Patients’ perspectives and experiences about private practice health care management of their chronic musculoskeletal pain

Webb, Marna (2018-03)

Thesis (MScPhysio)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY : Background: Understanding patients’ perspectives about living with chronic pain in the South African context and their views about the private health care they received is important because it can identify facilitators and barriers for health care management. It was proposed that this information would produce meaningful information to be incorporated into the health care management of chronic musculoskeletal pain (CMSP) patients. Aim: The purpose of this study was to explore patients’ perspectives about living with CMSP and their experiences with health care management of their CMSP in the private health care sector of South Africa. Methodology: A descriptive qualitative case study design with an interpretative and phenomenological approach was conducted. The sampling was purposive. Fourteen patients with CMSP were recruited to participate in semi-structured individual interviews. The research was conducted in the private health care sector of the West Coast region of the Western Cape, South Africa. The interviews were recorded and transcribed ensuring confidentiality. Inductive, thematic content analysis of the transcripts was undertaken. Initial codes were assigned and a codebook was developed, which was applied to the transcripts to develop categories and themes. Results: Eight themes emerged from the data: (1) living with chronic pain, (2) disrupted identity, (3) knowledge and beliefs about chronic pain, (4) health care system factors, (5) interactions with health care providers, (6) management of CMSP, (7) hope (or hopelessness) for the future, and (8) barriers and facilitators to pain management in this context. Conclusions: Participants with CMSP indicated that there were numerous challenges throughout their journey with chronic pain in the private health care sector of South Africa. Participants had a disjointed pathway of care and management of HCP did not offer the solutions that the participants were hoping for, which led to depersonalised care. This study supports the need for establishing a way of collaboration and communication to achieve multidisciplinary care to benefit the CMSP patients in the West Coast region. Two options are the formation of a multidisciplinary pain clinic or pain academy or group in the region. Case managers might also be an option to assist patients to navigate through the HCS. Patients require pain education, self-management strategies and emotional support throughout the process of coming to terms with their chronic pain and redefining their self-identity. Empowering patients with self-management strategies enhance coping mechanisms needed for chronic pain and to regain a sense of control over their lives. In the end this could lead to participants’ being able to accept and manage their future with pain.

AFRIKAANSE OPSOMMING : Agtergrond: Oorweging van pasiënte se begrip van pyn en hulle perspektiewe oor ’n lewe met kroniese pyn in die Suid-Afrikaanse verband en die gebruik van privaat gesondheidsorg is belangrik, omdat dit fasiliteerders en hindernisse vir gesondheidsorgbestuur sal identifiseer. Daar word voorsien dat hierdie bewyse betekenisvolle inligting kan oplewer wat ingesluit behoort te word by die gesondheidsorgbestuur van pasiënte met kroniese muskuloskeletalepyn. Doel: Die doel van hierdie studie was om pasiënte se perspektiewe en ervarings oor die gesondheidsorgbestuur van hulle kroniese muskuloskeletale pyn in privaat gesondheidsorgbestuur van Suid-Afrika te ondersoek. Metode: ’n Beskrywende kwalitatiewe gevallestudie-ontwerp met ’n interpretatiewe en fenomenologiese benadering is uitgevoer. Die steekproefneming was doelgerig. Veertien pasiënte met kroniese muskuloskeletalepyn is gewerf om deel te neem aan semi-gestruktureerde individuele onderhoude. Die navorsing is uitgevoer in die privaat gesondheidsorgsektor van die Weskusstreek, Wes-Kaap, Suid-Afrika. Die onderhoude is met ’n bandopnemer opgeneem, die data getranskribeer en vertroulikheid is verseker deur deelnemers anoniem te laat bly. Induktiewe, tematiese inhoudsanalise van die transkripsies is uitgevoer. Aanvanklike kodes is toegeken,’n kodeboek is ontwikkel en die kodeboek is toegepas om kategorieë en temas te ontwikkel, sodat die navorser die inligting kan ontleed en interpreteer. Resultate: Agt temas is uit die data geskep: (1) lewe met kroniese pyn, (2) verlore identiteit, (3) kennis en perspektiewe oor kroniesepyn, (4) faktore in die gesondheidsorgstelsel, (5) interaksies met gesondheidsorgverskaffers, (6) bestuur van kroniese muskuloskeletalepyn, (7) hoop (of hopeloosheid) oor die toekoms, en (8) hindernisse en fasiliteerders tot pynbestuur. Gevolgtrekking: Deelnemers met kroniese muskuloskeletalepyn het aangedui dat hulle reis met kroniese pyn in die privaat gesondheidsorgsektor van Suid-Afrika verskeie uitdagings opgelewer het. Deelnemers het ’n uiteenlopende pad van sorg gehad en die bestuur van die gesondheidsorgverskaffers het nie die oplossings gebied waarop die deelnemers gehoop het nie. Hierdie studie ondersteun die behoefte om ’n manier van samewerking en kommunikasie te vestig en multidissiplinêre sorg te bewerkstellig, sodat dit pasiënte met kroniese muskuloskeletalepyn in die Weskus-streek kan bevoordeel. Twee moontlikhede is die vorming van ’n multidissiplinêre pynkliniek of pynakademie in die streek. Gevalbestuurders kan ook ’n opsie wees om pasiënte te help om deur die gesondheidsorgstelsel te beweeg. Pasiënte benodig pynvoorligting, selfhanteringstrategieë en emosionele ondersteuning gedurende die proses om hulle kroniese pyn te bepaal en hulle selfidentiteit te herdefinieer. Bemagtiging van pasiënte met selfhanteringstrategieë verbeter versorgingsmeganismes wat nodig is vir kroniese pyn en om ’n gevoel van beheer oor hulle lewens te herwin. Op die ou end kan dit daartoe lei dat deelnemers hulle toekoms met pyn kan aanvaar en bestuur.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/103722
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