Musculoskeletal care program in primary care: first six-monthly assessment

Abstract

Musculoskeletal diseases result in functional impairment and chronic pain. The public health system concentrates a great part of its resolutions for the secondary health care level, thus generating long waiting lists. The present work reports the first results from the operation of a Musculoskeletal Care Pilot Program (PAME).

Management and referral guidelines for the main musculoskeletal conditions in waiting list were developed with specialists from the secondary care level.

While being developed, the existence of primary care physical therapy wards was considered. An outpatient clinic belonging to the Southern Metropolitan Health Service was selected, and a to implement a pilot ward with a physical therapist. The physicians from the outpatient clinic were trained in the adequate patient referral, adjusted to the service portfolio. Each patient receiving care at the floor, was assessed for pain (VAS) and functional capacity (HAQ-8) upon admission and discharge. Moreover, a waiting list count was performed at all the outpatient clinics from the Health Service.

The cost of the implementation of PAME was $7.086.925. During the first 6 months, 301 patients received health care (81% females, x=60 years). The assessment of patients in conditions for discharge evidenced a significant improvement of pain and functionality in all pathologies.

The rate of referrals to the secondary level was 4,2 x 10.000 registered-year, the lowest in the Health Service.

The PAME constitutes a viable strategy, improving pain, functionality and access of musculoskeletal disease, and increasing the capacity of resolution of the primary care levels and the coordinated work of the care network.