Comparing fly-in fly-out and telehealth models for delivering advanced-practice physiotherapy services in regional Queensland: An audit of outcomes and costs

Abstract

Introduction Recruitment of advanced-practice physiotherapists to regional and rural healthcare facilities in Queensland, Australia remains a challenge. To overcome this barrier, two different service delivery models (Fly-In, Fly-Out (FIFO), Telehealth) were trialled by one regional facility. This study aims to describe the economic- and service-related outcomes of these two methods of service delivery. Methods A retrospective audit was conducted where two nine-week time periods were selected for each service delivery model. Outcomes of interests include patient demographics and case-mix, service utilisation, clinical actions, adverse events and costs. Net financial position for both models was calculated based upon costs incurred and revenue generated by service activity. Results A total of 33 appointment slots were recorded for each service delivery model. Patient case-mix was variable, where the Telehealth model predominately involved patients with musculoskeletal spinal conditions managed from a neurosurgical waiting list. Appointment slot utilisation and pattern of referral for further investigations were similar between models. No safety incidents occurred in either service delivery model. An estimated cost-savings of 13% for the Telehealth model could be achieved when compared to the FIFO model. Discussion Telehealth is a safe, efficient and viable option when compared to a traditional in-person outreach service, while providing cost-savings. Telehealth should be seen as a service delivery medium in which sustainable recruitment of advanced-practice physiotherapists to regional and rural healthcare facilities can be achieved.

Telehealth for musculoskeletal physiotherapy

“…This is not unique to musculoskeletal physiotherapy and demonstrates the value that individuals place on accessing care via telehealth. While more work needs to be done to confirm the economic implications of providing musculoskeletal services via telehealth, research to date has shown telehealth services to be cost-effective with cost-savings to the health service generally favouring telehealth over usual in-person care (Cottrell et al, 2019a;Nelson et al, 2019;Pastora-Bernal et al, 2017;Tousignant et al, 2015).…”

Economic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses

“…Four RCTs [31][32][33][34], three prospective cohort studies [35][36][37], four retrospective cohort studies [38][39][40][41][42] and one economic modeling study (2 articles) [43,44] were included.…”

“…Two studies also compared APP care to nurse practitioners care [33,40,41] while one study also compared APP care to osteopathic physicians and physician assistant care [40,41]. One study compared APP telehealth care to APP face-to-face care [42].…”

“…Three studies were performed in primary care clinics [31,37,40,41], two in emergency departments [33,34] and eight in specialized care including five in adults orthopaedic outpatient clinics [32,35,[42][43][44], two in paediatrics orthopaedic outpatient clinics [36,38] and one in a gynaecology and urology outpatient clinic [39]. All included studies were conducted in Western Countries.…”

“…All included studies were conducted in Western Countries. More specifically, four studies were conducted in the United Kingdom [32][33][34]38], four in Australia [35,39,[42][43][44], two in Sweden [31,37], one in Ireland [31,36] and one in the United States [40,41].…”