‘All Under One Roof’: Health Professional Perspectives on Integrating Musculoskeletal Pain Management in a Proximity‐Based Primary Healthcare Model

ABSTRACT

Introduction

Musculoskeletal (MSK) pain is a leading contributor to disability and service demand in primary healthcare (PHC), particularly in socioeconomically disadvantaged communities. Contemporary responses increasingly emphasise people‐centred, multimodal and non‐pharmacological approaches. However, in practice, service integration is often limited to co‐location, with insufficient clarity regarding how collaboration and integration are operationalised within private, fee‐for‐service PHC environments.

Methods

This qualitative study explored how 22 health professionals working within a large‐scale, proximity‐based primary healthcare precinct in Australia defined and experienced service integration for MSK pain management. Semi‐structured interviews were conducted across two timepoints (2021 and 2023) and analysed using reflexive thematic analysis, informed by implementation and people‐centred care principles.

Results

Three interdependent enablers of integration were identified: (1) Relationships, enabled by physical proximity, including shared philosophy and respect for professional roles; (2) Communication, characterised by knowledge exchange, forward momentum and shared processes; and (3) Consumer‐centred access, via availability of affordable and needed services. Integration was experienced as a continuum, ranging from parallel multidisciplinary practice to higher‐order interdisciplinary collaboration involving shared processes and collective responsibility for consumer outcomes.

Conclusion

Within this site‐specific context, physical proximity acted as a necessary but insufficient condition for effective integration. Higher levels of interdisciplinary practice emerged only when proximity was combined with shared values, effective communication and coordinated consumer flow. These findings provide a base for how proximity‐based primary healthcare environments can operationalise people‐centred integration and can inform scalable models of MSK care in private PHC settings.

1. Introduction

Primary healthcare (PHC) plays a central role in providing individualised support, as it is often the first point of contact for consumers seeking care for MSK pain (Babatunde et al. 2020). Evidence suggests that higher levels of interdisciplinary integration may be associated with improved consumer outcomes (Jenkins et al. 2023; Kudre et al. 2020). Integrating consumer‐centred interdisciplinary and multidisciplinary approaches to musculoskeletal (MSK) pain management into PHC supports broader access to treatment modalities and improved outcomes (Lamper et al. 2021). The complexity of MSK pain management, whether arising from acute injury or chronic conditions, has required increasing focus on multimodal, non‐pharmacological approaches to reduce reliance on unimodal opioid treatments (Seal et al. 2017). In practice, this integration commonly involves multiple health professionals working together in consumer care, including general medical practitioners (GPs), nurses, physiotherapists, chiropractors and mental health clinicians (Connell et al. 2022).

Despite growing emphasis on collaborative care, previous literature highlights persistent inconsistencies in the use and interpretation of the terms ‘collaboration’ and ‘integration’, which vary across healthcare settings and may contribute to communication challenges and fragmented consumer care (Jeffs et al. 2012; Wan et al. 2018). Interdisciplinary collaboration is typically defined as health professionals from different disciplines working as a unified team, engaging in shared decision‐making and processes to co‐develop individualised care plans with consumers (Flores‐Sandoval et al. 2021). In contrast, multidisciplinary approaches involve multiple disciplines operating independently and contributing in parallel, often with limited shared communication, processes, or collective decision‐making (Begley et al. 2019). Both forms of collaboration can be strengthened through a clearer understanding of communication pathways, professional roles and responsibilities, and shared values (Sarakbi et al. 2021). Such exchanges of knowledge between health professionals and consumers can support more coordinated and integrated service delivery, enabling safe, effective, and individualised MSK pain management (Slater and Briggs 2024).

In this study, we use the term proximity‐based PHC to describe a service model in which multiple private and mixed‐funding health services are intentionally placed within the same site or precinct to enable convenient consumer access and to increase opportunities for interdisciplinary interaction beyond simple geographic co‐location, with the ecosystem functioning as an organising feature of care delivery. This context includes independent private health professionals within general practice and urgent care, as fee‐for‐service and mixed‐funding PHC settings are common and drive PHC service delivery in Australia and similar hybrid health systems. The mechanisms by which integration is achieved or constrained in these environments remain under‐described. Examining integration from the perspective of general practice is therefore important for informing scalable, ‘real‐world’ models of MSK pain management that reflect prevailing PHC funding and governance arrangements.

