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

Deslauriers, Simon; Raymond, Marie-Hélène; Laliberté, Maude; Hudon, Anne; Desmeules, François; Feldman, Debbie Ehrmann; Perreault, Kadija

doi:10.7202/1058251ar

Cited by 9 publications

(4 citation statements)

References 46 publications

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“…Considering patients in the low risk group had the highest NP:R ratio it may be possible that these patients have been over treated and perhaps should be directed to self‐management on a sooner basis (Deyo et al., 2009; Hill et al., 2011). Long waits for physiotherapy has been shown to result in higher healthcare utilisation and costs for patients along with poor outcomes (Deslauriers et al., 2018) and if these patients in the low risk can be identified early and managed appropriately with less input then capacity and waiting times could improve. It is important to recognise, however, that clinicians should be allowed to use their clinical judgement to determine if the patient requires further input or not and can overrule the risk stratification tool (Hill et al., 2011).…”

Section: Discussionmentioning

confidence: 99%

Service evaluation of telehealth in a physiotherapy musculoskeletal setting: Patient outcomes and results from risk stratification

Slattery

Ackerman

Jagadamma

2022

Musculoskeletal Care

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Introduction: Due to COVID-19 the ability to see all patients face-to-face (FTF) was removed. Services implemented telehealth to cater for patients requiring musculoskeletal care. A service evaluation was undertaken to assess the effectiveness of a mixed telehealth/FTF approach and identify if stratifying patients could help tailor intervention.Methods: Retrospective analysis of data collected from patients who were assessed by Musculoskeletal Physiotherapists in one Scottish health board was undertaken.Patients were divided into low, medium and high risk sub-groups through the Keele STarT MSK tool. Outcome measures for pain and musculoskeletal health were taken at baseline/discharge along with satisfaction/preference. Descriptive and Inferential statistical analysis was conducted to establish whether changes in the outcome measures within and between risk sub-groups were statistically significant.Results: Pain level difference from baseline to discharge demonstrated clinically and statistically significant improvements across all risk groups (N = 89). Musculoskeletal health demonstrated clinically significant improvements across all risk groups and statistically significant improvements in the medium/high risk groups but not the low risk. Patients with knee osteoarthritis and low back pain in the medium risk group had fewest appointments while patients with chronic shoulder pain had the most. The majority of patients were satisfied with all mediums but preferred FTF or an option between telehealth/FTF in the future. Conclusion:Telehealth is a promising model of care when utilised in combination with FTF for patients with musculoskeletal conditions. Through stratification, identifying specific conditions and shared decision making it may be possible to treat certain patient groups via telehealth.

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Section: Discussionmentioning

confidence: 99%

Service evaluation of telehealth in a physiotherapy musculoskeletal setting: Patient outcomes and results from risk stratification

Slattery

Ackerman

Jagadamma

2022

Musculoskeletal Care

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

BScPT

BScOT

et al. 2021

Physiotherapy Canada

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Purpose: This study identified the individuals responsible for making decisions about physiotherapy (PT) wait time, frequency of treatment, and treatment duration for persons with low back pain and determined which factors guided these decisions. Method: A cross-sectional survey was sent to Canadian PT professionals treating adult patients with musculoskeletal problems. It included a clinical vignette describing a patient with low back pain. Respondents were asked who made decisions about wait time, treatment frequency, and treatment duration as well as on which factors they based these decisions. Results: Clinicians were most often responsible for making decisions about treatment frequency and duration. Although clinicians and managers or coordinators were mainly responsible for making decisions about wait time, there was more variability depending on sector of care: in the private sector, administrative assistants played a much larger role. Clinical judgment, clinical guidelines, and patients' demands were the predominant factors influencing wait time and frequency decisions. Treatment duration was related to patients' goals, clinical progression, patients' motivation, and patients' return to work. Conclusions: Decisions about service provision for wait times are made by a range of stakeholders, and a wide variety of factors guide Canadian PT professionals' decision making. Identifying these factors is essential for informing a discussion of decisions about evidence-based and equitable service delivery so that the actors involved can reach a consensus.

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“…This difficulty in securing an appointment in a timely manner could be due to the process of traditional triage used in outpatient rehabilitation clinics that prioritizes patients who are in an acute phase or patients with orthopedic needs, over patients with a chronic condition or more complex cases. 42,43 This delay caused some study participants in the intervention arm to decide against following through with therapy, without being seen by rehabilitation services. For those who received PT/OT evaluation, patients faced yet another barrier.…”

Section: Discussionmentioning

confidence: 99%

Older Adults with Cancer: A Randomized Controlled Trial of Occupational and Physical Therapy

Pergolotti

Deal

Williams

et al. 2019

J American Geriatrics Society

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OBJECTIVES The impact of occupational therapy (OT) and physical therapy (PT) on functional outcomes in older adults with cancer is unknown. DESIGN Two‐arm single‐institution randomized controlled trial of outpatient OT/PT. SETTING Comprehensive cancer center with two off‐site OT/PT clinics. PARTICIPANTS We recruited adults 65 years and older with a recent diagnosis or recurrence of cancer within 5 years, with at least one functional limitation as identified by a geriatric assessment. Participants were randomized to OT/PT or usual care. INTERVENTION Rehabilitation consisted of individualized OT and PT that addressed functional activities and strength/endurance needs. MEASUREMENTS Primary outcome was functional status as measured by the Nottingham Extended Activities of Daily Living scale. Secondary outcomes were Patient‐Reported Outcomes Measurement Information System‐Global Mental Health (GMH) and Global Physical Health (GPH), ability to participate in Social Roles (SR), physical function, and activity expectations and self‐efficacy (Possibilities for Activity Scale [PActS]). RESULTS Among those recruited (N = 63), only 45 patients (71%) were evaluable due to loss of follow‐up and/or nonreceipt of intervention. The median age was 74 years; 53% were female, and 91% were white. Overall, 30% patients had hematologic malignancies, 30% breast cancer, and 16% colorectal cancers. A total of 65% were in active treatment; 49% had stage 3 or 4 disease. At follow‐up, both OT/PT (P = .02) and usual care (P = .03) groups experienced a decline in functional status. PActS scores between groups (P = .04) was significantly improved in the intervention group. GMH and SR met criteria for minimally important clinical difference favoring the intervention, but not statistical significance. Several barriers were noted in the implementation of the intervention program: recruitment, concerns about cost, distance, scheduling, and limited treatment provided. CONCLUSION OT/PT may positively influence activity expectations and self‐efficacy. Future research needs to address significant barriers to implementation to increase use of OT/PT services and access to quality care. J Am Geriatr Soc 67:953–960, 2019.

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

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Cited by 9 publications

References 46 publications

Service evaluation of telehealth in a physiotherapy musculoskeletal setting: Patient outcomes and results from risk stratification

Service evaluation of telehealth in a physiotherapy musculoskeletal setting: Patient outcomes and results from risk stratification

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

Older Adults with Cancer: A Randomized Controlled Trial of Occupational and Physical Therapy

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