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Reducing strain on primary healthcare systems through innovative models of care: the impact of direct access physiotherapy for musculoskeletal conditions-an interrupted time series analysis.

التفاصيل البيبلوغرافية
العنوان: Reducing strain on primary healthcare systems through innovative models of care: the impact of direct access physiotherapy for musculoskeletal conditions-an interrupted time series analysis.
المؤلفون: Zouch JH; Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia jzou3929@uni.sydney.edu.au., Berg B; Centre for Intelligent Musculoskeletal Health, Oslo Metropolitan University Faculty of Health Sciences, Oslo, Norway., Pripp AH; Oslo Metropolitan University Faculty of Health Sciences, Oslo, Norway.; Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway., Storheim K; Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University Faculty of Health Sciences, Oslo, Norway.; Department of Research and Innovation, Oslo University Hospital Division of Clinical Neuroscience, Oslo, Norway., Ashton-James CE; Sydney Medical School, Kolling Institute, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia., Ferreira ML; The George Institute for Global Health, Sydney, New South Wales, Australia., Grotle M; Department of Research and Innovation, Oslo University Hospital, Oslo, Norway.; Department of Rehabilitation and Technology, Oslo Metropolitan University Faculty of Health Sciences, Oslo, Norway., Ferreira PH; Charles Perkins Centre, Sydney Musculoskeletal Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.
المصدر: Family medicine and community health [Fam Med Community Health] 2024 Sep 24; Vol. 12 (3). Date of Electronic Publication: 2024 Sep 24.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: BMJ Country of Publication: England NLM ID: 101700650 Publication Model: Electronic Cited Medium: Internet ISSN: 2009-8774 (Electronic) Linking ISSN: 23056983 NLM ISO Abbreviation: Fam Med Community Health Subsets: MEDLINE
أسماء مطبوعة: Publication: 2019- : London, United Kingdom : BMJ
Original Publication: Shannon, Ireland : Compuscript for Chinese General Practice Press, [2013]-[2018]
مواضيع طبية MeSH: Primary Health Care* , Musculoskeletal Diseases*/therapy , Physical Therapy Modalities* , Interrupted Time Series Analysis*, Humans ; Norway ; Female ; Male ; Middle Aged ; Adult ; Aged ; Health Services Accessibility ; Adolescent ; Young Adult ; Referral and Consultation
مستخلص: Objectives: To evaluate the longitudinal impact of introducing a national, direct access physiotherapy model of care on the rates of primary and secondary care consultations for musculoskeletal (MSK) conditions.
Design: Interrupted time series analysis using segmented linear regression.
Setting: Norway primary care PARTICIPANTS: A cohort of 82 072 participants was derived from 3 population-based health surveys conducted across separate geographical regions in Norway. All participants surveyed were eligible for inclusion as a national representative sample of the Norwegian population. Registered MSK consultations were linked to the Norwegian Control and Payment of Health Reimbursement database and the Norwegian Patient Register using the International Classification of Primary Care diagnostic medical codes L-chapter for MSK conditions and spine related International Classification of Diseases, 10th Revision, codes.
Intervention: Direct access to physiotherapy model of care introduced nationally in Norway in 2018. This model allowed Norwegians to consult directly with qualified physiotherapists for MSK conditions (eg, back pain, knee osteoarthritis) without the need for a medical referral in order to claim a social security reimbursement.
Main Outcomes Measured: Rates of primary care consultations per 10 000 population (general practitioner (GP) and physiotherapist consultations) and secondary care (specialist consultations and surgical procedures) measured from 2014 to 2021.
Results: The introduction of the direct access physiotherapy model was associated with an immediate stepped reduction of 391 general practice consultations per 10 000 population, (95% CI: -564 to -216), without an associated change in physiotherapy consultations. Subgroup analyses suggested there was an associated reduction in physiotherapy consultations for those in the lowest education group of 150 consultations per quarter (95% CI:-203 to -97), 70 consultations per quarter in the intermediate education group (95% CI:-115 to -27) and a stepped reduction of 2 spinal surgical procedures per 10 000 population, for those aged between 40 and 60 years (95% CI: -3 to -1) following the introduction of the direct access physiotherapy model.
Conclusion: The national introduction of a direct access to physiotherapy model of care was associated with a reduction in the workload of GPs for the management of MSK conditions. The use of physiotherapists in direct contact roles is a potential strategic model to reduce the burden on the GP workforce in primary care worldwide.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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فهرسة مساهمة: Keywords: Health Policy; Health Services; Primary Health Care
تواريخ الأحداث: Date Created: 20240924 Date Completed: 20240924 Latest Revision: 20240927
رمز التحديث: 20240927
مُعرف محوري في PubMed: PMC11423733
DOI: 10.1136/fmch-2024-002998
PMID: 39317459
قاعدة البيانات: MEDLINE
الوصف
تدمد:2009-8774
DOI:10.1136/fmch-2024-002998