Ethical Challenges for Patient Access to Physical Therapy: Views of Staff Members from Three Publicly–Funded Outpatient Physical Therapy Departments

Abstract

Demographic change and changing population needs are important drivers of increased demand for rehabilitation. These developments place significant stress on access to physical therapy services, as current resources are insufficient to meet the growing demand. This situation presents ethical challenges for physical therapists and others involved in managing wait lists and prioritizing access to services. The purpose of this study is to explore how outpatient physical therapy department (OPD) staff experience ethical issues relating to access to physical therapy services. We conducted semi-structured interviews with 13 participants who were staff at three publicly-funded OPDs in Montreal, Quebec, Canada. Using interpretive description methodology, we developed four themes related to access to physical therapy services: 1) negotiating access to physical therapy services; 2) navigating a complex system with outside influences and constraints, such as professional regulation and third-party payers; 3) managing wait lists responsibly; and 4) striving to be a good professional in a non-ideal world. Across the four themes, two main sources of tension that influence the staff were identified in relation to the experience of wait list management: responsibility and power. This study highlights how difficult it is for OPD staff to balance competing interests and values, and to respond to outside influences, when making resource allocation decisions. Until resource limitations are addressed, wait lists may be an unavoidable feature of many OPDs in the Canadian public health care system. Improving fairness in the access to and distribution of services is thus important in ensuring that professionals are able to treat patients based on their clinical needs, and in a timely fashion.

Making Decisions about Service Provision for Clients with Low Back Pain: Perspectives of Canadian Physiotherapy Professionals

“…Our results are consistent with those of recent studies of the practices in Quebec PT outpatient departments, where physiotherapists with managerial responsibilities and administrative staff decide how to prioritize access for people on the waiting list, whereas physiotherapists decide on frequency and duration of treatment for their patients. 1,49 Figure 3 Importance of factors associated with making decisions about treatment duration, according to respondents working in either the private or the public sector. This advance online version may differ slightly from the final published version.…”

Barriers and Facilitators for Implementation of a Patient Prioritization Tool in Rehabilitation Settings

“…These barriers were related to the lack of compatibility with actual prioritization practice and lack of common vision about prioritization, which were highlighted in our study. The complexity of the implementation can be partly explained by the fact that patient prioritization in waiting lists is a decision which encompasses ethical challenges [60,61]. Having a common vision about prioritization in a team, such as in a rehabilitation program, can lead to a clash of values related to equity.…”

“…care [61]. Laliberté et al [61] suggested to improve training and combine with research on evidence-based practices to document current weaknesses, and to identify waiting list management procedures that can make resource allocation decisions more equitable and transparent.…”

Prioritization of Referrals in Outpatient Physiotherapy Departments in Québec and Implications for Equity in Access

“…While the results of our survey indicate that a majority of outpatient physiotherapy departments in Québec used the diagnosis as their most important criterion to prioritize referrals, level of acuity was also frequently considered. Furthermore, in many settings, postoperative conditions were systematically prioritized over chronic conditions, thus compromising access to physiotherapy for the latter [21]. Studies from Ontario and Australia found that the most frequent prioritization criterion for physiotherapy was the acuity of the condition.…”