title: Implementation of musculoskeletal Models of Care in primary care settings: Theory, practice, evaluation and outcomes for musculoskeletal health in high-income economies.
abstract: Musculoskeletal conditions represent one of the largest causes of years lived with disability in high-income economies. These conditions are predominantly managed in primary care settings, and yet, there is a paucity of evidence on which approaches work well in increasing the uptake of best practice and in closing the evidence-to-practice gap. Increasingly, musculoskeletal models of service delivery (as components of models of care) such as integrated care, stratified care and therapist-led care have been tested in primary health care pathways for joint pain in older adults, for low back pain and for arthritis. In this chapter, we discuss why implementation of these models is important for primary care and how models are implemented using three case examples: we review implementation theory, principles and outcomes; we consider the role of health economic evaluation; and we propose key evidence gaps in this field. We propose the following research priorities for this area: investigating the generalisability of models of care across, for example, urban and rural settings, and for different musculoskeletal conditions; increasing support for self-management; understanding the importance of context in choosing a model of care; detailing how implementation has been undertaken; and evaluation of implementation and its impact.
authors.affiliation: Institute of Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Keele University, Keele, ST5 5BG, UK. Electronic address: k.s.dziedzic@keele.ac.uk.
authors.forename: Krysia S
authors.initials: KS
authors.lastname: Dziedzic
authors.affiliation: School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Louise D. Acton Building, 31 George St, Kingston, ON K7L 3N6, Canada. Electronic address: simon.french@queensu.ca.
authors.forename: Simon
authors.initials: S
authors.lastname: French
authors.affiliation: Division of Health Care and Outcomes, Krembil Research Institute, University of Toronto, MP11-322, 399 Bathurst Street, Toronto, ON M5T2S8, Canada. Electronic address: adavis@uhnresearch.ca.
authors.forename: Aileen M
authors.initials: AM
authors.lastname: Davis
authors.affiliation: Health Economics, School of Population Health M431, The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia. Electronic address: Elizabeth.Geelhoed@uwa.edu.au.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Geelhoed
authors.affiliation: Institute of Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Keele University, Keele, ST5 5BG, UK. Electronic address: m.porcheret@keele.ac.uk.
authors.forename: Mark
authors.initials: M
authors.lastname: Porcheret
mesh_terms: D006801:Humans; D009140:Musculoskeletal Diseases / Q000628:therapy*; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration
keywords: Implementation; Models of care; Musculoskeletal; Primary care