Deferred care for adults with musculoskeletal complaints

Area of Science:

• Ambulatory care research
• Clinical guideline development
• Musculoskeletal medicine

Background:

• Many ambulatory care facilities face resource limitations for same-day walk-in patient care.
• Existing guidelines for safely deferring care for specific patient groups are scarce.

Purpose of the Study:

• To develop and implement evidence-based guidelines for deferring care in adults presenting with musculoskeletal complaints.
• To assess the safety and feasibility of these deferred-care guidelines in a real-world clinical setting.

Main Methods:

• A multidisciplinary physician panel used a consensus process to identify critical factors for same-day care versus deferred care.
• Clinical scenarios were developed and tested for reliability between healthcare providers.
• Guidelines were field-tested in a Veterans Administration ambulatory care triage setting with 448 patients.

Main Results:

• The developed guidelines identified 24% (107 out of 448) of patients with musculoskeletal complaints as suitable for deferred care.
• Interrater reliability for the guidelines was nearly perfect (kappa = 0.95).
• Of those identified for deferred care, 76% agreed to defer, and 87% of those kept their follow-up appointments.

Conclusions:

• A significant proportion of patients with musculoskeletal complaints can safely have their care deferred using these guidelines.
• The majority of patients were willing to defer care and attended follow-up appointments.
• Implementing these guidelines can help alleviate pressure on ambulatory settings with limited resources for same-day care.