Multidisciplinary Team Care in an Australian State-Wide Advanced Practice Public Musculoskeletal Service: A Service Evaluation
Peter Window, Andrew Hislop, Sonia Sam, Maree Raymer, Michelle Cottrell, Nadine E Foster, Tracy Comans, Shaun O'LearyBackground
The Musculoskeletal Physiotherapy Screening Clinic and Multidisciplinary Service is a state-wide service in Queensland, Australia, providing multidisciplinary team (MDT) care (dietetics, physiotherapy, occupational therapy, pharmacy, psychology) following an advanced musculoskeletal physiotherapist assessment for patients with musculoskeletal conditions on public specialist waiting lists. However, the services’ usage of the MDT has not been formally evaluated.
Objectives
To explore and describe MDT care relative to phases of a patient’s journey in the service, specifically; 1) initial consultation: recorded referral acceptance relative to clinical features, 2) clinical management: patient uptake of recorded acceptance of MDT referrals, 3) duration and quantity of MDT care up to clinical review and screening clinic discharge, 4) factors associated with recorded MDT referral acceptance.
Design
Retrospective service evaluation with data linkage.
Methods
Data between July 2018 and June 2021 from 16 state-wide service facilities were exported from relevant administrative databases, cleaned, linked, and analysed descriptively. Regression analyses explored features associated with recorded referral acceptance to specific MDT disciplines.
Results
Of the 16,216 patients attending the facilities, 8,631 (53.2%) were recorded to have accepted ≥1 MDT referral. Recorded acceptance rates across disciplines ranged widely (4.3% occupational therapy to 96% physiotherapy). Accepted referrals to potentially warranted disciplines relative to clinical features was low (9.9%-30.2%). Initial appointment attendance to accepted MDT referrals ranged from 75.9-90.3%, while an episode of care included a median 5 [IQR 3,9] appointments over 149 [95, 238] days. 75.3% of patients accepting MDT referral were discharged without requiring medical specialist review. Additional to potential clinical features, patient- and service-related factors appeared to be associated with acceptance of referral to MDT care, however explained variance was low (Nagelkerke R 2 : 0.11 to 0.29).
Conclusion
Overall findings suggest factors influencing referral outcomes and subsequent uptake of specific MDT referrals needs further evaluation at the patient, clinician, and systems level.