MSK Pathways Study
Research type
Research Study
Full title
A Randomised Control Trial comparing Usual Care Vs CrossCover OrthoPathway Clincial Decision Support System in Primary Care
IRAS ID
326002
Contact name
Jonathan Hill
Contact email
Sponsor organisation
Keele University
ISRCTN Number
ISRCTN38924614
Duration of Study in the UK
0 years, 10 months, 19 days
Research summary
Research Summary:
Musculoskeletal pain is very common, accounting for a large number of GP appointments. NHS staff often have to make assessment and treatment decisions for these conditions in short consultations. Whilst national guidelines for MSK conditions are available, they are complex and cover many different conditions separately. Therefore, there is often variability in the care patients receive. Orthopathway is a system that is installed onto GP practice computers for use in appointments help clinicians make these decisions. Pathways are built for each pain site, that contain best practice national guidelines adapted by local experts. This means that all clinicians in the local area follow the same high quality guidance.
The MSK Pathways study plans to establish whether using Orthopathway in primary care has an effect on patient outcomes, clinical decision making, is cost-effective, and reduces carbon. We will recruit 40 GP practices; 20 will continue providing usual care for MSK consultations, and 20 will use Orthopathway. We will recruit patients who consult for neck, shoulder, elbow, wrist/hand, back, hip, knee, or foot pain. After the consultation, patients will be asked to complete questionnaires at baseline, 3 months, and 6 months to monitor their outcomes. Consent will be sought to review the medical records of participants to see what health care usage there was after the consultation. Some clinicians and patients from the intervention arm will be asked to take part in interviews to talk more in depth about their experiences.
Summary of Results:
Muscle and joint problems, such as back pain, arthritis, and shoulder pain, are very common reasons for people to visit their GP. In the UK, around one in seven GP appointments are for these conditions. Although national guidelines exist, people do not always receive the best possible care.
Computer tools called clinical decision support systems are designed to help doctors make good, evidence-based decisions during consultations. In this study, we tested a digital tool called CrossCover to see whether it could improve care for people with muscle and joint problems in GP surgeries.
We carried out the study in 19 GP practices between February and July 2024. Some practices used CrossCover for three months, while others continued with usual care. We analysed anonymised medical records and carefully reviewed a sample of consultations to compare the quality of care. We also interviewed clinicians to understand their experiences of using the tool.
We found that patients were much less likely to receive poor-quality or unnecessary care when CrossCover was used. Only 3 out of 60 consultations in the CrossCover group showed sub-optimal care, compared with 15 out of 60 in the usual care group. When doctors used the tool, they were more likely to give advice on self-management and refer patients to community services, and less likely to prescribe unnecessary medicines or issue sick notes.
No serious safety concerns were found. If this tool were used more widely, it could also reduce NHS costs and lower carbon emissions. Doctors generally felt positive about CrossCover but said it was sometimes difficult to fit into their daily work.
Overall, this study shows that CrossCover can improve care for people with muscle and joint conditions. Future work will focus on making the system easier to use so that more clinicians choose to use it regularly.REC name
Yorkshire & The Humber - Sheffield Research Ethics Committee
REC reference
23/YH/0105
Date of REC Opinion
1 Jun 2023
REC opinion
Further Information Favourable Opinion