NEW ZEALAND JOURNAL OF PHYSIOTHERAPY | 47 What factors affect attendance at musculoskeletal physiotherapy outpatient services for patients from a high deprivation area in New Zealand (original) (raw)
Related papers
Musculoskeletal physiotherapy provided within a community health centre improves access
This study assessed whether the provision of a musculoskeletal physiotherapy service within a Community Health Centre situated in a high deprivation area would change access rates. Retrospective data were collected from the health records of all patients referred for outpatient musculoskeletal physiotherapy at the Health Centre and at the city's primary hospital. Age, sex, ethnicity, deprivation level at first consult, and overall appointment attendance rates from the Hospital service in 2009 were compared with data from 2010 to April 2012 for the two service sites. An increase in patients identifying themselves as Mäori (>120%) and Pacific Island (>130%) attending their first physiotherapy consult was found. Difference in sex, age, ethnicity and deprivation level between patients attending the two sites was significant (p-value <0.001). Patients who attended their first consultation predominantly identified themselves as European (Hospital; 69-71% and Health Centre; 20-22%) and as Mäori (Hospital; 13% and Health Centre; 32-34%) respectively. Over 80% of the Health Centre's attendees lived in a high deprivation area compared to less than 60% of patients attending the Hospital service. The placement of fully funded physiotherapy services within a high deprivation area improved access particularly for minority ethnic groups living in New Zealand.
Determining priority of access to physiotherapy at Victorian community health services
Prioritisation of clients requesting physiotherapy in Victorian community health services has occurred in the absence of a uniform evidence-based prioritisation process. The effect of the varying prioritisation procedures on client outcomes is unknown. This two-part study sought to answer two questions: what are the current prioritisation practices? And what is the evidence for prioritisation? Staff of Victorian community health services offering physiotherapy (n = 67) were sent a structured questionnaire regarding their prioritisation practices. The questionnaire data revealed a wide range of poorly defined criteria and methods of assessment for prioritisation. The evidence for prioritisation and the use of specific prioritisation criteria were examined via a literature search. The literature suggested the use of acute severe pain, interference with activities of daily living and falls as indicators of need for priority service. The lack of uniformity found in determining priority of access reflects the complexity of determining need and the lack of research and validated tools to assist decision making. Further research into prioritisation criteria is required to determine their validity and if their use in a prioritisation tool would actually improve outcomes for clients. What is known about the topic? Although there is some research on medical prioritisation of clients awaiting surgery little is known about prioritisation practices in allied health in general and physiotherapy in particular. There is also little known about client outcomes when clients are either not prioritised or have been incorrectly prioritised. The literature provides expert opinion on the potential usefulness of prioritisation criteria in determining client need. What does this paper add? This paper highlights the discrepancy between the various poorly defined and complex physiotherapy prioritisation practices that occurred in Victorian Community Health Services at the time of the study and the literature regarding the assessment of need. The underpinning evidence base for uniform prioritisation criteria is explored. Further research is required into the risks and effect on client outcomes of prioritisation. What are the implications for practitioners? Although practitioners, in the absence of any guidelines, have developed their own prioritisation protocols, the Victorian Department of Health has recently mandated the use of a uniform community health prioritisation procedure for physiotherapy and other allied health services, developed from the findings of this research. This study provides practitioners with an understanding of the evidence base for prioritisation criteria and approaches for assessing criteria in practice.
