Variations in demand and provision for publicly funded outpatient musculoskeletal physiotherapy services across <scp>Q</scp>uebec, <scp>C</scp>anada

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

doi:10.1111/jep.12838

Cited by 13 publications

(6 citation statements)

References 83 publications

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“…That study concluded that variation in provision of physiotherapy service did not appear to be related to demand for care, but rather was driven by wait times and indicators of insufficient provision of service. 33 We also reported an inverse association of the availability of PTs and chiropractors with the tendency to prescribe opioids at the first SP visit. A cross-sectional study of younger (disabled) Medicare beneficiaries also reported that the per-capita supply of DCs and spending on chiropractic manipulative therapy were inversely correlated with the percentage of younger Medicare beneficiaries receiving at least one opioid as well as 6 or more opioid prescription fills.…”

Section: Discussionmentioning

confidence: 64%

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Clinician approaches to new spine pain cases in primary care: Balance of opioid prescribing and early linkage to exercise therapy and spinal manipulation

Bauer,

Richard,

Ritter

et al. 2023

Evaluation Clinical Practice

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Rationale, Aims and ObjectivesSpine pain (SP) is common and often disabling. Clinical practice guidelines discourage opioid treatment and outline the value of varied nonpharmacologic therapies (NPTs). This study elucidates the amount of variability in primary‐care clinicians' (PCPs') prescribing of opioids and in their cases' receipt of the two most common NPTs (exercise therapy and spinal manipulation).MethodThe design was a retrospective cohort study examining variation in the treatment of PCPs' new SP cases, classified by receipt of (a) prescription of an opioid at the initial visit; (b) exercise therapy and/or spinal manipulation within 30 days of initial visit. The study was set in the primary care clinics at military treatment facilities of the US Military Health System in the period between October 2011 and September 2016.ResultsThe majority of cases did not receive a study treatment (66.3%); 19.6% of cases received only NPT within 30 days of initial visit; 11.5% were prescribed only an opioid at the initial visit with receipt of both NPT and opioid during early treatment rare (2.6%). Exercise therapy within 30 days exhibited more than a twofold difference in interquartile percentile rates (IQR) (median provision 15.8%, IQR 9.8%−22.1%). The other treatments exhibited even greater variation; specifically, spinal manipulation (median 8.5%, IQR 3.3%−15.8%), and opioid at initial visit (median 10.3%, IQR 4.4%−18.2%). The availability of physical therapists and doctors of chiropractic had significant association with several clinical provision rates.ConclusionAmong providers of spine care for a sample of Army soldiers, there was substantial variation in the early provision of exercise therapy, spinal manipulation, and opioid prescriptions. The magnitude of the case‐mix adjusted variation and its association with facility availability of providers suggests that quality of care initiatives may help reduce this variation.

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Section: Discussionmentioning

confidence: 64%

“…This is supported by findings in the province of Quebec, Canada of the use of early physiotherapy services. That study concluded that variation in provision of physiotherapy service did not appear to be related to demand for care, but rather was driven by wait times and indicators of insufficient provision of service 33 …”

Section: Discussionmentioning

confidence: 98%

Clinician approaches to new spine pain cases in primary care: Balance of opioid prescribing and early linkage to exercise therapy and spinal manipulation

Bauer,

Richard,

Ritter

et al. 2023

Evaluation Clinical Practice

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“…Findings showed that the ETOs are concentrated in three Canadian provinces (Ontario, Québec, and British Columbia). Previous research has found variations in the density of rehabilitation professionals in different Canadian provinces, 64 with a greater density in areas with academic centers compared with rural and remote areas. [65][66][67][68] The concentration of ETOs in these three provinces seems to reflect the presence of larger numbers of rehabilitation professions and academic settings in those areas and provinces.…”

