Do patients discharged from advanced practice physiotherapy-led clinics re-present to specialist medical services?

Abstract

Objective. The aim of the present study was to determine the rates of re-referral to specialist out-patient clinics for patients previously managed and discharged from an advanced practice physiotherapy-led service in three metropolitan hospitals.Methods. A retrospective audit was undertaken of 462 patient cases with non-urgent musculoskeletal conditions discharged between 1 April 2014 and 30 March 2015 from three metropolitan hospitals. These patients had been discharged from the physiotherapy-led service without requiring specialist medical review. Rates and patterns of re-referral to specialist orthopaedic, neurosurgical, chronic pain, or rheumatology services within 12 months of discharge were investigated.Results. Forty-six of the 462 patients (10.0%) who were managed by the physiotherapy-led service were re-referred to specialist medical orthopaedic, neurosurgical, chronic pain or rheumatology departments within 12 months of discharge. Only 22 of these patients (4.8%) were re-referred for the same condition as managed previously and discharged.Conclusions. Ninety-five per cent of patients with non-urgent musculoskeletal conditions managed by an advanced practice physiotherapy-led service at three metropolitan hospitals did not re-present to access public specialist medical services for the same condition within 12 months of discharge. This is the first time that re-presentation rates have been reported for patients managed in advanced practice physiotherapy services and the findings support the effectiveness of these models of care in managing demand for speciality out-patient services.What is known about the topic? Advanced practice physiotherapy-led services have been implemented to address the needs of patients referred with non-urgent musculoskeletal conditions to hospital specialist out-patient services. Although this model is widely used in Australia, there has been very little information about whether patients managed in these services subsequently re-present for further specialist medical care. What does this paper add? This paper identifies that the majority (95%) of patients managed by an advanced practice physiotherapy-led service did not re-present for further medical care for the same condition within 12 months of discharge. What are the implications for practitioners? This paper supports the use of advanced practice physiotherapy-led services in the management of overburdened neurosurgical and orthopaedic specialist out-patient waiting lists.

Physiotherapist‐Led Triage at a Rheumatology‐Based Musculoskeletal Assessment Clinic: an 18‐Month Service Evaluation of Activity and Outcomes

“…The findings of this service evaluation show that the majority of patients (75%) directed to the MAC were independently managed by the CSPs without review by the rheumatology consultant or team. This is comparable to the findings of similar orthopedic service evaluations , which have reported that 50%‐92% of patients seen in physiotherapist‐led triage services were managed without referral to orthopedic clinics.…”

“…A substantial number of trials, observational studies, and service evaluations of physiotherapist‐led musculoskeletal triage services in primary and secondary care settings have found that suitably trained CSPs can independently and appropriately manage a significant proportion (50%‐92%) of patients within physiotherapist‐led musculoskeletal triage clinics . A systematic review of extended‐scope physiotherapy practice in patients with musculoskeletal disorders suggests that the quality of care is at least equivalent to that of physician‐led care with respect to diagnostic accuracy, clinical effectiveness, use of health care resources, and patient satisfaction .…”

“…A systematic review of extended‐scope physiotherapy practice in patients with musculoskeletal disorders suggests that the quality of care is at least equivalent to that of physician‐led care with respect to diagnostic accuracy, clinical effectiveness, use of health care resources, and patient satisfaction . A retrospective review of 462 patients with nonurgent musculoskeletal presentations who were discharged from a musculoskeletal triage service reported that less than 5% of patients re‐presented to the service within 12 months . Similarly, in a service evaluation of 184 patients discharged over a 2‐month period from physiotherapist‐led musculoskeletal triage clinics, only 6.5% of patients (n = 12) were re‐referred to the service within 12 months .…”

<p>The Role and Development of Advanced Clinical Practice Within Allied Health Professions: A Mixed Method Study</p>

“…The international physiotherapy literature provides many examples of ACPs delivering new models of care, particularly in musculoskeletal services, and across different settings, including emergency, primary and secondary care. [20][21][22][23][24][25][26][27] Many of these examples involved the physiotherapy ACPs assessing and treating patients for musculoskeletal conditions, instead of medical practitioners, both in routine clinics and emergency care. These models consistently evaluate well, providing not only an equivalent quality but also additional benefits, such as increased accessibility and wider range of strategies.…”

Advanced musculoskeletal physiotherapy: Barriers and enablers to multi‐site implementation

“…Within health services with existing AMP services, experienced and qualified musculoskeletal physiotherapists have a pathway to achieve full advanced practice competency, supported by a competency‐based training and assessment framework leading to credentialing (Department of Health, ). This has resulted in the formation of a capable workforce which has further potential to improve patient outcomes and the efficiency and cost‐effectiveness of service delivery (Chang, Gavaghan, O'Leary, McBride, & Raymer, ).…”