Profiling bone and joint problems and health service use in an Australian regional population: The Port Lincoln Health StudyClarabelle Pham A , Tiffany K. Gill B , Elizabeth Hoon A F , Muhammad Aziz Rahman C , Deirdre Whitford A , John Lynch A D and Justin Beilby E
B School of Medicine, The University of Adelaide, Adelaide, SA 5005, Australia. Email: firstname.lastname@example.org
C St Vincent’s Centre for Nursing Research, Australian Catholic University, East Melbourne, Vic. 3002, Australia. Email: email@example.com
D School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK.
E Faculty of Health Sciences, The University of Adelaide, Adelaide, SA 5005, Australia. Email: firstname.lastname@example.org
F Corresponding author. Email: email@example.com
Australian Health Review 37(4) 504-512 http://dx.doi.org/10.1071/AH13064
Submitted: 27 March 2013 Accepted: 9 July 2013 Published: 10 September 2013
Objectives To describe the burden of bone and joint problems (BJP) in a defined regional population, and to identify characteristics and service-usage patterns.
Methods In 2010, a health census of adults aged ≥15 years was conducted in Port Lincoln, South Australia. A follow-up computer-assisted telephone interview provided more specific information about those with BJP.
Results Overall, 3350 people (42%) reported current BJP. General practitioners (GP) were the most commonly used provider (85%). People with BJP were also 85% more likely to visit chiropractors, twice as likely to visit physiotherapists and 34% more likely to visit Accident and Emergency or GP out of hours (compared with the rest of the population). Among the phenotypes, those with BJP with co-morbidities were more likely to visit GP, had a significantly higher mean pain score and higher levels of depression or anxiety compared with those with BJP only. Those with BJP only were more likely to visit physiotherapists.
Conclusions GP were significant providers for those with co-morbidities, the group who also reported higher levels of pain and mental distress. GP have a central role in effectively managing this phenotype within the BJP population including linking allied health professionals with general practice to manage BJP more efficiently.
What is known about the topic? As a highly prevalent group of conditions that are likely to impact on health-related quality of life and are a common cause of severe long-term disability, musculoskeletal conditions place a significant burden on individuals and the health system. However, far less is known about access and usage of musculoskeletal-related health services and programs in Australia.
What does this paper add? As a result of analysing the characteristics of the overall BJP population, as well as phenotypes within it, a greater understanding of patterns of health service interactions, care pathways and opportunities for targeted improvements in delivery of care may be identified. The results emphasise that participants with BJP utilised the services of a narrow range of providers, which may have workforce implications for these sectors. The funding models for physiotherapists and chiropractors in Australia involve a mix of private and fees for service, which limits access to those who have private health insurance or can pay directly for these services.
What are the implications for practitioners? These analyses indicate the importance of linking allied health professionals with general practice to manage BJP more efficiently. Alternative and appropriate care pathways need to be more strongly developed and identified for effective management of these conditions rather than relying on a traditional range of practitioners. Alternatively, greater ease of access to allied health practitioners may enable more effective treatment and improved quality of life for those with BJP. There is an urgent need to develop an effective population-based model of integrated care for BJP within regional Australia.
References Woolf AD, Vos T, March L. How to measure the impact of musculoskeletal conditions. Best Pract Res Clin Rheumatol 2010; 24 723–32.
| How to measure the impact of musculoskeletal conditions.CrossRef | 21665121PubMed |
 Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ 2003; 81 646–56.
| 14710506PubMed |
 Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380 2197–223.
| Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010.CrossRef |
 Australian Institute of Health and Welfare. Arthritis and musculoskeletal conditions in Australia 2005. AIHW cat. no. PHE 67. Canberra: Australian Institute of Health and Welfare; 2005.
 Australian Bureau of Statistics. National health survey: summary of results. 2007–2008 (reissue). Cat. no. 9.4364.0. Canberra: Australian Bureau of Statistics; 2009.
 Australian Institute of Health and Welfare. A snapshot of arthritis in Australia 2010. Arthritis series no. 13. Cat. no. PHE 126. Canberra: Australian Institute of Health and Welfare; 2010.
 Access Economics. Painful realities: the economic impact of arthritis in Australia in 2007. Canberra: Arthritis Australia; 2007.
 Australian Institute of Health and Welfare. Use of health services for arthritis and osteoporosis. Arthritis series no. 14. Cat. no. PHE 130. Canberra: Australian Institute of Health and Welfare; 2010.
 Australian Institute of Health and Welfare. Population differences in health-care use for arthritis and osteoporosis in Australia. Arthritis series no. 17. Cat. no. PHE 147. Canberra: Australian Institute of Health and Welfare; 2011.
 Britt HC, Harrison CM, Miller GC, Knox SA. Prevalence and patterns of multi-morbidity in Australia. Med J Aust 2008; 189 72–7.
| 18637770PubMed |
 Hoon-Leahy CE, Newbury JW, Kitson AL, Whitford DJ, Wilson A, Karnon , et al The LINKIN Health Census process: design and implementation. BMC Health Serv Res 2012; 12 321
| The LINKIN Health Census process: design and implementation.CrossRef | 22985220PubMed |
 Ware J, Sherbourne D. The MOS 36-item shortform, health survey (SF-36). Med Care 1992; 30 473–83.
| The MOS 36-item shortform, health survey (SF-36).CrossRef | 1593914PubMed |
 Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med 2001; 33 337–43.
| EQ-5D: a measure of health status from the EuroQol Group.CrossRef | 1:STN:280:DC%2BD3MvksFWqsw%3D%3D&md5=2a05fa2ecfc7df7653bf6771217080beCAS | 11491192PubMed |
 Jennings PA, Cameron P, Bernard S. Measuring acute pain in the pre-hospital setting. Emerg Med J 2009; 26 552–5.
| Measuring acute pain in the pre-hospital setting.CrossRef | 1:STN:280:DC%2BD1Mrgt1ensw%3D%3D&md5=a29735c66c899f0231901fafe504214bCAS | 19625547PubMed |
 Australian Bureau of Statistics. National regional profile: Port Lincoln 2006–2010, Table 02. Population and people, Time series spreadsheet, cat. no. 1379.0.55.001. Available at http://www.abs.gov.au/AUSSTATSfirstname.lastname@example.org/Lookup/LGA46300Main%20Features12006-2010?OpenDocument&tabname=Summary&prodno=LGA46300&issue=2006-2010&num=&view=& [verifed 25 August 2011]
 Belsley DA, Kuh E, Welsch RE. Regression diagnostics: identifying influential data and sources of collinearity. New York: Wiley; 1980.
 Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 2006; 10 287–333.
| Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment.CrossRef | 16095934PubMed |
 Kopansky-Giles D, Vernon H, Boon H, Steiman I, Kelly M, Kachan N. Inclusion of a CAM therapy (chiropractic care) for the management of musculoskeletal pain in an integrative, inner city, hospital-based primary care setting. Journal of Alternative Medicine Research 2010; 2 61–74.
 Bernstein I. Integrated musculoskeletal service design by GP consortia. London J Prim Care 2011; 4 16–26.