Section: Etos Characteristicsmentioning

confidence: 94%

Nationwide Environmental Scan of Knowledge Brokers Training

Gaid¹,

Mate²,

Ahmed³

et al. 2021

J Contin Educ Health Prof

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Introduction: Knowledge brokers (KBs) can promote the uptake of best practice guidelines in rehabilitation. Although many institutions offer training opportunities to health care professionals who wish to undertake KBs roles, the characteristics and content of those educational training opportunities (ETOs) are currently unknown. This study aimed to describe the ETOs available to rehabilitation professionals in Canada and determine whether the ETOs meet the competencies expected of the KBs roles. Methods: We conducted a Canada-wide environmental scan to identify ETOs using three strategies: online search, phone calls, and snowball. To be included in the study, ETOs had to be offered to rehabilitation professionals in Canada and be targeting KBs competencies and/or roles. We mapped each of the content to the KBs competencies (knowledge and skills) within the five roles of KBs: information manager, linking agent, capacity builder, facilitator, and evaluator. Results: A total of 51 ETOs offered in three Canadian provinces, British Columbia, Ontario, and Quebec, were included in the analysis. For KBs competencies, 76% of ETOs equipped attendees with research skills, 55% with knowledge brokering skills, and 53% with knowledge on implementation science. For KBs roles, over 60% of ETOs supported attendees to in performing the capacity builder role and 39% the evaluator role. Discussion: Findings suggest that ETOs focused primarily on preparing participants with the research and knowledge brokering skills required to perform the capacity builder and evaluator roles. Comprehensive educational training covering all KBs roles and competencies are needed.

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“…Similarly, a study by Deslauriers, Raymond [ 19 ] found a mean waiting time of 7.6 months (range from 0 to 77 months) for outpatient physiotherapy services in publicly funded hospitals in the province of Quebec (Canada). This delay in access to external rehabilitation services is exacerbated by a persistent shortage of healthcare professionals and an increasing demand for services for an aging population [ 20 , 21 ]. With the goal of optimizing post-acute care physical functioning and functional independence among older adults admitted to acute care or their rehabilitation facilities, the MWIIUHSSC piloted the Post-Acute Home Physiotherapy Program (PAHP).…”

Section: Introductionmentioning

confidence: 99%

Transition of care from post-acute services for the older adults in Quebec: a pilot impact evaluation

Ghai,

Chassé,

Renaud

et al. 2024

BMC Health Serv Res

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Background Early discharge of frail older adults from post-acute care service may result in individuals’ reduced functional ability to carry out activities of daily living, and social, emotional, and psychological distress. To address these shortcomings, the Montreal West Island Integrated University Health and Social Services Centre in Quebec, Canada piloted a post-acute home physiotherapy program (PAHP) to facilitate the transition of older adults from the hospital to their home. This study aimed to evaluate: (1) the implementation fidelity of the PAHP program; (2) its impact on the functional independence, physical and mental health outcomes and quality of life of older adults who underwent this program (3) its potential adverse events, and (4) to identify the physical, psychological, and mental health care needs of older adults following their discharge at home. Methods A quasi-experimental uncontrolled design with repeated measures was conducted between April 1st, 2021 and December 31st, 2021. Implementation fidelity was assessed using three process indicators: delay between referral to and receipt of the PAHP program, frequency of PAHP interventions per week and program duration in weeks. A battery of functional outcome measures, including the Functional Independence Measure (FIM) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 scale, as well as fall incidence, emergency visits, and hospitalizations were used to assess program impact and adverse events. The Patient’s Global Impression of Change (PGICS) was used to determine changes in participants’ perceptions of their level of improvement/deterioration. In addition, the Camberwell Assessment of Need for the Elderly (CANE) questionnaire was administered to determine the met and unmet needs of older adults. Results Twenty-four individuals (aged 60.8 to 94 years) participated in the PAHP program. Implementation fidelity was low in regards with delay between referral and receipt of the program, intensity of interventions, and total program duration. Repeated measures ANOVA revealed significant improvement in FIM scores between admission and discharge from the PAHP program and between admission and the 3-month follow-up. Participants also reported meaningful improvements in PGICS scores. However, no significant differences were observed on the physical or mental health T-scores of the PROMIS Global-10 scale, in adverse events related to the PAHP program, or in the overall unmet needs. Conclusion Findings from an initial sample undergoing a PAHP program suggest that despite a low implementation fidelity of the program, functional independence outcomes and patients’ global impression of change have improved. Results will help develop a stakeholder-driven action plan to improve this program. A future study with a larger sample size is currently being planned to evaluate the overall impact of this program. Clinical trial registration Retrospectively registered NCT05915156 (22/06/2023).

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Variations in demand and provision for publicly funded outpatient musculoskeletal physiotherapy services across Quebec, Canada

Cited by 13 publications

References 83 publications

Clinician approaches to new spine pain cases in primary care: Balance of opioid prescribing and early linkage to exercise therapy and spinal manipulation

Clinician approaches to new spine pain cases in primary care: Balance of opioid prescribing and early linkage to exercise therapy and spinal manipulation

Nationwide Environmental Scan of Knowledge Brokers Training

Transition of care from post-acute services for the older adults in Quebec: a pilot impact evaluation

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