Within-team Patterns of Communication and Referral in Multimodal Treatment of Chronic Low Back Pain Patients by an Integrative Care Team

Abstract

Background:

Nonspecific chronic low back pain (CLBP) is a highly prevalent and costly public health problem with few treatment options that provide consistent and greater than modest benefits. Treatment of CLBP is shifting from unimodal to multimodal and multidisciplinary approaches, including biopsychoso-cially-based complementary and integrative care. Multidisciplinary approaches require unique levels of communication and coordination amongst clinicians; however, to date few studies have evaluated patterns of communication and decision making amongst clinicians collaborating in the care of challenging patients with CLBP.

Methods:

As part of an observational study evaluating the effectiveness and cost-effectiveness of an integrative, team-based care model for the treatment of CLBP, we used multiple qualitative research methods to characterize within-team cross-referral and communication amongst jointly-trained practitioners representing diverse biomedical and complementary disciplines. Patterns of communication and coordinated care are summarized for 3 cases of CLBP treated by multiple members (≥3) of an integrative medical team embedded within an academic hospital.

Results:

Patients were aged from 36 to 88 years with varied comorbidities. Qualitative content analysis revealed 5 emergent themes regarding integrative patient care and treatment decision in this clinic: (1) the fundamental importance of the clinic’s formal teamwork training; (2) the critical communicative and collaborative function of regular team meetings; (3) the importance to patient care goals of having the varied disciplines practicing “under one roof”; (4) a universal commitment to understanding and treating patients as whole persons; and (5) a shared philosophy of helping patients to help themselves. These key themes are all interconnected and form the foundation of the clinic’s culture.

Conclusions:

Our qualitative findings provide context for current trends in enhancing patient-centered, coordinated, and team-based care; efforts towards better understanding interprofessional communication; overcoming barriers to successful collaboration; and identifying best practices for fostering clinical teamwork and a strong team identity. Our findings also support the need for further qualitative research, in combination with quantitative research, for evaluating the effectiveness and cost-effectiveness of resource-intensive integrative models for the treatment of chronic conditions.

Keywords: Clinician communication, collaborative care, coordinated care, back pain, qualitative research

Abstract

Antecedentes:

el dolor lumbar crónico (chronic low back pain, CLBP) no específico es un problema de salud de gran prevalencia y coste público con pocas opciones terapéuticas que proporcionen beneficios consistentes y evidentes. El tratamiento del dolor lumbar crónico está cambiando desde enfoques unimodales a enfoques multimodales y multidisci-plinarios, incluida la atención de tipo biopsicosocial complementaria e integral. Los enfoques multidisciplinarios requieren niveles únicos de comunicación y coordinación entre médicos; sin embargo, hasta la fecha pocos estudios han evaluado los patrones de comunicación y toma de decisiones entre los clínicos que colaboran en la atención de pacientes con dolor lumbar crónico difíciles.

Métodos:

como parte de un estudio observacional que evalúa la efectividad y rentabilidad de un modelo integral de atención para el tratamiento del dolor lumbar crónico realizado en equipo, utilizamos múltiples métodos de investigación cualitativos para caracterizar las referencias cruzadas y la comunicación intragru-pales entre médicos que representan diversas disciplinas biomédicas y complementarias que habían recibi-do formación conjuntamente. Los patrones de comunicación y aten-ción coordinada se resumen para tres casos de dolor lumbar crónico trata-do por varios (13) miembros de un equipo médico integral que formaba parte de un hospital docente.

Resultados:

los pacientes tenían edades comprendidas entre los 36 y los 88 años, y diversas comorbilidades. El análisis cualitativo del con-tenido reveló cinco temas emergentes respecto a la atención integral del paciente y la decisión acerca del tratamiento en esta práctica clínica: 1) la importancia fundamental del adiestramiento formal del equipo de trabajo; 2) la función de comuni-cación y colaboración crucial que representan las reuniones regulares del equipo; 3) la importancia para los objetivos de atención del pacien-te de tener las diversas disciplinas ejerciendo “bajo el mismo techo”; 4) un compromiso universal para com-prender y tratar a los pacientes como personas completas; y 5) una filosofía compartida de ayudar a los pacientes a ayudarse a sí mismos. Todos estos temas clave están inter-conectados y constituyen la base de la cultura de la práctica clínica.

Conclusiones:

nuestros hallazgos cualitativos proporcionan contexto para las tendencias actuales de poten-ciar la atención centrada en el paciente, coordinada y realizada en equi-po; los esfuerzos hacia una mejor comprensión de la comunicación interprofesional; la superación de las barreras para conseguir una colabo-ración que tenga éxito; y la identificación de las mejores prácticas para fomentar el trabajo en equipo clínico y una fuerte identidad grupal. Nuestros hallazgos también res-paldan la necesidad de una mayor investigación cualitativa, junto con la cuantitativa, para evaluar la efectividad y rentabilidad de los modelos integrales que consumen grandes cantidades de recursos para el tratamiento de las afecciones crónicas.

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