Background/Purpose
While musculoskeletal (MSK) problems are common in primary care, current training models do not adequately prepare primary care providers (PCP) to deal with these issues. With funding from the Veterans Affairs (VA) Office of Academic Affiliations (OAA), we developed a Center of Excellence (COE) for MSK Care and Education to meet this training need for health care professional trainees.
Methods
Two new weekly outpatient clinics, the Primary Care MSK (PC-MSK) and the Multidisciplinary (COE-MSK) Clinics were developed as key components of the COE. The PC-MSK is staffed by a rheumatologist and a physician assistant (PA) with orthopaedic experience. The COE-MSK is attended by a rheumatologist, endocrinologist, orthopaedic surgeon, physiatrist, and a PCP. All categorical internal medicine (IM) interns, orthopaedic interns, PM&R residents, and rheumatology fellows participate in this clinic over the course of the academic year. Additional IM residents, medical students, nurse practitioner students and physician assistant students are also included as space allows.
Results
In 2013-14, 80 trainees participated in the PC-MSK and COE-MSK clinics. The distribution of disciplines and professions represented in this multi-level cohort are shown in Table 1.
Table 1
|
|
Post-Graduate Trainees |
Students |
||||||||
|
Discipline/Profession |
IM |
Rheum |
Geri |
Neuro |
Ortho |
PM&R |
Occ Med |
Med |
APRN |
PA |
|
Number of Trainees |
39 |
4 |
2 |
1 |
4 |
6 |
1 |
4 |
9 |
10 |
|
Percentage of Cohort |
49% |
5% |
3% |
1% |
5% |
8% |
1% |
5% |
11% |
12% |
Since June 2013, 330 patients have been seen in these clinics. As shown in Table 2, most are referred from primary care, mainly by providers in non-resident clinics. Most non-resident referrals were to the PC-MSK clinic, all others tended to request the multidisciplinary COE-MSK clinic.
Table 2
|
|
Referral Destinations |
||
|
Referral Sources |
Total |
COE |
MSK |
|
All Patients (n, %) |
330 (100) |
191 (58) |
139 (42) |
|
Primary Care |
217 |
110 |
107 |
|
Resident Continuity Clinics |
73 |
47 |
26 |
|
Faculty and Staff Clinics |
138 |
60 |
78 |
|
Women’s Clinics |
6 |
3 |
3 |
|
Specialty Care |
36 |
28 |
8 |
|
Medicine Subspecialties |
25 |
18 |
7 |
|
Surgery |
11 |
10 |
1 |
|
PC-MSK + COE-MSK (self-referrals) |
23 |
19 |
4 |
|
Other |
54 |
34 |
20 |
|
Procedures Performed (n, % of patients referred) |
115 (35%) |
43 (23%) |
72 (52%) |
|
Days to Consult Completion (mean, st.dev.) |
47 (31.7) |
55 (36.3) |
36 (19.8) |
Conclusion
These clinics provide unique and innovative opportunities for a broad range of trainees in a rich interdisciplinary and interprofessional educational environment. Additionally, these clinics are a valuable resource to primary care providers, specialty physicians, and patients for prompt and comprehensive care for veterans with either limited or complex MSK problems.
Disclosure:
M. J. Battistone,
None;
A. M. Barker,
None;
M. Grotzke,
None;
P. Beck,
None;
J. Berdan,
None;
P. Lawrence,
None;
G. W. Cannon,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-training-opportunities-in-two-innovative-ambulatory-resources-the-primary-care-musculoskeletal-clinic-and-center-of-excellence-multidisciplinary-clinic/