Factors influencing referrals amongst allied health and medical practitioners managing people with musculoskeletal conditions in Australian primary care

Clinical pathways that increase utilization of specialist allied health practitioners (AHPs) are proposed as a solution to the increasing burden of musculoskeletal (MSK) conditions amidst an overwhelmed medical workforce. However, despite clinical recommendations, referral and collaboration between AHPs and medical practitioners (MPs) in primary care remains limited. Gaining insight into factors that influence referral decisions may improve collaboration and inform the design of more effective care pathways. 1. Describe referral practices of Australian AHPs and MPs managing people with MSK conditions in primary care. 2. Explore practitioners’ perceptions of optimal referral pathways, and the barriers and facilitators to implementing a proposed clinical pathway of care (PACE–MSK). Semi-structured interviews were conducted with 58 Australian AHPs (physiotherapists, exercise physiologists, psychologists) and MPs (orthopaedic and neurosurgeons, physicians, general practitioners (GPs)). Practitioners in primary care managing MSK conditions on at least two days per week were invited to participate. Participants discussed current referral practices and identified barriers and facilitators to involving specialist AHPs in a proposed care pathway. Data collection and analysis were iterative. Themes were generated using reflexive thematic analysis, refined through team discussion and consensus. Referral practices of both AHPs and MPs were prompted by the patient’s presentation and preferences, but the choice of whom to refer was shaped by trusted professional relationships. System-level constraints, such as service affordability and access for both practitioners and patients, determined whether referrals occurred and were identified as barriers to optimal and proposed care pathways. Referral practices of Australian AHPs and MPs are influenced by patient, practitioner and system-level factors. Clarifying interprofessional roles, building trusted professional relationships and reforming funding models to improve affordability and access for patients and practitioners are likely to be key to improving referral pathways and patient outcomes in MSK primary care.