Abstract：
UNASSIGNED: To explore the views of general practitioners and physiotherapists on the current model of care for patients with musculoskeletal disorders in Norwegian primary care, and if the English First Contact Practitioner model, where patients have access to multiple professional groups with musculoskeletal health expertise, could inform service development.
UNASSIGNED: We analysed interviews with five GPs and 11 physiotherapists and used Lipsky\'s theories about street-level bureaucracy and Foucault\'s theories of mechanisms of power and institutional structures to explore task shifting and cooperation between different professions.
UNASSIGNED: The empirical material reflected a multi-faceted discourse about skill-mix in primary care, where financial factors, perceptions about competence, and task preferences moderated attitudes to task shifting. Competition and cooperation coexist between the professions, and the seemingly gradual blurring between historical hegemony and new models of care creates both alliances and rivalries. Examples of deviations from the Choosing Wisely principles and evidence-based practice indicate that both general practitioners and physiotherapists balance the roles of patient advocate, gatekeeper, and homo economicus, in a context where task shifting is challenged by established practice. It appears that the management of patients with musculoskeletal disorders is fragmented and to some extent reflects a supply-driven system.
The demand on primary care is placing increasing pressure on general practitioners.Multidisciplinary teamwork has potential to improve primary care, for both healthcare professionals and for patients.In this study, it appeared that both competition and cooperation exist between general practitioners and physiotherapists around the management of patients with musculoskeletal disorders in primary care.There is a case for change in service delivery for patients with musculoskeletal disorders in Norwegian primary care.
UNASSIGNED: We analysed interviews with five GPs and 11 physiotherapists and used Lipsky\'s theories about street-level bureaucracy and Foucault\'s theories of mechanisms of power and institutional structures to explore task shifting and cooperation between different professions.
UNASSIGNED: The empirical material reflected a multi-faceted discourse about skill-mix in primary care, where financial factors, perceptions about competence, and task preferences moderated attitudes to task shifting. Competition and cooperation coexist between the professions, and the seemingly gradual blurring between historical hegemony and new models of care creates both alliances and rivalries. Examples of deviations from the Choosing Wisely principles and evidence-based practice indicate that both general practitioners and physiotherapists balance the roles of patient advocate, gatekeeper, and homo economicus, in a context where task shifting is challenged by established practice. It appears that the management of patients with musculoskeletal disorders is fragmented and to some extent reflects a supply-driven system.
The demand on primary care is placing increasing pressure on general practitioners.Multidisciplinary teamwork has potential to improve primary care, for both healthcare professionals and for patients.In this study, it appeared that both competition and cooperation exist between general practitioners and physiotherapists around the management of patients with musculoskeletal disorders in primary care.There is a case for change in service delivery for patients with musculoskeletal disorders in Norwegian primary care.
摘要：
■探讨全科医生和物理治疗师对挪威初级保健中肌肉骨骼疾病患者的当前护理模式的看法，如果英国第一接触从业者模型，患者可以接触多个具有肌肉骨骼健康专业知识的专业团体，可以为服务发展提供信息。
■我们分析了对5位全科医生和11位物理治疗师的访谈，并利用利普斯基关于街头官僚主义的理论和福柯关于权力和制度结构机制的理论来探索任务转移和不同职业之间的合作。
■经验材料反映了关于初级保健中技能组合的多方面论述，其中财务因素，对能力的看法，任务偏好调节了对任务转移的态度。行业间的竞争与合作并存,历史霸权和新的护理模式之间似乎逐渐模糊，这既造成了联盟，也造成了竞争。与明智选择原则和循证实践的偏差的例子表明，全科医生和物理治疗师都平衡了患者倡导者的角色，看门人,和同质经济，在任务转移受到既定实践挑战的情况下。肌肉骨骼疾病患者的管理似乎是分散的，在某种程度上反映了供应驱动的系统。
对初级保健的需求给全科医生带来了越来越大的压力。多学科团队合作有可能改善初级保健，对于医疗保健专业人员和患者。在这项研究中,看来，在初级保健中，全科医生和物理治疗师之间存在竞争和合作。挪威初级保健中肌肉骨骼疾病患者的服务提供有改变的情况。
■我们分析了对5位全科医生和11位物理治疗师的访谈，并利用利普斯基关于街头官僚主义的理论和福柯关于权力和制度结构机制的理论来探索任务转移和不同职业之间的合作。
■经验材料反映了关于初级保健中技能组合的多方面论述，其中财务因素，对能力的看法，任务偏好调节了对任务转移的态度。行业间的竞争与合作并存,历史霸权和新的护理模式之间似乎逐渐模糊，这既造成了联盟，也造成了竞争。与明智选择原则和循证实践的偏差的例子表明，全科医生和物理治疗师都平衡了患者倡导者的角色，看门人,和同质经济，在任务转移受到既定实践挑战的情况下。肌肉骨骼疾病患者的管理似乎是分散的，在某种程度上反映了供应驱动的系统。
对初级保健的需求给全科医生带来了越来越大的压力。多学科团队合作有可能改善初级保健，对于医疗保健专业人员和患者。在这项研究中,看来，在初级保健中，全科医生和物理治疗师之间存在竞争和合作。挪威初级保健中肌肉骨骼疾病患者的服务提供有改变的情况。
