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A PhD opportunity exists for a student interested in understanding referral practices of allied health and medical professionals working in primary care. People with musculoskeletal (MSK) conditions are frequently referred from one health care practitioner to another. For example, a general practitioner might refer a person with low back pain or neck pain to a physiotherapist. A physiotherapist might refer a patient with knee osteoarthritis to an orthopaedic surgeon for an opinion or, conversely, an orthopaedic surgeon might refer a patient to a physiotherapist or exercise physiologist for an exercise program. Despite the importance of inter-professional collaboration and multidisciplinary care, greater clarity regarding when, why and to whom, patients with musculoskeletal pain are / or should be referred. This is particularly relevant for people at risk of poor outcome when multidisciplinary care is most likely to be required. There is also a need to understand the experience from the perspective of the referral recipient. For example, do rheumatologists perceive those patients referred to them from allied health professionals appropriate? Do physiotherapists perceive patients referred to them by sports and exercise physicians appropriate? Given the divergence between professionals in their practices, there may be a disconnect between referral practices not only within, but between allied health and medical professionals. Gaining greater understanding of referral practices of healthcare professionals has the potential to assist in developing more effective inter-professional collaboration and clinical guidelines with the ultimate goal of improving health outcomes for patients.
The PhD student will work with a multidisciplinary, national and motivated team. The researchers involved in this program of research include Trudy Rebbeck, Kerrie Evans, Milena Simic, Marnee McKay, Sonia Coates, Paulo Ferreira, Darren Beales, Michele Sterling, Kim Bennell, Ian Cameron, Michael Nicholas, Gwendolen Jull, Julia Treleaven, Kathryn Refshauge, Luke Connelly, Nadine Foster, Deborah Black, Paul Hodges, Manuela Ferreira, Timothy Shaw.
Clinical practice guidelines for patients with musculoskeletal conditions such as hip / knee osteoarthritis, low back pain and neck pain all emphasise the importance of education, self-management strategies, and exercise in the management of these conditions. However, for some people, the chance of optimising health outcomes is enhanced with multidisciplinary care. For example, people may need assistance adopting long-term behavioural/lifestyle changes which are difficult to implement and/or be closely monitored by their general practitioner but which can be successfully developed and executed in collaboration with a physiotherapist or dietician. Patients presenting to a physiotherapist may require further investigations by a rheumatologist to ‘rule out’ non-musculoskeletal pathologies prior to the implementation of care. For patients with more complex presentations, a less experienced healthcare practitioner (HCP) may seek the advice of a more senior colleague or a specialist in a particular area for differential diagnosis or for opinions on management. Similarly, medical professionals may refer a patient to an allied healthcare practitioner for an exercise program rather than performing a surgical procedure.
Despite the importance of inter-professional collaboration and multidisciplinary care, there is a lack of understanding around inter-professional collaboration. Specifically, greater clarity regarding when, why and to whom, patients with musculoskeletal pain are / or should be referred is needed. Gaining greater understanding of referral practices of HCPs has the potential to assist in developing more effective inter-professional collaboration and clinical guidelines with the ultimate goal of improving health outcomes for patients.
One health service delivery model gaining favour is using risk assessment to stratify patients with MSK conditions into low, medium or high risk of poor outcome to guide referral. People with low risk of poor outcome should do well with minimal intervention under the guidance of their primary HCP. Conversely, those at higher risk of poor outcome may benefit from multidisciplinary care and/or care from HCPs with expertise in managing MSK conditions. This clinical pathway of care aims to result in more efficient use of medical services, and minimise unnecessary imaging and referrals. To date, however, given there are no guidelines of when secondary referral for particular services are indicated, it seems prudent to investigate opinions of current allied and medical professionals on their opinions of both current practice, and the practices proposed in the suggested clinical pathway. Key to successful implementation of the pathway is to understand barriers and facilitators to proposed referral practices.
The aims of this study are to:
1. Evaluate current referral practices of allied health and medical practitioners in the management of people with musculoskeletal pain, specifically those with knee osteoarthritis, low back pain or neck pain.
2. Investigate practitioners’ perceptions of optimal best practice for referrals and clinical pathways of care.
3. Explore multiple perspectives on the barriers and facilitators to a proposed clinical pathway of care.
OPPORTUNITY. This program of research will involve both qualitative and quantitative methods to explore referral practices of allied health and medical professionals.
A/Prof Trudy Rebbeck | PhD, FACP, MHealthSc(ManipPhty), BAppSc(Phty)
Trudy Rebbeck is an A/Prof at The University of Sydney and a Specialist Musculoskeletal Physiotherapist. At the University of Sydney, she leads a national program of research in implementation of clinical pathways for MSK pain conditions. This includes risk stratification and implementation of clinical pathways matched to risk. She led the development and implementation of Mywhiplash.com.au and the PACE-MSK trial which underpin this work. She has >60 publications, 2200 citations and h-index of 20. In specialist clinical practice, she specialises in assessment and management of complex upper cervical spine and head conditions including whiplash, neck pain, headache, concussion and dizziness. Trudy also runs national and international education courses on the above (for Physiotherapy and multi-disciplinary organisations).
Dr. Kerrie Evans | PhD, FACP, MHealthSc(ManipPhty), BAppSc(Phty), GAICD
Kerrie Evans is a Senior Research Fellow and a Specialist Musculoskeletal Physiotherapist. She is currently managing a large national NHMRC-funded project grant (PACE MSK, APP1141377 $1.5m 2018-2022), part of which involved the development of mypainhub. She co-supervises 5 research assistants, 4 PhD students and 1 Honours student. Prior to her post-doctoral appointment, she was a Senior Lecturer at Griffith University for 18 years and was program director of the Masters in Musculoskeletal and Sports Physiotherapy program. She has 49 publications in peer-reviewed journals and has presented at numerous international and national conferences. Dr. Evans is also the Group Chief Education and Research Officer for a large national allied health organisation and maintains a clinical caseload, consulting to national sporting teams and providing second opinions on patients with complex MSK presentations.
The opportunity ID for this research opportunity is 3084