Consistent with the World Health Organization's Integrated People‐Centred Health Services (WHO‐IPCHS) framework, integration is conceptualised as extending beyond referral pathways or co‐location to encompass relational, organisational, and process‐based mechanisms that support continuity, coordination, and consumer‐centred outcomes. Within this context, MSK pain management provides a critical lens for examining how integration is enacted at the micro‐ecosystem level within private, fee‐for‐service PHC environments.

2. Methods

This study was conducted at a large‐scale, 15,000 sqm, proximity‐based, integrated PHC precinct opened in 2017 in an outer metropolitan and low socio‐economic region in Queensland, Australia (Oprescu et al. 2023). Services included a general practice as the main tenant, with co‐located and separate allied health, diagnostics, pharmacy and community‐based services (Oprescu et al. 2023). It uniquely included embedded specialised services, such as chiropractic (Fjaagesund et al. 2024) and urgent care (Fjaagesund et al. 2025) within the general practice area.

At the time of the study, the precinct serviced over 200,000 consumers on record (Oprescu et al. 2023). The service provider tenant mix comprised independent health professionals operating under different funding and governance arrangements, including universally funded (public) services and privately billed fee‐for‐service practices. This mixed‐funding or hybrid context formed the setting in which interdisciplinary integration for MSK pain management was explored. Purposive sampling was used to recruit a diverse sample of health professionals working within the precinct. Recruitment material focused on exploring the integration of non‐pharmacological services in the management of acute and chronic MSK pain.

In alignment with the study aim, sampling focused on the core clinical and operational workforce who routinely initiate, coordinate, and follow up MSK pain management referral pathways. As such, participants volunteered from the general practice, urgent care, and specialist services. Allied health, outside chiropractic or relevant specialised care, did not volunteer for the study. However, the role of allied health is described in the results as part of the service context, because they were frequently referenced by participants in relation to referral and coordination processes. Inclusion and exclusion criteria are detailed in Supporting Information S1: Material S1. Eligible participants were aged 18 years or older, employed or contracted within the precinct, had reviewed the study information sheet, and provided written informed consent prior to participation.

A total of 25 health professionals were approached, with twenty‐two (n = 22, 12 males, 10 females) participating in the study. The three refusals cited time constraints. Disciplines represented included general practitioners (GPs; n = 10), practice nurses (n = 5), medical specialists (n = 3), and managers (n = 4) working across general practice (with special interest in MSK management) and urgent care contexts. Specialities were not specifically disclosed to protect the identity of participants. Interviews were conducted over two timepoints, 2021 (n = 11) and 2023 (n = 11), to support pragmatic sampling across operational constraints, such as COVID‐19, and to confirm whether the same integration mechanisms were described as the precinct matured. The study was not designed as a longitudinal evaluation of individual change. Recruitment continued until information redundancy was achieved and no new themes developed (Malterud et al. 2016).

The analysis was informed by implementation research principles and the precinct's guiding WHO‐IPCHS people‐centred care governance lens, enabling attention to both structural enablers (e.g., co‐location, shared systems) and relational mechanisms (e.g., trust, professional respect) that underpin service integration in practice. At the time of data collection, the participant sample represented ∼30% of the onsite full‐time equivalent general practice consumer‐facing workforce. To protect participant anonymity within this single‐site setting, detailed information regarding individual fellowship completion, years of professional experience, and specific specialties is not reported in the main manuscript. A summary of participant roles, sex, data collection timepoint, and general work areas is provided in Supporting Information S1: Material S2.

A pragmatic approach, informed by the Guba and Lincoln framework (Guba and Lincoln 1985), guided the semi‐structured interview approach and interview guide to explore health professionals' perceptions and experiences of service integration before and after working within the precinct. The interview guide, including prompts relating to organisational, clinical, and consumer‐centred aspects of integration, is provided in Supporting Information S1: Material S3. Participants were able to clarify, expand, or amend their responses with the interviewer, and no participants requested transcript review following the interview.

Interviews averaged approximately 32 minutes, were audio recorded, and transcribed verbatim. Transcripts were individually reviewed and initially coded by two team members using Braun and Clarke's (2019) reflexive thematic analysis approach. Coding involved familiarisation with the data, generation of initial codes, and iterative development of candidate themes across the dataset. Themes were discussed, refined, and defined by three team members through repeated comparison between coded extracts and the full dataset to ensure coherence and distinctiveness.

