Strength and limitations
APPTs
STILL
This study is the first multicenter pragmatic trial with a cost analysis assessing APP-led ED care. The trial has been designed by a group of experts with expertise in the management of MSKD, public health, epidemiology, cost analyses, health services, ED medicine, interprofessional collaboration, rehabilitation, and designing and performing RCTs. The stepped-wedge design is an emerging and original methodology that facilitates the evaluation and implementation of new models of care [Although this trial is a pragmatic design, because of its experimental nature, it may not fully represent usual care that APPTs or ED physicians offer as they are aware of the objective of the trial. Moreover, patients are not blinded to providers that will offer care, and it may influence their perceptions. Still, this approach is necessary because of the pragmatic nature of the proposed trial, and it is important that patients know which provider and models of care they are exposed to as this increases the external validity of the current trial. Also, only a limited number of APPTs (12) will be assessing patients within this study across six EDs across Canada.While APP-led ED models of care are emerging globally, none of these models has been evaluated across Canada where these models are also becoming more prominent. MSKD not only represent a significant economic burden for Canadians, but also have a significant impact on population health, the Canadian workforce, and our health care system. As such, new models of care that result in more efficient care are needed. Given the high consultation rates for MSKD and known overcrowding in EDs, this trial has the potential to improve access and efficiency of ED care.