Extended roles in primary care when physiotherapist-initiated referral to X-ray can save time and reduce costs

Abstract

Background We evaluated an extended role for the physiotherapist in primary care in referring patients to plain X-ray. Methods This prospective cohort study was set in a single region in Sweden. It included 20 physiotherapists who were educated in a one-day training in performing referral to X-ray, along with 107 patients with musculoskeletal disorders who were referred to X-ray. We evaluated that referral quality, patient and physiotherapist satisfaction, and calculated health care and patient costs. Results All referrals fulfilled the basic requirements of quality, and 78% were classified as good, fulfilling all criteria. Both patients and physiotherapists were satisfied with the extended role for the physiotherapist that decreased waiting time to diagnosis and to adequate treatment. Costs were reduced for patients (by €53/patient) and health care (by €6286.2/107 patients). The cost to visit a physician was twice that of a physiotherapist visit. Conclusions An extended role for physiotherapists in primary care in referring patients to X-ray was effective and safe for patients and reduced costs for patients and for health care. Physiotherapists in primary care were able to refer patients to X-ray after one day of training, and the extended role freed up 45 minutes of physician time for each patient with a musculoskeletal disorder in need of an X-ray.

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

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

“…All included studies measured health care system costs, five studies measured patient costs [ 32 – 35 , 37 ] and two studies measured patients’ productivity losses [ 31 , 34 ]. Four observational studies only included health care practitioner’s salary in their health care system costs outcomes (Table 3 ).…”

“…APP care was compared to care provided by orthopaedic surgeons [ 32 , 35 , 36 , 38 , 43 , 44 ], emergency physicians [ 33 , 34 ] family physicians [ 31 , 37 , 40 , 41 ] or gynecologists [ 39 ] . 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 ].…”

“…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 – 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 – 34 , 38 ], four in Australia [ 35 , 39 , 42 – 44 ], two in Sweden [ 31 , 37 ], one in Ireland [ 31 , 36 ] and one in the United States [ 40 , 41 ].…”