To examine whether the thematic structure differed by interview period, the team compared the presence, salience, and meaning of codes/themes across the 2021 and 2023 subsets. No material differences in themes or their interpretation were identified, and datasets were therefore combined for the final analysis. The resulting themes were validated by two GPs and one specialist involved in MSK pain management.

Ethics approval was obtained from the University of the Sunshine Coast Human Research Ethics Committee (HREC #A191263). All participants received a detailed study information sheet and provided written informed consent prior to the interview. Participation was voluntary, and all transcripts were de‐identified to ensure confidentiality.

Reporting of this qualitative study was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ), with a completed checklist mapped to manuscript sections being provided in Supporting Information S1: Material S4.

3. Results

Analysis indicated that integration was not experienced as a single, uniform practice but rather as a set of interrelated mechanisms operating across practitioner, organisational and consumer‐flow dimensions. Integration was shaped by how health professionals related to one another, communicated across disciplines, and enabled consumer access to needed services. These mechanisms are presented below as three themes, followed by an explanation of how participants described varying levels of service integration.

Health professional participants (n = 22) used formal electronic referral pathways to allied health and specialist services, while some participants (n = 3), due to their role (e.g., managers), facilitated access through direct booking or encouraged consumers to use self‐referral processes. Health professionals identified allied health services as necessary for multi‐modal MSK pain management. Physiotherapy was most commonly referred to, followed by chiropractic care, psychological services, exercise physiology, occupational therapy, and dietetics. Services which commanded higher out‐of‐pocket fees, such as osteopathy, were highlighted as needed but were unavailable not only within the precinct, but also the immediate surrounding area. All services described were viewed as contributing to integrated care and were available within the precinct, including chiropractic care embedded within the general practice.

3.1. Theme 1—Relationships

Trusted professional relationships emerged as a foundational enabler of integration. These relationships were shaped by physical proximity, shared philosophy, and respect for professional roles, which together supported confidence in referrals, informal consultation, and shared responsibility for consumer care.

Health professionals described physical proximity as creating regular, convenient opportunities for interaction, allowing familiarity, trust, and confidence in other's practice to develop over time. Shared consumer‐centred values and evidence‐based approaches further reinforced collaboration, while mutual respect for professional expertise reduced hierarchical barriers and supported integrated decision‐making. Illustrative participant quotations demonstrating these relationship‐based enablers are presented in Table 1.

TABLE 1.

Relationship‐based enablers of interdisciplinary integration within a large‐scale, proximity‐based, mixed funding primary healthcare setting.

Physical proximity	‘It is important that nurse practitioners are not siloed and working independently from the rest of the clinic’ (P3). ‘Everything is all in the same place.’ (P6). ‘Integration means all under one roof, one programme for the patient that lets them access all layers of holistic care’ (P11). ‘Integration is someone that you can actually talk to and get direct feedback from and also have the confidence that they are a good practitioner’ (P19).
Shared philosophy	‘Common philosophy follows my belief that if you do not see any improvement, it is time to re‐evaluate the treatment plan’ (P1). ‘Integration is the patient's journey and their experiences’ (P8). ‘…Putting the patient first and doing what's best for the patient and working together to provide a therapy or a treatment or a plan for the individual to better improve’ (P12). ‘Integration is everyone working together with united goals, united vision and our ethos’ (P16).
Respect for professional roles	‘Arrogance in my profession towards other services creates poor communication, including the lack of patient outcome and feedback sharing’ (P4). ‘Referrals are an extension of the reputation of the practitioner.’ (P6). ‘Integration means we are coming together as a whole healthcare team. Each person has a sub‐speciality and we complement each other’ (P14). ‘Substantial respect of each other's profession is needed for successful integration’ (P20).

3.2. Theme 2—Communication

Communication functioned as a key mechanism through which relationships were translated into coordinated care. Three interrelated communication motivators were identified: knowledge sharing, forward momentum, and shared processes.

Frequent in‐person interactions enabled informal and formal knowledge exchange, professional learning, and greater awareness of available services. Communication was described as most effective when it created forward momentum, which included timely feedback, shared problem‐solving, and collective decisions that progressed consumer care. Shared processes were facilitated by access to shared electronic health records (EHRs) and administrative systems within the MSK cluster, further supporting continuity and coordination. However, system and regulatory constraints limited shared access for some providers. For example, differences in software platforms and permissions, information‐sharing and privacy requirements between separate business entities, and contractual or billing arrangements that restrict the use of common internal referral pathways. Exemplar quotations illustrating these communication processes are provided in Table 2.

