Improving general practice management of patients with chronic musculoskeletal pain: Interdisciplinarity, coherence, and concerns

OBJECTIVES

Management of patients with chronic musculoskeletal pain (CMP) remains a challenge in general practice. The general practitioner (GP) often experiences diagnostic uncertainty despite frequently referring patients with CMP to specialized departments. Therefore, it remains imperative to gain insights on how to optimize and reframe the current setup for the management of patients with CMP. The objective was to explore GP's perspectives on the challenges, needs, and visions for improving the management of patients with CMP.

METHODS

A qualitative study with co-design using the future workshop approach. Eight GPs participated in the future workshop (five females). Insights and visions emerged from the GP's discussions and sharing of their experiences in managing patients with CMP. The audio-recorded data were subjected to thematic text analysis.

RESULTS

The thematic analysis revealed four main themes, including (1) challenges with current pain management, (2) barriers to pain management, (3) the need for a biopsychosocial perspective, and (4) solutions and visions. All challenges are related to the complexity and diagnostic uncertainty for this patient population. GPs experienced that the patients' biomedical understanding of their pain was a barrier for management and underlined the need for a biopsychosocial approach when managing the patients. The GPs described taking on the role of coordinators for their patients with CMP but could feel ill-equipped to handle diagnostic uncertainty. An interdisciplinary unit was recommended as a possible solution to introduce a biopsychosocial approach for the examination, diagnosis, and management of the patient's CMP.

CONCLUSIONS

The complexity and diagnostic uncertainty of patients with CMP warrants a revision of the current setup. Establishing an interdisciplinary unit using a biopsychosocial approach was recommended as an option to improve the current management for patients with CMP.

Improving working conditions in an Iranian hospital: a participatory ergonomics approach

Objectives. The future workshop (FW), as a participatory ergonomics approach, is used to change the actual situation of a system into a preferable one. This study was conducted at a major hospital to identify ergonomic problems and provide appropriate solutions for improving working conditions using the FW technique. Methods. Twenty-five mid-level managers of the hospital participated in a 2-day FW. In the critique phase, the ergonomic problems were thoroughly discussed. After brainstorming followed by structuring and grouping of ideas, 75 ergonomic problems were identified and classified into four groups. Solutions and action plans were proposed to improve working conditions. Results. There were nine problems in the personnel-managerial group. Eighteen action plans were proposed to fix them. Stressful occupational factors were the worst problem in this group. Five problems were characterized in the physical space group and 10 action plans were presented. Seven problems were detected in the equipment group, for which 13 action plans were presented. In the welfare group, six problems and 12 action plans were presented. Conclusion. The results revealed that the FW was an appropriate method to find ergonomic bottlenecks in the hospital and a good basis for devising ergonomic interventions.

Envisioning robotic surgery: Surgeons' needs and views on interacting with future technologies and interfaces

BACKGROUND

The development of technology in robotic surgery is typically presented from a technical perspective. This study considers the user perspective as an input to the development of technology by exploring potential solutions within and beyond the field of robotic surgery.

METHODS

Advanced technological solution concepts were selected based on a technology review and an ethnographic study. Using a future workshop method, these were rated and discussed by a group of surgeons from three perspectives: enhancing operation outcome, user experience and learning in the operating theatre.

RESULTS

Diverse technologies were considered to offer potential for supporting the surgeons' work. User experience and learning could be improved especially via solutions novel to robotic surgery. Robotic surgery technologies currently under development were mainly considered to support a good operation outcome. Suitability for practical work was elaborated upon, and related concerns were identified.

CONCLUSIONS

The results can support development of robotic surgery to enhance surgeons' work.