Acceptability of a task sharing and shifting model between family physicians and physiotherapists in French multidisciplinary primary healthcare centres: a cross-sectional survey

Abstract

ObjectivesThe rising prevalence of musculoskeletal disorders increases pressure on primary care services. In France, patients with musculoskeletal disorders are referred to physiotherapist (PT) by family physician (FP). To improve access to musculoskeletal care, a new model of task sharing and shifting is implemented between FPs and PTs for patients with acute low back pain. This new model enables French PTs to expand their usual scope of practice by receiving patients as first-contact practitioner, diagnosing low back pain, prescribing sick leave and analgesic medication. The aim of this study is to investigate the acceptability of FPs and PTs regarding this new model.DesignA cross-sectional survey design was used. Acceptability was measured using a questionnaire on the perception of the model and the perception of PTs’ skills to manage low back pain. Descriptive analyses were performed to compare results among participants.SettingFrench FPs and PTs working in multidisciplinary primary healthcare centres were invited to complete an online survey.ParticipantsA total of 174 respondents completed the survey (81 FPs and 85 PTs).ResultsA majority of participants had a positive perception of the task sharing and shifting model. A majority of the participants were mostly or totally favourable towards the implementation of the model (FPs: n=46, 82% and PTs: n=40, 82%). The perceived level of competencies of PTs to manage acute low back pain was high. The confidence level of FPs was higher than that of PTs regarding PTs’ ability to adequately diagnose low back pain, refer patient to physiotherapy and prescribe sick leave or analgesic medication.ConclusionBased on this limited sample of participants, there appears to be good acceptability of the task sharing and shifting model for acute low back pain. Additional studies are needed to better determine the factors affecting the acceptability of such a model.

“Cooperation between physicians and physios fosters trust you know”: a qualitative study exploring patients’ experience with first-contact physiotherapy for low back pain in French primary care

“…This is a significant result showing that respondents were receptive to the evolution of the gatekeeper positioning of family physicians regarding access to primary care services and diagnosis of MSKD. These results are concordant with views from French physiotherapists and physicians who reported the new FCP model to be highly acceptable [41].…”

“…Inductive analysis was conducted to ensure that the findings emerged from the data and not from the researcher's perception. Findings of this study were consistent with other studies exploring patients' perspectives with advanced practice physiotherapy models and with the results of a previous acceptability study on this FCP model conducted by our team [26,35,41]. Some limitations should, however, be considered.…”

Coopérations entre professionnels de santé en soins primaires pour la prise en charge des troubles musculosquelettiques une revue narrative

“…Dix études visant à explorer qualitativement ou à évaluer quantitativement les modèles de modification des rôles et des tâches des professionnels de santé en soins primaires pour la prise en charge des troubles musculosquelettiques ont été incluses dans la présente revue [29,[42][43][44][45][46][47][48][49][50]. Ces études ciblent majoritairement la délégation de tâches et les modèles de pratique avancée en kinésithérapie.…”

“…Une seconde étude réalisée en France rapporte une bonne acceptabilité de la part des professionnels vis-à-vis d'un protocole de coopération entre les médecins généralistes et des kinésithérapeutes travaillant au sein de structures pluriprofessionnelles de santé pour la prise en charge de la lombalgie aiguë. Cette étude met en évidence un niveau de confiance élevé des médecins généralistes en la capacité du kinésithérapeute à prendre en charge un patient souffrant de lombalgie aiguë en première intention et à réaliser des actes médicaux délégués tels que l'établissement d'un diagnostic, la prescription d'antalgiques, d'arrêt de travail et de séances de kinésithérapie [42]. Ce modèle de soins est plus précisément décrit dans la 3 e partie de cette revue.…”

A Model of Triage of Serious Spinal Pathologies and Therapeutic Options Based on a Delphi Study

“…In these countries, new models of care integrating a more autonomous role of the physiotherapist are being gradually implemented. For instance, new models of task sharing and shifting are being implemented in France between general practitioners and physiotherapists for patients with non-urgent musculoskeletal disorders, such as ankle sprains or low back pain [ 3 ]. Its implementation is a major shift for the evolution of physiotherapists’ skills, roles and responsibilities, since French patients are traditionally referred to physiotherapists by physicians.…”