TABLE 2.

Communication mechanisms supporting interdisciplinary integration within a large‐scale proximity‐based, mixed funding primary healthcare setting.

Knowledge sharing	‘I like to chit chat…develop relationships with staff and have visits in the tearoom too. I like mentoring people and passing my knowledge onto the next generation’ (P10). ‘Sharing of knowledge, all under one roof creates informal integration in where professionals gain better understanding of what each other does’ (P15). ‘Most of us have access to the same programs where we can rub shoulders and because everyone is inside the same building it is a much more fluid and dynamic’ (P17). ‘I always want to know and can find out about wait times, how the process is going, where the patient needs to go, so that I can explain and manage expectations better’ (P20).
Forward momentum	‘…Like a chain working through a smooth process. Easy to get from start to finish, a planned approach without having to go outside’ (P12). ‘Integration means teamwork…it involves basically working together, being able to talk about the cases, or to have feedback backwards and forwards’ (P13). ‘The services at the hub mesh together well and it is the only way to provide care going forward’ (P16).
Shared processes	‘Not all parts of the facility may have shared patient record or internal referral ability due to [regulatory] administrative red tape’ (P3). ‘I have those conversations with other tenants around what can we do, what are we doing independently, and what can we do collectively? (P16)’. ‘Integrated care is all the autonomous tenants in this building working together to provide the very best care to the patient…it is about how we create processes to produce better outcomes for patients. (P20)’

3.3. Theme 3—Consumer‐Centric Access

Consumer‐centred access was identified as a key determinant of whether integration could be realised in practice. Participants described access as a combined function of affordability and consumer capability to attend or use services (e.g., cost, transport, health literacy) and the onsite availability and capacity of the services required for MSK management (e.g., workforce capacity, wait times, scope of onsite offerings). Financial barriers, workforce shortages, transport challenges, and variable health literacy constrained consumer engagement with multimodal, non‐pharmacological care. Where access was limited, delays in care and reduced engagement undermined the potential benefits of integration. Conversely, onsite availability of a broad range of services, including urgent care, mental health support, and allied health, improved service navigation and awareness of available services, reduced fragmentation, and supported coordinated care. Participant quotations illustrating these consumer‐centred influences are summarised in Table 3.

TABLE 3.

Consumer‐centred access influences on interdisciplinary integration within a large‐scale proximity‐based, mixed‐funding primary healthcare setting.

Access

‘It varies person to person, but many could use up to 10 [allied health] sessions to help their problem. Yet many cannot afford extra sessions or are not willing to pay’ (P2). Patients learn and access modalities of treatment they did not know existed’ (P5). ‘Integration would be having easily accessible care…with allied health [knowing] the minimal financial charges’ (P12). ‘I think our biggest challenge is that we all have workforce shortages, so we don't always have enough capacity to meet patient demand’ (P20).

Needed services

‘Psychology services are important to treat anxiety triggered by pain, as people get worried, they will not be able to work, or the pain is going to last a long time’ (P2). ‘The integration experience is more community‐based…a mix of public‐funded, private billings and community not‐for‐profit services’ (P6). ‘The urgent care centre is an important integration at the hub…the reality is when people are unwell or injured, they should be treated urgently, not waiting around at the hospital for hours on end’ (P9). ‘We have a mental health cluster onsite. It is within [GP] scope of practice to provide psychosocial supports, usually referrals to meet the needs of patients, including those that might not always be clinical’ (P20).

3.4. Theme 4—Level of Integration

Lower levels of integration were characterised using parallel processes, with greater reliance on electronic referrals and follow‐up reports between professionals. Information contained within electronic documentation was not always timely or consistent. For more complex cases, in‐person or telephone discussions with other providers were often required to inform the next steps. Parallel processes were most described as working with external practices, where health professionals were unable to leverage shared systems or the benefits of physical proximity.

