School of Rehabilitation Therapy, Queen's University, Louise D Acton Building, 31 George St, Kingston, ON, K7L 3N6, Canada.
Department of Chiropractic, Macquarie University, Sydney, Australia.
BMC Prim Care. 2022 Aug 11;23(1):201. doi: 10.1186/s12875-022-01817-5.
Low back pain (LBP) is one of the most common reasons for primary care visits and is the leading contributor to years lived with disability worldwide. The purpose of this study was to understand the perspectives of patients and primary care team members related to their experiences with a new physiotherapist-led primary care model for LBP.
We conducted an interpretive description qualitative study. Data were collected using a combination of semi-structured interviews and focus group discussions and analyzed using thematic analysis. Participants included adults (> 18 years of age) with LBP and primary care team members who participated in a physiotherapist-led primary care model for LBP in Kingston, Ontario, Canada.
We conducted 18 semi-structured interviews with patients with LBP (10 women; median age of 52) as well as three focus group discussions with a total of 20 primary care team members representing three teams. Four themes (each with sub-themes) were constructed: 1) enhanced primary care delivery for LBP (improved access and engagement in physiotherapy care, improved communication and care integration between the physiotherapist and primary care team, less inappropriate use of healthcare resources); 2) positive patient experiences and perceived outcomes with the new model of care (physiotherapist built therapeutic alliance, physiotherapist provided comprehensive care, improved confidence in managing LBP, decreased impact of pain on daily life); 3) positive primary care team experiences with the new model of care (physiotherapist fit well within the primary care team, physiotherapist provided expertise on LBP for the primary care team, satisfaction in being able to offer a needed service for patients); and 4) challenges implementing the new model of care (challenges with prompt access to physiotherapy care, challenges making the physiotherapist the first contact for LBP, and opportunities to optimize communication between the physiotherapist and primary care team).
A new physiotherapist-led primary care model for LBP was described by patients and primary care team members as contributing to positive experiences and perceived outcomes for patients, primary care team members, and potentially the health system more broadly. Results suggest that this model of care may be a viable approach to support integrated and guideline adherent management of LBP in primary care settings.
下腰痛（LBP）是基层医疗就诊的最常见原因之一，也是全球导致残疾年限的主要原因。本研究旨在了解患者和基层医疗团队成员对新的以物理治疗师为主导的 LBP 基层医疗模式的体验。
我们进行了一项解释性描述的定性研究。数据收集采用半结构化访谈和焦点小组讨论相结合的方式，并采用主题分析进行分析。参与者包括安大略省金斯顿的 LBP 患者（> 18 岁）和参与 LBP 物理治疗师主导的基层医疗模式的基层医疗团队成员。
我们对 18 名患有 LBP 的患者（10 名女性；中位年龄 52 岁）进行了半结构化访谈，并对代表三个团队的 20 名基层医疗团队成员进行了三次焦点小组讨论。构建了四个主题（每个主题都有子主题）：1）增强 LBP 的基层医疗服务（改善对物理治疗护理的获取和参与，改善物理治疗师和基层医疗团队之间的沟通和护理整合，减少对医疗资源的不当使用）；2）患者对新模式的积极体验和感知结果（物理治疗师建立治疗联盟，物理治疗师提供全面护理，提高对管理 LBP 的信心，减轻疼痛对日常生活的影响）；3）基层医疗团队对新模式的积极体验（物理治疗师很好地融入基层医疗团队，物理治疗师为基层医疗团队提供 LBP 专业知识，为患者提供所需服务的满意度）；4）实施新模式的挑战（物理治疗护理的即时获取挑战，使物理治疗师成为 LBP 的第一接触点的挑战，以及优化物理治疗师和基层医疗团队之间沟通的机会）。
患者和基层医疗团队成员将新的以物理治疗师为主导的 LBP 基层医疗模式描述为对患者、基层医疗团队成员，甚至更广泛的医疗系统产生积极体验和感知结果。结果表明，这种护理模式可能是一种可行的方法，可支持在基层医疗环境中对 LBP 进行综合和遵循指南的管理。
