These digital tools are designed to build capacity in the workforce and among consumers
Healthcare priorities have shifted globally towards improved management of non-communicable diseases, which now reflect the largest burden of disease in most countries.1
This shift is particularly relevant to chronic musculoskeletal conditions, where the burden of disease continues to increase and care delivery or support is typically required over years or decades.2
This context highlights the need to re-orient care to build capacity among both consumers to better manage their musculoskeletal pain through active self-management strategies, and also among their health professionals to guide and support effective self management.3-5
Similarly, the CSIRO argues that Australia’s future health system will have a strong focus on leveraging digital technologies to support care delivery, provide more flexible options for health professional training and empower consumers to participate in their care.6
Digital technologies, such as web-based tools, apps and resources are increasingly recognised as important enablers to the delivery of high-value, integrated and person-centred care for non-communicable diseases7 and can support strengthening of health systems.8
In this article, we provide an overview of two digital eHealth solutions that our team has developed, implemented into health systems and evaluated over the last six years – RAP-eL (http://rap-el.com.au/) and painHEALTH (https://painhealth.csse.uwa.edu.au/).
These tools are not siloed initiatives, but rather reflect components of a broader, integrated program of work focused on implementation of “models of care” for musculoskeletal conditions which targets building capacity in the workforce and among consumers, respectively.7,9
Both initiatives are underpinned by the principles outlined in Box 1.
What is RAP-eL it?
RAP-eL is a web-based, open access resource that aims to build capacity among physiotherapists, physiotherapy students and medical students in the delivery of high-value care to people with rheumatoid arthritis (RA). RAP-eL is focused around four modules, aligned to the different stages of RA, including:
- Disease overview and early recognition
- Care in the early stages of RA (first two years)
- Care in the chronic stage of RA (after the first two years)
- Management of extra-articular features and co-morbid health conditions.
RAP-eL adopts an educational framework that links essential knowledge of RA disease and management with clinical skills – that is, linking “knowing” with “doing”. This “know-do” link is facilitated through practice-ready supports, such as assessment and screening tools, quick reference evidence summaries, referral letter templates and links to other within-platform multimedia resources and external evidence resources. Application of knowledge to practice is facilitated with two case studies that draw on key topics presented across the four modules and show the “how to” build knowledge and skill competency.
Why was it developed?
RAP-eL was developed to support implementation of the WA Inflammatory Arthritis Model of Care and other jurisdictional and national frameworks for care delivery for inflammatory arthritis.11 Building capacity in the workforce was identified as an essential enabler to sustainable implementation of the model of care.12,13
Is it effective?
RAP-eL was tested in a randomised controlled trial to assess its effectiveness in improving self-reported confidence in knowledge and skills and practice behaviours in response to clinical case studies.14 RAP-eL has subsequently been evaluated for implementation in pre-licensure physiotherapy and medical curricula,15-17 and has been independently critically appraised.18
How is it being used and maintained?
RAP-eL is currently accessed by users in 123 countries (2019 Google Analytics data) and has been integrated into pre-licensure physiotherapy and medical curricula in Australia and internationally. RAP-eL is also recommended as a key resource in the National Strategic Action Plan for Arthritis.
RAP-eL is updated every two years to reflect trials and clinical guidelines published in the preceding two-year period. Ultimately, we aim to extend RAP-eL to incorporate other common inflammatory arthritis conditions and target competencies relevant for other disciplines.
What is painHEALTH?
PainHEALTH is a web-based, open access digital information resource for adult consumers that provides evidence-based information and practical skills to support co-management of musculoskeletal pain. The resource was launched in April 2013 with key features including consumer-oriented information on musculoskeletal pain conditions, including:
ankylosing spondylitis
complex regional pain syndrome
fibromyalgia
low back pain
neck pain
osteoarthritis
osteoporosis
rheumatoid arthritis;
a suite of practical and evidence-based pain management modules (integrated pain care for the whole person); real world narratives from consumers about their pain experience and care pathways; and self-report screening tools for red and yellow flags, risk of musculoskeletal pain disability and other pain conditions. The information is supported by comprehensive multimedia features such as videos (consumers and clinicians), podcasts and downloadable fact sheets.
Why was it developed?
PainHEALTH was commissioned by the Department of Health, Government of Western Australia in 2011, in response to recommendations across the WA musculoskeletal Models of Care, chronic disease self-management policy and the National Pain Strategy.
The aim of this digital tool was to provide a credible, accurate and integrated resource for all West Australians to access contemporary, evidence-based pain care information and support, particularly in light of evidence for care disparity gaps due to geography.19,20
Is it effective?
In 2017-18, a comprehensive mixed-methods evaluation of painHEALTH was conducted to understand users’ perceptions and experiences.21 A total of 414 users participated in an online survey and 26 in in-depth interviews – 44% consumers, 3% carers and 53% implementers (defined collectively as health professionals, researchers, service providers, policy makers). Users perceived painHEALTH as fulfilling its main purpose as a credible, readily accessible, contemporary and evidence-based consumer resource supporting self-management (figures below) and rated it highly in terms of being user friendly (consumers/carers 80%, implementers 84%) and accessible (consumers/carers 84%, implementers 87%).
The evaluation highlighted that while painHEALTH was primarily developed for consumers, it is clearly being used more widely and has achieved implementation at scale. Health professionals perceived painHEALTH as a useful tool to complement clinical care – 51% of participants utilised painHEALTH as a referral resource for their patients, while others utilised it during clinical consultations (17%) and for clinical training purposes (16%). Consumers advocated for painHEALTH to be more widely promoted to health professionals, particularly in primary care.
How is it being used and maintained?
PainHEALTH continues to be supported by the Department of Health (WA) with activity overseen by an advisory committee. Content and multimedia resources are updated in two-yearly cycles supported by an independent, expert interdisciplinary panel with consumer representation.
Since its launch in 2013, painHEALTH has been accessed >19.2 million times from 1.3 million visitors across >150 countries (Google Analytics data). The e-resource is integrated into in Australian clinical guidelines, Care Standards and linked through government and non-government websites.
Conclusions
Both RAP-eL and painHEALTHTM are examples of digital tools that have been used as enablers to drive implementation of musculoskeletal models of care into health systems and services. Effectiveness and scalability of implementation have been facilitated through co-design from inception through partnership models including strong consumer and interdisciplinary representation, following best-practice design methods and investment in maintaining and updating the resources.
Acknowledgements
We acknowledge the work of our team, collaborators and funders (Department of Health WA, National Health and Medical Research Council, Physiotherapy Research Foundation, Curtin University) in these initiatives and the supporting research.
Andrew M Briggs, PhD, FACP (A.Briggs@curtin.edu.au) and Helen Slater, PhD, FACP (H.Slater@curtin.edu.au) work for the School of Physiotherapy and Exercise Science at Curtin University in Perth, Western Australia
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21.
Slater H, Jordan JE, Houlding E, et al. painHEALTH Evaluation Report Executive Summary. Perth: Department of Health, Government of Western Australia; 2019.