In contrast, health professionals embedded within the centre's musculoskeletal (MSK) cluster in the general practice described higher levels of integration, with treatment approaches and interactions experienced as more unified. Enablers of integration included shared records, processes, and procedures as well as additional resourcing through shared administrative support. This enabled coordinated support for GPs or nurse practitioners alongside specialist referrals within the same practice area and systems. Examples of highly integrated services included an onsite chiropractor, an urgent care fracture specialist, GPs with a special interest in pain management, nurse practitioners, and an orthopaedic surgeon providing prolotherapy.

Across the three themes, integration was experienced as a continuum, progressing from parallel multidisciplinary practice to higher‐order interdisciplinary collaboration. The key relational, communication, and consumer‐centred enablers associated with these differing levels of integration are synthesised in Table 4, with a more detailed comparison of multidisciplinary and interdisciplinary models provided in Table 5.

TABLE 4.

Distinguishing features of multidisciplinary and interdisciplinary integration within a large‐scale proximity‐based, mixed funding primary healthcare setting.

Relationships	Communication	Consumer‐centric
Enabled by physical proximity	Motivated by learning and knowledge sharing	Access by removing personal barriers to care
Built on shared philosophy of practice	Forward momentum to progress consumer outcomes	Ensuring needed services were available
Supported by respect for professional roles	Convenience of shared processes, records and procedures	Enabled by streamlined pathways (e.g., referral support, scheduling, follow‐up)

TABLE 5.

Comparison of multidisciplinary and interdisciplinary care models within a large‐scale, proximity‐based, mixed funding primary healthcare service.

Multidisciplinary (less integrated)	Description	Interdisciplinary (more integrated)	Description
Shared philosophy	Consumer‐centred Evidence‐based Individual contributions	Shared philosophy	Consumer‐centred Evidence‐based Collective contributions
Knowledge sharing	Electronic documents Discussion Supervision	Knowledge sharing	Case conferences Electronic documents Discussion Supervision
Siloed processes	Separate practice and procedures Isolated care delivery	Shared processes	Shared practice and procedures Shared care delivery
Separate records and external communication	Separate systems External correspondence	Shared records and internal communication	Shared systems Internal correspondence
Responsible for their part	Individual ownership of consumer care ‘my patient’	Ethos of shared responsibility	Shared reviews, decisions and responsibility ‘we or the patient’
Siloed decisions and feedback	Individual ownership of consumer care	Shared decisions and feedback	Shared reviews, decisions and responsibility
New knowledge remains within own practice	Innovation and improvement remain in own practice	Co‐create new knowledge into practices	Shared innovation and implemented across multiple practices

Onsite and adjacent allied health practices operating in parallel with the general practice, but seeking higher levels of integration, were able to leverage physical proximity to develop co‐designed systems; that is, jointly developed, practical workflows agreed across services to make coordination easier (e.g., agreed referral and feedback routines, shared administrative touchpoints, and informal case checks to streamline consumer flow). These arrangements increased the frequency of communication and supported shared information exchange, decision‐making, and responsibility for consumer outcomes. Overall, practices within the centre operated under a shared consumer‐centred philosophy and principles of evidence‐based care, and it was common for available health professionals to assist consumers with system or service navigation. Table 5 summarises key distinctions between multidisciplinary and interdisciplinary integration within a large‐scale proximity‐based PHC setting, highlighting differences in philosophy, knowledge sharing, processes, information systems, responsibility for care, and innovation.

4. Discussion

4.1. Integration Beyond Co‐Location

This study demonstrates that the integration of non‐pharmacological MSK management within PHC is enacted through a combination of structural, relational and process‐based mechanisms. Consistent with broader integrated care literature, findings indicate that co‐location alone is insufficient to achieve meaningful integration. Rather, integration emerged incrementally through trusted relationships, shared communication practices and coordinated consumer pathways. These findings align with people‐centred PHC principles and extend understanding of how integration is operationalised within large‐scale, mixed‐funding PHC environments that include private, fee‐for‐service providers through mechanisms such as shared workflows, internal communication norms, and locally negotiated arrangements for consumer flow and information exchange (Contandriopoulos et al. 2015; Valaitis et al. 2018).