BMJ, 2004
The hospital based musculoskeletal service in northwest Wales was unable to cope with the demand for referrals from general practitioners. Waiting times were long, duplicate referrals to other departments were common, and general practitioners were reluctant to refer patients with common problems because of the perceived lack of service. Many referrals were made to the inappropriate specialty, especially orthopaedics. At least part of this problem was due to a lack of coordination between the four hospital departments providing musculoskeletal services and the emphasis on district general hospital based rather than community provision. Design Review over 18 months of impact of the targeted early access to musculoskeletal services (TEAMS) programme on accessibility to musculoskeletal services. Setting Northwest Wales. Key measures for improvement Number of patients referred and seen with musculoskeletal problems, waiting times, number of duplicate referrals, and surgery conversion rates in orthopaedic clinics. Strategies for change Establishing with central clinical triage a common pathway for all musculoskeletal referrals so that patients attend the appropriate department. A back pain pathway led by extended scope physiotherapists was developed, and general practitioners with special interests and extended scope physiotherapists were trained to provide services for patients with uncomplicated musculoskeletal problems in the community. Effects of change Over 18 months the number of referrals more than doubled. Despite this, waiting times for musculoskeletal services fell; this was noticeable for rheumatology and pain management. Duplicate referrals were abolished. Surgery conversion rates did not, however, change. Questionnaires from the clinics showed a high level of patient satisfaction. Lessons learnt Integration of hospital services that traditionally have worked in isolation can result in greatly improved access to musculoskeletal services. Community based multidisciplinary clinics run by specially trained general practitioners with special
Applied Geography, 2013
Despite the high incidence of musculoskeletal health problems in New Zealand, the use of specialised musculoskeletal healthcare providers appears to be limited to a small subsection of society. Analysis of the spatial distribution of musculoskeletal and general practice clinics in Auckland, New Zealand was undertaken to understand the geographical component of the issue of musculoskeletal healthcare accessibility. The locations of all physiotherapy, chiropractic, osteopathic, podiatry, acupuncture and general practitioner (GP) clinics in urban Auckland were mapped and analysed using a combination of spatial statistical tools. Results showed a contrast between the distribution of the predominantly privately-funded musculoskeletal clinics, which appeared clustered in central areas of the city, and predominantly publicly-funded GP clinics, which appeared more evenly spread across the study area. Several physical and social environmental variables appeared to be correlated with clinic location, including clinic proximity to major roads and urban centres, and residential socioeconomic status and ethnicity. This study represents a first step in understanding the underlying causes of the demographic divide between users and non-users of musculoskeletal healthcare. These results may help to inform the development of strategies to improve the accessibility of musculoskeletal healthcare services for people living or working in areas with low provision of musculoskeletal clinics.
Does deprivation influence treatment outcome in physiotherapy?
Physical Therapy Reviews, 2014
Background: The relationship between deprivation status and health is well documented with less deprived populations experiencing lower rates of morbidity and mortality than those from more deprived groups. The mechanisms that link deprivation to health are multi-factorial and complex. The relationship between deprivation and health remains largely unexplored in physiotherapy management. Objectives: To systematically collate, appraise, and summarize primary studies that investigate the relationship between deprivation and treatment outcomes in physiotherapy. Methods: A systematic search of electronic databases was performed using a specified strategy. A threephase screening process was used to identify relevant primary studies. Two independent reviewers selected the articles, rated quality, and extracted data. Meta-analysis was not performed due to diversity of conditions, interventions, and outcome measures used. Qualitative analysis was performed, and levels of evidence were generated using an established framework. Results: Three studies met the inclusion criteria; all were deemed of high quality. All three studies found that low socioeconomic status (SES) negatively influenced physiotherapy treatment outcomes. Conclusion: There is strong evidence to suggest that low SES negatively affects treatment outcomes in physiotherapy. This is in line with findings from other areas of medicine and allied health. The relationship appears to be complex and multifaceted. Key potential causal mechanisms are identified and explored with reference to existing literature. Further research is required to elucidate this complex relationship and to allow development of strategies that reduce the impact of deprivation on physiotherapy outcomes.
Pattern and determinants of willingness-to-pay for physiotherapy services
European Journal of Physiotherapy, 2019
Purpose: To evaluate willingness-to-pay for physiotherapy services and explore its determinants. Methods: Willingness-to-pay, health-related quality of life and physiotherapy satisfaction were assessed in 100 physiotherapy outpatients with willingness-to-pay, Short Form-12 and physiotherapy satisfaction questionnaires, respectively. Data were analysed with Chi-square and logistic regression. Results: A 45% 'nowillingness-to-pay' rate was found in this study. Pattern of willingness-to-pay for different physiotherapy modalities and techniques were varied. Socioeconomic status, treatment duration, amount willing to pay for treatment and physiotherapy satisfaction were significant determinants of willingness-to-pay. With one week increase in treatment duration, the participants were 8.4% less likely willing to pay for physiotherapy. Those who were satisfied with physiotherapy treatment were 21times more likely willing to pay compared with those who were not satisfied. Those in middle and high socioeconomic status were more likely willing to pay for physiotherapy compared with low socioeconomic status. With an increment in amount willing-to-pay more than median fee [₦ 1500 ($4.2)]; the participants were more likely willing to pay for physiotherapy. Conclusions: About 50% rate of no-willingness to pay for physiotherapy services was observed among Nigerian patients. Socioeconomic status, treatment duration, amount willing-to-pay for treatment and physiotherapy satisfaction were predictors of willingness-to-pay for physiotherapy services.
