Implementering af udvidet patientuddannelse i kiropraktorpraksis - forandringsparathed og barrierer. Et mixed-methods studie.

Abstract

Abstrakt Formål En ny ydelse, "udvidet patientuddannelse", indgår i overenskomsten mellem Dansk Kiropraktor Forening (DKF) og Regionernes Løn- og Takstnævn (RLTN) pr. 1. april 2024. Ydelsen er målrettet patienter med kroniske eller gentagne episoder med stærke smerter i bevægeapparatet, og hvor det samlede biopsykosociale billede vurderes at have en signifikant betydning for prognosen. Ydelse omfatter undervisning af patienten i forståelse af sygdom og smerter generelt, i kroppens alarmsystem og i egenhåndtering af smertetilstande. En dybt forankret biomekanisk identitet er tidligere blevet identificeret som en barriere for implementering af den biopsykosociale model i kiropraktisk praksis. Formålet med dette studie er at undersøge danske kiropraktorers forandringsparathed i forhold til implementering af udvidet patientuddannelse og at belyse barrierer for implementering af udvidet patientuddannelse. Metode Dette mixed-methods studie bruger et sekventielt, forklarende design. Den består af en spørgeskemaundersøgelse baseret på den transteoretiske model for adfærdsændring (TTM) og semistrukturerede interviews med en fænomenologisk, induktiv tilgang. Resultater Af de 145 spørgeskemabesvarelser, der var inkluderet, var 62% (n = 90) på vedligeholdelsesstadiet, 11% (n = 16) var på handlingsstadiet, 17% (n = 25) var på overvejelsesstadiet, og 10% (n = 14) var på før-overvejelsesstadiet med hensyn til implementering af udvidet patientuddannelse i deres praksis. Interviewundersøgelsen identificerede fem barrierer for implementering af udvidet patientuddannelse: 1) mange kiropraktorer er usikre på den præcise definition af udvidet patientuddannelse, 2) de fleste kiropraktorer mener, at de mangler kommunikative færdigheder, 3) de kiropraktorer, der er mest forandringsparate, ser en barriere i tid og økonomi, 4) manglende undervisningsmateriale og 5) patienternes forventninger om passiv behandling. Konklusion De fleste kiropraktorer er forandringsparate. De identificerede barrierer kan imødegås med klar kommunikation om ydelsens indhold, videndeling om eksisterende undervisningsmateriale og udarbejdelse af manglende undervisningsmateriale samt en dybdegående og struktureret efteruddannelse af kiropraktorerne i kommunikation rettet mod håndtering af psykosociale faktorer og facilitering af adfærdsændring hos patienterne.

Abstract Purpose A new service, "extended patient education", is included in the collective agreement between the Danish Chiropractor Association (DKF) and the Regions' Salary and Tariff Board (RLTN) as of 1 April 2024. The service is targeted at patients with chronic or repeated episodes of severe pain in the musculoskeletal system, and where the overall biopsychosocial picture is considered to have a significant impact on the prognosis. The service includes education of the patient in understanding illness and pain in general, in the body's alarm system and in self-management of pain conditions. A deeply rooted biomechanical identity has previously been identified as a barrier to implementing the biopsychosocial model in chiropractic practice. The purpose of this study is to investigate Danish chiropractors' stage of readiness for change in terms of implementing extended patient education, and to elucidate barriers to implementation of extended patient education. Method This mixed-method study uses a sequential, explanatory design. It consists of a questionnaire survey, based on the transtheoretical model of behaviour change (TTM), and semi-structured interviews with a phenomenological, inductive approach. Results Of the 145 questionnaire responses included, 62% (n=90) were at the maintenance stage, 11% (n=16) were at the action stage, 17% (n=25) were at the contemplation stage, and 10% (n=14) were at the pre-contemplation stage in terms of implementing extended patient education in their practice. The interview study identified five barriers to the implementation of extended patient education: 1) many chiropractors are uncertain about the exact definition of extended patient education, 2) most chiropractors think that they lack communicative skills, 3) the chiropractors that are most ready to change see a barrier in time and finances, 4) lack of teaching material and 5) patients' preferences for passive treatment. Conclusion Most chiropractors are ready for change. The identified barriers can be addressed with clear communication about the content of the service, knowledge sharing about existing teaching material and the preparation of missing teaching material, as well as an in-depth and structured continuing education of the chiropractors in communication aimed at dealing with psychosocial factors and facilitating behavioural change in patients.

A master programme thesis from Aalborg University

Implementering af udvidet patientuddannelse i kiropraktorpraksis - forandringsparathed og barrierer. Et mixed-methods studie.

[Implementation of extended patient education in chiropractic practice - readiness for change and barriers. A mixed-methods study.]