4.2. Integration as a Continuum, Not Binary

Findings support conceptualisations of integration as a continuum, ranging from parallel multidisciplinary practice to higher‐order interdisciplinary collaboration. Lower levels of integration were characterised by transactional referrals and isolated decision‐making, whereas higher levels involved shared processes, collective responsibility and unified treatment planning (Körner 2010). This continuum provides a pragmatic lens for understanding variability in integration within the same setting and highlights that progression towards interdisciplinary practice requires deliberate relational, organisational and governance investment. Examples include protected time and informal spaces for relationship building, governance participation support for interprofessional norms (e.g., expected feedback loops), shared administrative coordination, explicit escalation pathways, and investment in interoperable or jointly usable systems that reduce friction in referrals and follow up. Understanding integration helps practices strategically adapt to population needs and policy change to maintain financial viability, which may also include connections with community‐based supports (O’Neill et al. 2022). Building on the comparative synthesis presented in Table 5, we interpret these findings as highlighting practical differences in how knowledge is shared, how processes are coordinated, and how responsibility for outcomes is distributed across multidisciplinary versus interdisciplinary models.

4.3. Managing Chronic Pain in PHC: It Takes a Village

Health professionals also identified workforce capacity, affordability and service availability as key constraints, indicating that integration is shaped by broader financial and workforce conditions (O’Neill et al. 2022). While sustainability was not evaluated directly, findings indicate that sustaining higher levels of interdisciplinary integration requires stable resourcing, workforce continuity and practical strategies to manage consumer demand. These may include triage and stepped‐care approaches, shared waiting‐list visibility, administrative navigation support, group‐based or hybrid service options where clinically appropriate, and clearer pathways to low‐cost or community‐based services. In low‐socioeconomic PHC settings, these pressures were amplified, as high demand and constrained funding shaped the feasibility of maintaining integrated, consumer‐centred models of care (Begley et al. 2019; O’Neill et al. 2022).

Understanding the nature of integration within localised environments is essential for creating a culture of collaboration supported by aligned strategic business, governance and leadership processes (Contandriopoulos et al. 2015). In mixed‐funding PHC precincts, leadership and cross‐organisation arrangements are particularly important because services may share consumer pathways while remaining separate business entities with distinct accountabilities, billing structures and information‐sharing restrictions created by policymakers and professional bodies. Participants' accounts suggest that operational governance can support integration when it clarifies shared expectations for referral quality, feedback timeframes, privacy‐compliant information exchange, escalation of complex cases, and responsibility for consumer navigation and outcomes. Health professionals describe their environment as consumer‐centric and forward‐focused on better outcomes (Karam et al. 2017), within interdisciplinary practice, enabled through relational elements of sharing and co‐creation of treatment plans and processes (Sarakbi et al. 2021).

Barriers to interdisciplinary integration included professional hierarchy and fragmented communication processes (Bångsbo et al. 2022; Sarakbi et al. 2021), which may be mitigated through targeted investment in culture and knowledge‐sharing mechanisms (Valaitis et al. 2018). These strategies support relationship‐building beyond siloed and parallel multidisciplinary approaches (Sarakbi et al. 2021) and enable co‐creation of adaptive processes to solve complex problems (Bångsbo et al. 2022; Petruzzi et al. 2024). Where deeper interdisciplinary collaboration is constrained by regulatory or system barriers, dedicated consumer care coordination (e.g., consumer scheduling, system navigation, referral support) becomes increasingly important (Lentz et al. 2023).

4.4. Physical Proximity as a Logistical Enabler

A key logistical enabler identified was physical proximity to non‐pharmacological pain management services (Romm 2023). Proximity improved access and engagement by enabling multiple, same‐location appointments and increasing awareness of different treatment modalities (Becker et al. 2017). At the health professional level, proximity facilitates information exchange between providers and smoother care transitions (Sarakbi et al. 2021). Frequent contact and knowledge sharing are critical in building trust, rapport and shared understanding, creating a foundational culture of mutual respect and enabling higher levels of interdisciplinary integration (DiazGranados et al. 2018; Lancaster et al. 2015). This includes shared processes and decision‐making to enhance consumer engagement in pain management (Giusti et al. 2017; Romm 2023).

4.5. Consumer‐Centred Constraints

Health professionals emphasised that not all consumers were able to engage effectively with multimodal MSK pain management. Financial barriers, including out‐of‐pocket fees for multiple appointments, reduced service engagement (Becker et al. 2017) and were compounded by lower reimbursable rates and higher administrative burden for non‐pharmacological care compared with pharmacological treatment (Lentz et al. 2023). Consumers may also undervalue non‐pharmacological modalities or face challenges with the longer‐term investment of time, money and emotional energy required for effective self‐management (Becker et al. 2017). Although this study focused on health professional perspectives, these findings should be interpreted alongside the centrality of consumer perspectives to better understand the impact of varying integration levels on service engagement and care experiences. Without regular, sustained consumer engagement, the potential benefits of service integration may remain unrealised, limiting shared decision‐making to inform treatment adjustments to improve self‐management outcomes (Dongen et al. 2016).

