4Harnessing and supporting consumer involvement in the development and implementation of Models of Care for musculoskeletal health
Introduction
Consumer involvement is becoming an increasingly important part of health systems, health policy and service design. Consumer involvement is seen as ‘an important way to improve our healthcare system’ [1], and encompasses not only consumers being involved in decisions about their own care but also in decisions about how health services and systems are designed and delivered [2]. In some countries, such as Australia [3], New Zealand [4] and Canada [5], consumer involvement is embedded into the national accreditation standards for health services. Internationally, the World Health Organization has promoted concepts such as informed and empowered individuals and families as one strategy for achieving improved health outcomes worldwide [6].
Alongside this environment of increasing consumer participation, there is also increased focus on using Models of Care (MoCs) as a vehicle to drive evidence into policy and practice through whole-of-sector changes at a health system, health service, health professional and consumer level as a way to manage the increasing burden of chronic disease care. MoCs are defined by Briggs et al. (2014) as “an evidence-informed policy or framework that outlines the optimal manner in which condition-specific care should be made available and delivered to consumers. MoCs aim to address current and projected community needs in the context of local operational requirements. The guidance provided is coined as ‘the right care, delivered at the right time, by the right team, in the right place, with the right resources’” [7]. A MoC approach ideally encourages co-design for health policy, programme and service delivery between clinicians and consumers and also between policy makers and consumers, ensuring comprehensive embedding of consumers' perspectives and needs. This intersection of increasing consumer involvement and increased focus on MoC development provides an exciting opportunity to harness consumer involvement activities to inform and strengthen the design and implementation of MoCs.
This chapter will present contemporary, state-of-the-art and practice-relevant reviews for different strategies for consumer involvement informed by the strongest evidence (from systematic reviews [8]). The evidence will be the focus of this chapter, and where possible we have drawn a series of practice points from the systematic reviews to show how to facilitate implementation of consumer involvement across all levels of healthcare design and delivery. Additionally, we have provided some directions to different guides and toolkits from around the world that can be used to support the local implementation of consumer involvement activities as it relates to MoCs.
Importantly, while there are recommendations included in this chapter, it is not intended as a manual for implementation of consumer involvement in musculoskeletal MoCs. The design and implementation of consumer involvement activities is necessarily dependent on local context – including features of the health system, health service, environment and the consumers themselves. Importantly, the ‘one-size-fits-all’ approach is not available to implement consumer involvement activities within MoCs, instead this chapter aims to provide information on the many options available.
This chapter will examine aspects of musculoskeletal MoCs which provide opportunities for consumer involvement and present the systematic review evidence relating to each. To examine the levels of intervention and influence within the health system, we have used the three levels of micro, meso and macro identified by Speerin et al. (2014) [9]:
- 1.
The micro level – participation of consumers in the co-care of their condition;
- 2.
The meso level – delivery systems, infrastructure and the competencies/training of health professionals; and
- 3.
The macro level – health systems, organisations, health policy and socioeconomic factors.
Micro-level consumer participation interventions typically take place between consumers and health professionals; meso-level interventions between consumers and health services; and macro-level interventions between consumers and health system designers (see Fig. 1).
Before the examination of systematic review evidence, a number of case studies have been presented to illustrate how consumer involvement has been harnessed in relation to musculoskeletal MoCs. Additionally, at the end of the chapter, we have outlined some areas for future research to further support consumer involvement in the development and implementation of musculoskeletal MoCs.
Section snippets
Which aspects of healthcare matter to people with musculoskeletal conditions?
