Exploring the feasibility of a network of organizations for pain rehabilitation: what are the lessons learned? [post]

Cynthia Lamper, Ivan PJ Huijnen, Mariëlle EAL Kroese, Albère J Köke, Gijs Brouwer, Dirk Ruwaard, Jeanine AMCF Verbunt
2020 unpublished
Background and aims: Integration of care is lacking for chronic musculoskeletal pain (CMP) patients. Network Pain Rehabilitation Limburg (NPRL), a transmural health care network, has been designed to provide integrated rehabilitation care from a biopsychosocial perspective to improve patients' levels of functioning. This feasibility study aims to provide insight into barriers and facilitators for the development, implementation, and transferability of NPRL.Methods: This study was conducted with
more » ... a three-phase iterative and incremental design from October 2017 to October 2018. NPRL comprises two rehabilitation practices, and three local primary care networks, with a general practitioner together with, a mental health practice nurse, and a physiotherapist or exercise therapist. These stakeholders with a random sample of participating patients took part in evaluations, consisting of interviews, focus groups, and observations. Field notes and observations were recorded during meetings. The Consolidated Framework for Implementation Research guided data collection and analysis. Results were used to refine the next phase.Results: According to health care professionals (HCPs), guidelines and treatment protocols facilitate consistency and transparency in collaboration, biopsychosocial language, and treatment. One barrier is stigmatization of CMP in society. Non-participating HCPs' treatment approaches are often more biomedical than biopsychosocial, causing patients to resist participating in NPRL. The current organization of health care, with cultural, structural, and financial aspects, acts as a barrier, complicating implementation between and within practices. HCPs preferred the iterative, bottom-up strategy. A critical mass of participating organizations is needed for proper implementation.Conclusion: NPRL is feasible in daily practice if barriers are overcome and facilitators of development, implementation, and transferability are promoted. These findings will be used to refine NPRL. A large-scale process and effect evaluation will be performed. Our implementation strategies and results may assist other health care organizations aspiring to implement a transmural network using a similar model.
doi:10.21203/rs.3.rs-91315/v1 fatcat:vxsj4uxghrfm5px5jlubhb7jpi