This study contributes to integrated MSK pain management by showing that effective non‐pharmacological pathways in PHC depend on more than assembling services in one location. I Integration was enacted through relationship building and communication practices between health professionals, to create forward momentum within unified MSK pain management plans under a shared principle of consumer‐centred care. Additionally, deliberate support and adjustment at the health professional level was needed to create opportunities for consumer access and navigation.

Transferable implications include the value of making integration visible as a continuum (multidisciplinary to interdisciplinary), investing in shared workflows and feedback expectations, and resourcing care coordination functions that reduce friction for consumers and health professionals. At the same time, several features appear context‐specific to proximity‐based, mixed‐funding precincts. In particular, scale and co‐location increase informal interaction and strengthen relationship‐building opportunities between PHC provider organisations and individual health professionals. However, separate business entities, billing arrangements, and data‐sharing constraints, arising from health policy, regulatory requirements, or professional codes of practice can limit interoperability and shared processes. These insights can inform the design and implementation of scalable MSK models that are fit‐for‐purpose for real‐world PHC environments where public and private services coexist.

4.6. Limitations

This single‐site study was conducted within a large‐scale, proximity‐based PHC model operating under a hybrid funding structure combining universal public funding and private fee‐for‐service payments. The inclusion of embedded urgent care and chiropractic services, while novel, may limit transferability to settings where such care options are not routinely integrated. Participant recruitment relied on a convenience sample and may have preferentially attracted professionals with an interest in non‐pharmacological MSK pain management, introducing a potential selection bias.

Allied health professionals (e.g., physiotherapists and exercise physiologists) were not interviewed, as they did not volunteer. This limits the extent to which the findings capture the perspectives of providers whose discipline (outside of chiropractic care) is focused on non‐pharmacological MSK care. It also highlights a presence within this site‐specific context; professionals working for or embedded into the general practice have developed an MSK cluster or special interest in multi‐modal pain management. The study did not include direct consumer interviews, as it was focused on the role of health professionals and referral pathways within non‐pharmacological MSK pain management. Therefore, insights about consumer‐centred access are based on health professional accounts rather than the lived experiences of the person navigating and/or receiving care. Consequently, findings may not be generalisable to all PHC health professionals and may not be reflective of consumer experiences. Results may not apply to public‐funded‐only systems and organisations, smaller general practices, or other national and international contexts.

4.7. Recommendations for Future Research

This research project provided context‐specific insights into real‐world, operationalised integrated PHC (Babatunde et al. 2020; Bångsbo et al. 2022; Seal et al. 2017). Research can be expanded beyond MSK pain to examine integration across additional conditions and disciplines (Babatunde et al. 2020; Seal et al. 2017), including multi‐site and international research evaluating fit‐for‐purpose models (Bångsbo et al. 2022; Begley et al. 2019; Jenkins et al. 2023). Future studies should include allied health professionals and consumers to compare how integration is experienced across referral, treatment and navigation roles. Further investigation is needed into the determinants of interdisciplinary collaboration, including communication, power dynamics, and role expectations, as well as consumer factors influencing the effectiveness of team‐based care approaches (Begley et al. 2019; Jenkins et al. 2023).

Specifically, multi‐site or international research aimed at developing or evaluating operationalised integration models that are fit‐for‐purpose is recommended (Babatunde et al. 2020; Bångsbo et al. 2022; Seal et al. 2017). This could involve examining factors that enable or hinder interprofessional collaboration, such as communication deficits, professional status and power dynamics, and diverging expectations of care responsibilities (Bångsbo et al. 2022; Seal et al. 2017). Additionally, lived experience research is needed to understand the impact of consumer and system factors on the effectiveness of multidisciplinary or interdisciplinary approaches (Babatunde et al. 2020; Seal et al. 2017).