As worldwide morbidity and mortality continues to shift away from communicable diseases to non-communicable and chronic conditions [10], health systems worldwide need to adapt to better service health consumers who will have contact with health services and professionals over long periods of time through many life and disease stages. The 2010 Global Burden of Disease study showed that musculoskeletal conditions were the second most common cause of disability worldwide [10]. Disability
A framework for consumer involvement in the development and implementation of musculoskeletal MoCs
In 2011, Lowe and colleagues [15] published a taxonomy of communication and involvement interventions for consumers' safe and effective use of medicines. This publication was based on earlier work performed by the Cochrane Consumers and Communication Group in developing a taxonomy of interventions for consumer communication and participation [16]. The taxonomy provides a framework for analysis of consumer communication and participation across all levels (macro, meso and micro) of healthcare.
Real-world consumer involvement: case studies
Three case studies of consumer involvement in different aspects of healthcare are presented to help translate the systematic review evidence into practice and to provide direction to available resources which, through consumer involvement, support implementation of MoCs.
Evidence for involving people with musculoskeletal conditions to support the development and implementation of musculoskeletal MoCs
MoCs are usually constructed from a variety of healthcare interventions, policies and approaches, which include, or have the potential to include, consumer participation. For example, a MoC might recommend a model of service delivery that includes the use of a self-management programme; or advocate the use of decision aids consumer; or specify how consumer-centred care might be delivered; or recommend the use of a consumer advisory committee to aid a MoC design. To strategically manage the
Consumer involvement in components of care at the micro level to support implementation of MoCs (Supplemental File 1)
At the micro level, consumers are most often involved in MoCs as end users through models of service delivery and interventions, which encourage participation in the co-care of their condition. This involvement usually happens within the relationship between the health professional and the consumer. In regard to Lowe's taxonomy, education/information interventions, supporting behaviour change, teaching skills, facilitating decision-making and providing support, all provide opportunities for
Opportunities for consumer involvement in meso-level interventions
At the meso level, consumers can be involved in MoCs through the design of healthcare delivery systems and infrastructure and in the design and delivery of competencies/training of health professionals (Supplemental File 2). This work mainly happens between the consumer and their health service (Fig. 3). In regard to Lowe's taxonomy, activities which minimise risks and harms, and those that improve healthcare quality, exist at the meso level of healthcare.
Because of shortage of good quality
Consumer involvement in components of care at the macro level to support implementation of MoCs
At the macro level, consumers can be involved in MoCs through involvement in the design of health systems, services, health policy and in being involved in addressing socioeconomic factors, which influence health systems and access to healthcare (Supplemental File 3). This work largely happens between consumers and health system designers (e.g., government and private providers). In regard to Lowe's taxonomy, all activities which involve consumers at the systems level exist at the macro level
Limitations
A limitation of the approach of this paper was the decision to primarily present systematic review evidence as this meant some newer strategies might not be presented. However, in the context of a rapidly evolving area of research, a vast amount of single-study trials, and enormous variation in approaches to consumer involvement, we decided that presenting systematic review evidence was the best way to create an evidence-based, international platform for informing how to harness consumer
Future directions and further research
Consumer involvement in healthcare across all levels (micro, meso and macro) is generally under-researched. The evidence that is available is generally at the micro level, and some of the evidence is of a lower quality. This lack of research is particularly an issue at the meso- and macro levels of healthcare. Because of the complex nature of these interventions and the variety of interventions that lie under the ‘consumer involvement’ umbrella, it is unsurprising that study results are often
Conclusion
Including consumers in the design, delivery and evaluation of musculoskeletal MoCs has the potential to improve healthcare delivery by bringing services more in line with consumer wants and needs and supporting more effective implementation of MoCs.
Although the evidence of consumer needs is increasing, the evidence base about effective consumer involvement at all healthcare levels (macro, meso and micro) remains under developed. Despite the current gaps in evidence, in this chapter we have
Conflict of interest
The authors declare no conflicts of interest.
Acknowledgements
AW is supported by an NHMRC Career Development Fellowship clinical level 2 (1063574). RB is supported by an NHMRC Senior Principal Research Fellowship (1082138).
The authors thank the editors, associate professor Andrew Briggs and associate professor Helen Slater for their comments and support in preparing this manuscript.
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