Musculoskeletal triage physiotherapists’ perspectives on their role, the patient journey and implementation of interface triage clinics in primary care in Ireland

Objectives: To explore musculoskeletal triage clinical specialist physiotherapists' (CSPs) perspectives on the patient journey and their perspectives on the acceptability of implementing MSK triage interface clinics in primary care in Ireland.

Methods: A qualitative descriptive study design using a thematic approach was conducted. Semi-structured focus groups were conducted with 11 CSPs in 8 hospitals with urban and rural catchment areas across Ireland. Data analysis involved a two-stage framework; thematic analysis, followed by exploration of the findings on interface clinic implementation through the lens of Normalisation Process Theory (NPT).

Results: Four themes were identified: (1) Development of MSK pathways; (2) Clinical governance; (3) Implementation of interface clinics and (4) Physiotherapy role and identity. Interface clinics achieved some degree of 'coherence' (i.e. made sense) and 'cognitive participation' (i.e. fostered engagement) for CSPs with the expectation of patients receiving expert MSK care earlier in their journey. However, this was less beneficial to CSPs if interface clinics were not implemented as part of a wider integrated care pathway, and if clinics were established near the main hospital instead of primary care locations in the wider catchment area. CSPs conveyed strong recommendations on 'collective action' such as development and resourcing of integrated care pathways and primary care physiotherapy, investing in information technology infrastructure (electronic health records) and obtaining the ability to order investigations (e.g. MRI/x-ray).

Conclusions: These findings contribute new knowledge about MSK triage CSPs' perspectives on the patient journey through MSK services in Ireland, which can inform future implementation phases of MSK triage interface clinics.