification of Functioning, Disability and Health (ICF) Core Sets: Application to a postmenopausal woman with rheumatoid arthritis and osteoporosis of the spine

The International Classification of Functioning, Disability and Health (ICF) framework facilitates systematic assessment of functioning across four components. ICF Core Sets are proposed to be beneficial for clinicians in multidisciplinary care settings because they provide a common language for communication. A clinical vignette of a postmenopausal woman with rheumatoid arthritis (RA) and a non-traumatic vertebral fracture is presented to discuss how the ICF Core Sets for RA and osteoporosis (OP) can be helpful in structuring clinical decisions. To demonstrate how condition-specific ICF Core Sets can be used to evaluate and treat women with two comorbidities, each component of the ICF Core Sets is compared across conditions and integrated into clinical decision-making. Topics covered include: exercise tolerance, urinary continence, bone mass, fear of falling, and environmental factors. The benefits of thorough communication with the client and a common language across healthcare disciplines are highlighted as the potential benefits of the ICF framework; however, limitations to uptake of the ICF in clinical practice are also addressed.

International classification of functioning, disability and health and motor neurone disease rehabilitation

PurposeThe purpose of this paper is to determine if issues relevant to multidisciplinary rehabilitation care from the perspective of the patient and caregiver can be addressed utilising the International Classification of Functioning, Disability and Health (ICF) framework; also to identify gaps in evidence and service provision to optimise clinical care.Design/methodology/approachParticipants with motor neurone disease (MND) (n=44) and their caregivers (n=37) were recruited from a tertiary MND clinic. Cross‐sectional predominantly qualitative methodology was used to explore the perspectives of MND patients and their caregivers on disability and service gaps. Their disability experience and relevant environmental factors were then mapped onto the ICF framework. Personal factors were described. The impact of MND on caregivers was also described.FindingsThere were significant gaps in MND care. In particular, the need for coordinated care by neurology, rehabilitation and palliative care services (“neuropalliative rehabilitation” model) was highlighted. The ICF framework adequately incorporated patient‐and caregiver‐ reported disability in MND.Originality/valueThis is the first review that the authors can identify, that lays the foundation for development of an ICF “Core set” (expert‐selected ICF categories that should be addressed in multidisciplinary care settings) for MND, which could improve consensus of care and communication amongst treating clinicians.