Self-referral to physiotherapy: deprivation and geographical setting
Physiotherapy, 2006
Objectives To establish the level of self-referral in urban, semi-rural and rural primary care settings, encompassing a range of deprivation, in Scotland. Design of study Quasi-experimental. Setting Twenty-nine general practices throughout Scotland. Participants Three thousand and ten patients (>16 years) and physiotherapists from throughout Scotland. Method Practices were classified in terms of their location and level of deprivation (DEPCAT scores). Historical data were used to establish national referral rates in these settings. Self-referral was introduced in each setting and the proportions of patients referring themselves or being referred by their general practitioner (GP) were collated over a full year. A further category of 'GP-suggested' referral was also included. Results There were different rates of referral according to setting (P < 0.001). A national adult referral rate of 53.5/1000 was identified. Rural areas experienced the highest rates (66/1000) of referral compared with urban (44.5/1000) and semi-rural (49/1000) settings. An overall 'true' self-referral rate of 22% was found. Rural areas experienced the highest levels of both self-and GP-suggested referrals (32% and 26%, respectively). An increase in total referral numbers was experienced in less than 20% of locations after introducing self-referral, all of which had a history of underprovision. Self-referrers came from all socio-economic settings, although differences were observed between the groups (P < 0.001). Conclusions Introducing self-referral does not appear to result in an increase in the overall referral rate when reasonable levels of service are already being provided in line with national rates according to geographical setting. Deprivation does not appear to exert a major influence on referral rates. However, the rate of self-referral in the long-term future is impossible to predict.
Does deprivation influence treatment outcome in physiotherapy? A systematic review
Physical Therapy Reviews, 2014
Background: The relationship between deprivation status and health is well documented with less deprived populations experiencing lower rates of morbidity and mortality than those from more deprived groups. The mechanisms that link deprivation to health are multi-factorial and complex. The relationship between deprivation and health remains largely unexplored in physiotherapy management. Objectives: To systematically collate, appraise, and summarize primary studies that investigate the relationship between deprivation and treatment outcomes in physiotherapy. Methods: A systematic search of electronic databases was performed using a specified strategy. A threephase screening process was used to identify relevant primary studies. Two independent reviewers selected the articles, rated quality, and extracted data. Meta-analysis was not performed due to diversity of conditions, interventions, and outcome measures used. Qualitative analysis was performed, and levels of evidence were generated using an established framework. Results: Three studies met the inclusion criteria; all were deemed of high quality. All three studies found that low socioeconomic status (SES) negatively influenced physiotherapy treatment outcomes. Conclusion: There is strong evidence to suggest that low SES negatively affects treatment outcomes in physiotherapy. This is in line with findings from other areas of medicine and allied health. The relationship appears to be complex and multifaceted. Key potential causal mechanisms are identified and explored with reference to existing literature. Further research is required to elucidate this complex relationship and to allow development of strategies that reduce the impact of deprivation on physiotherapy outcomes.
Determinants of Physical Therapy Use by Compensated Workers with Musculoskeletal Disorders
Journal of Occupational Rehabilitation, 2013
Purpose The study aim was to quantify physiotherapy service distribution among compensated workers with musculoskeletal disorders, and identify risk factors for under-and overuse. Andersen and Newman's model of service use determinants was adapted for a compensated population, to provide a conceptual basis for the analyses. Methods WorkSafe Victoria (Australia) workers' compensation claims were analysed retrospectively. Workers with musculoskeletal disorders resulting in at least 10 days off work were included if their claim commenced between 1-1-2001 and 1-1-2005 (n = 36,995). Physiotherapy use over 4 years of follow-up was determined from service payment data. Regression models were used relating individual level predictors, regional physiotherapist supply and the role of individual physiotherapists to service use. Results Physiotherapy was used by 26,026 (70 %) workers. Young age, male gender, working as a labourer, disorders of the joints, and not being hospitalised were associated with non-use. Use above the 90th percentile ([125 sessions over 4 years) was considered 'high use': high users accounted for 41 % of all use. Age 50-60, female gender, working as tradespersons, and substantial hospital costs were associated with high use. For workers living in the most disadvantaged areas, use was positively associated with supply. Negative binomial modelling of the role of physiotherapists indicated that service providers were associated with the number of sessions used. Conclusions Physiotherapy services were not underused, but a small group of patients had very high use. Recommendations to limit overuse should be aimed at physiotherapists, and these could include effective monitoring of adherence to proposed treatment plans.