St George's, University of London and Kingston University, London, UK; Health Innovation Network, London, UK.
St George's, University of London and Kingston University, London, UK.
Physiotherapy. 2021 Dec;113:160-167. doi: 10.1016/j.physio.2021.01.004. Epub 2021 Feb 2.
Funding in health care has a critical impact on the implementation and sustainability of evidence-based interventions. This study explored the perspectives of physiotherapists on the influence of commissioning arrangements on the implementation and sustainability of a group rehabilitation programme for osteoarthritis (ESCAPE-pain).
A qualitative case study approach using in-depth interviews.
National Health Service (NHS) musculoskeletal (MSK) outpatient departments in England.
Thirty physiotherapists in clinical and senior management roles from 11 NHS MSK providers.
Five themes were identified: (1) clinical perspectives of ESCAPE-pain - MSK services wanted to implement and sustain ESCAPE-pain because it provided evidence-based, quality care; (2) focusing on clinical activity over outcomes - commissioners were perceived as prioritising activity-based performance over delivering clinical outcomes; (3) rationing availability - patient access to ESCAPE-pain could be limited due to rationing resources; (4) absorbing costs - contracts did not always cover the activities associated with delivering ESCAPE-pain meaning that providers bore the costs; and (5) relationship between commissioners and providers - physiotherapists perceived a disconnect with commissioners and had little power to influence decisions.
Commissioning arrangements for MSK physiotherapy services can impede providers from implementing and sustaining a clinically and cost-effective intervention. To be implemented and sustained, an intervention needs to integrate into clinical practice and the wider healthcare system. Commissioning arrangements for MSK physiotherapy need to allow providers the flexibility to deliver interventions that best meet the needs of their patients. The move to more strategic, integrated, outcome-based commissioning has the potential to facilitate the spread and sustainability of interventions.
医疗保健资金对循证干预措施的实施和可持续性有至关重要的影响。本研究探讨了物理治疗师对委托安排对骨关节炎（ESCAPE-pain）团体康复计划的实施和可持续性的影响的看法。
采用深入访谈的定性案例研究方法。
英格兰国民保健制度（NHS）肌肉骨骼（MSK）门诊。
来自 11 个 NHS MSK 提供者的 30 名临床和高级管理职位的物理治疗师。
确定了五个主题：（1）ESCAPE-pain 的临床观点-MSK 服务希望实施和维持 ESCAPE-pain，因为它提供了基于证据的高质量护理；（2）关注临床活动而不是结果-据认为，委托方将活动为基础的绩效优先于提供临床结果；（3）资源配给的可用性-由于资源配给，患者获得 ESCAPE-pain 的机会可能受到限制；（4）吸收成本-合同并不总是涵盖提供 ESCAPE-pain 相关的活动，这意味着提供者承担了成本；（5）委托方和提供者之间的关系-物理治疗师认为与委托方脱节，几乎没有权力影响决策。
MSK 物理治疗服务的委托安排可能会阻碍提供者实施和维持具有临床和成本效益的干预措施。为了实施和维持，干预措施需要融入临床实践和更广泛的医疗保健系统。MSK 物理治疗的委托安排需要为提供者提供灵活性，以提供最符合患者需求的干预措施。向更具战略性、综合性、基于结果的委托方式转变有可能促进干预措施的传播和可持续性。