4.8. Recommendations for Future Practice

Practices should define and assess their level of integration on a continuum to identify gaps and inform operational strategy (Bångsbo et al. 2022; Begley et al. 2019). This may include service consolidation, partnerships, or shared service agreements to improve efficiency and reduce fragmentation (Bångsbo et al. 2022; Begley et al. 2019). Practical strategies include communication, which supports the management of consumer expectations and outcomes. This may include logistical considerations, such as knowing potential out‐of‐pocket fees, current wait times, and steps consumers must take to receive care. Case discussions, treatment outcome reports, consumer feedback and education sessions establish care navigation roles, probability of a successful consumer outcomes and trust in shared consumer‐centred values and principles. Collaboration with community‐based services to address social determinants of health (Bångsbo et al. 2022; Begley et al. 2019) and greater consumer and provider involvement in co‐design processes may further strengthen integration (Bångsbo et al. 2022; Begley et al. 2019). Investment in digital infrastructure to support timely and consistent information exchange is also recommended (Bångsbo et al. 2022; Begley et al. 2019).

4.9. Recommendations for Future Policy

Higher levels of interdisciplinary integration support knowledge creation and process co‐design, contributing to population health outcomes (Babatunde et al. 2020; Seal et al. 2017). Recognising integration as a continuum can guide system reform related to remuneration, workforce investment, governance arrangements and service planning to support higher levels of health professional collaboration (Babatunde et al. 2020; Bångsbo et al. 2022). Policy incentives for digital interoperability, regulatory reform, and addressing medicolegal risks to data‐sharing may further enable greater shared decision‐making and collective responsibility for consumer outcomes (Bångsbo et al. 2022; Begley et al. 2019). Additionally, given the importance of interpersonal skills to initiate and build relationships between health professionals, workforce training should increasingly prioritise relational and communication competencies (Begley et al. 2019; Dongen et al. 2016).

5. Conclusion

Musculoskeletal (MSK) pain management service integration can be conceptualised as a continuum with varying levels of collaboration. In this study, focused on general practice embedded health professionals, interdisciplinary care is underpinned by the shared value of bringing diverse clinical knowledge together to co‐create comprehensive and individualised primary healthcare (PHC) services. Within the site‐specific context studied, higher levels of integration were enabled by physical proximity, scale of services, and a culture of continuous learning that increased awareness of professional roles and scopes of practice.

Recognising where MSK services sit along this continuum can inform operational decision‐making to improve consumer access and support the scaling of needed services at a local level, while also informing policy approaches that better align individualised care with broader population health goals. Consumer factors were not the focus of this study and remain influential in service engagement. These individual factors may significantly affect the effectiveness of multidisciplinary and interdisciplinary approaches.

Health professionals highlighted that without timely access to affordable services, the potential benefits of highly integrated care environments may remain unrealised, limiting forward momentum towards multimodal treatments which can improve consumer outcomes. Translating these context‐specific insights into broader practice will require continued investment in PHC research focused on real‐world implementation, practice development, and policy reform.

Author Contributions

Shauna Fjaagesund: methodology, formal analysis, investigation, data curation, writing – original draft, writing – reviewing and editing, visualization, project administration, funding acquisition. Gary Campbell: formal analysis, investigation, data curation, writing – reviewing and editing, visualization. Wayne Graham: conceptualization, methodology, writing – reviewing and editing, supervision. Mark Sayers: conceptualization, methodology, writing – reviewing and editing. Xiang‐Yu Hou: writing – reviewing and editing. Ryan Fraser: writing – reviewing and editing. Jodie Orchard: writing – reviewing and editing. Marius Ungureanu: writing – reviewing and editing. Alexandru Coman: writing – reviewing and editing. Florin Oprescu: conceptualization, methodology, formal analysis, investigation, data curation, writing – reviewing and editing, visualization, supervision, project administration, funding acquisition.

Funding

This study was supported by a 2022 Health Hub Morayfield REEC Seed Research Grant.

Ethics Statement

This study was approved by the University of the Sunshine Coast ethics committee #A191263.

Conflicts of Interest

The authors would like to express their sincere gratitude to Dr David Shahar, Dr Evan Jones and Dr Andrew Ladhams, who generously contributed their time, expertise, and insights as key informants for this study. Their invaluable knowledge and experience working within primary healthcare settings greatly enriched the research and provided critical perspectives that were essential for the completion of this work.

Supporting information

Supporting Information S1

Data Availability Statement

Research data are not shared.