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首页> 美国卫生研究院文献>British Medical Journal >Improved access and targeting of musculoskeletal services in northwest Wales: targeted early access to musculoskeletal services (TEAMS) programme
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Improved access and targeting of musculoskeletal services in northwest Wales: targeted early access to musculoskeletal services (TEAMS) programme

机译：改善威尔士西北部肌肉骨骼服务的获取和针对性：有针对性的尽早获取肌肉骨骼服务（TEAMS）计划

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>Problem The hospital based musculoskeletal service in northwest Wales was unable to cope with the demand for referrals from general practitioners. Waiting times were long, duplicate referrals to other departments were common, and general practitioners were reluctant to refer patients with common problems because of the perceived lack of service. Many referrals were made to the inappropriate specialty, especially orthopaedics. At least part of this problem was due to a lack of coordination between the four hospital departments providing musculoskeletal services and the emphasis on district general hospital based rather than community provision.>Design Review over 18 months of impact of the targeted early access to musculoskeletal services (TEAMS) programme on accessibility to musculoskeletal services.>Setting Northwest Wales.>Key measures for improvement Number of patients referred and seen with musculoskeletal problems, waiting times, number of duplicate referrals, and surgery conversion rates in orthopaedic clinics.>Strategies for change Establishing with central clinical triage a common pathway for all musculoskeletal referrals so that patients attend the appropriate department. A back pain pathway led by extended scope physiotherapists was developed, and general practitioners with special interests and extended scope physiotherapists were trained to provide services for patients with uncomplicated musculoskeletal problems in the community.>Effects of change Over 18 months the number of referrals more than doubled. Despite this, waiting times for musculoskeletal services fell; this was noticeable for rheumatology and pain management. Duplicate referrals were abolished. Surgery conversion rates did not, however, change. Questionnaires from the clinics showed a high level of patient satisfaction.>Lessons learnt Integration of hospital services that traditionally have worked in isolation can result in greatly improved access to musculoskeletal services. Community based multidisciplinary clinics run by specially trained general practitioners with special interests and extended scope physiotherapists are an effective way of managing patients with uncomplicated musculoskeletal problems and have been well received by patients and general practitioners. The huge unmet burden of need was reflected by the great increase in musculoskeletal referrals. Other approaches are needed to meet this, including better education of general practitioners and methods for identifying and modifying psychosocial risk factors for chronic pain at an early stage.
机译：>问题：位于威尔士西北部的医院肌肉骨骼服务无法满足全科医生转诊的需求。轮候时间很长，到其他科室重复转诊很普遍，而全科医生由于感觉不到服务而不愿转诊有共同问题的患者。许多人转介到不合适的专业，尤其是骨科。至少部分原因是由于提供肌肉骨骼服务的四个医院部门之间缺乏协调，以及对基于地区综合医院而不是社区服务的重视。>设计回顾了18个月的影响有针对性地尽早获得有关肌肉骨骼服务可及性的肌肉骨骼服务（TEAMS）计划。>设置西北威尔士。>主要改善措施因肌肉骨骼问题而被转诊和看过的患者数量，等待时间，骨科门诊的重复转诊次数和手术转换率。>变革策略与中心临床分流建立所有肌肉骨骼转诊的共同途径，以便患者就诊至相应的科室。开发了由扩大范围的物理治疗师领导的背痛途径，并对有特殊兴趣的全科医生和扩大范围的物理治疗师进行了培训，以为社区中没有复杂的骨骼肌肉问题的患者提供服务。>变化的影响推荐人数增加了一倍以上。尽管如此，等待肌肉骨骼服务的时间却减少了。这在风湿病学和疼痛管理方面很明显。重复的推荐被废除了。但是，手术转换率没有变化。诊所的问卷调查显示出很高的患者满意度。>经验教训传统上孤立工作的医院服务集成可以大大改善对肌肉骨骼服务的访问。由具有特殊兴趣的经过专门培训的全科医生经营的社区多学科诊所和扩大范围的物理治疗师，是处理无复杂性骨骼肌肉疾病的患者的有效方法，并受到患者和全科医生的好评。肌肉骨骼转诊的大量增加反映了巨大的未满足需求负担。还需要其他方法来解决此问题，包括对全科医生进行更好的教育以及在早期识别和修改慢性疼痛的社会心理危险因素的方法。

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