Quality of physiotherapist led orthopaedic triage compared with standard practice in primary care

Physiotherapist-led orthopaedic triage, where physiotherapists diagnose and determine management plans, aims to enhance effectiveness and provide the best care. However, scientific evidence for the effectiveness of this model of care remains limited, and there are few studies reporting on patients’ perceptions of the care provided.

Karin S. Samsson, Susanne Bernhardsson and Maria E. H. Larsson, BioMed Central 10 June 2016

Considering the increasing demand on health care to provide accurate and timely diagnosis and care for patients with musculoskeletal complaints, alternative models of care, such as physiotherapist-led orthopaedic triage, have been explored predominantly in the UK, Australia and Canada. The aims of triage have been suggested to be to reduce long waiting times and to enhance effectiveness and best care/practice, i.e. timely access to the right care from the appropriately qualified health care professionals who can direct patients towards the optimal treatment pathway.

Physiotherapists have been used to triage, diagnose, and determine management plans, and to refer for investigations, orthopaedic surgery or conservative management. Studies of this model of care, in various outpatient settings, have reported high agreement on diagnosis and treatment approach between physiotherapists and orthopaedic surgeons. Several studies have shown that physiotherapist-led orthopaedic triage also decreases referrals for orthopaedic consultation. Also, emerging evidence suggests that such a model of care can improve access to care with equal or better outcomes compared to standard practice (i.e. orthopaedic surgeon consultation) regarding waiting times, treatment effectiveness, use of healthcare resources, economic costs, both patient and provider satisfaction, and patient outcomes such as pain and functional disability.

We have previously reported primary outcomes from a randomised controlled trial investigating physiotherapist-led orthopaedic triage in a Swedish primary healthcare setting. The study showed significantly better selection accuracy and shorter waiting times with physiotherapist-led triage than with standard practice. Furthermore, the study showed no differences between physiotherapy-led triage and standard practice regarding the secondary outcome long-term follow-up of patient-reported outcome measures. In this paper, we report on the secondary outcome patients’ perceived quality of care with this model of care.

Several studies have reported that patients are either equally or even more satisfied with physiotherapist-led triage than with standard practice. Still, scientific evidence for the effectiveness of this model of care remains limited and there is a scarcity of high-quality studies. Few of the studies report on health outcomes using standardised outcome measures. Additionally, considering differences among national healthcare systems, studies of such a model need to be conducted in each respective country.

Good care should be patient-centred, which is characterised by respectful and individualised care. One of the core components of patient-centred care is participation in clinical decision-making, which empowers patients to actively engage in their care. Therefore, patients’ perceptions of the quality of their health care are of increasing interest for healthcare policy makers. Additionally, evaluating the patients’ perceptions is essential to any new role involving a shift in traditional practice boundaries.

Wilde et. al. have presented a model that stipulates that patients’ perceptions of what constitutes quality of care are formed by their encounters with an existing care structure, and by their norms, expectations, and experience. Based on this model, the questionnaire Quality from the Patient’s Perspective (QPP) was developed.

Considering that in many countries it is still standard practice for patients to be assessed by orthopaedic surgeons when referred for orthopaedic consultation, we were interested in exploring patients’ perceptions of the quality of care of a physiotherapist-led triage. Even though previously reported results indicate that physiotherapist-led orthopaedic triage could provide appropriate care for the patients, patients’ perceptions of this model need to be investigated before large scale implementation. Therefore, the purpose of this paper was to evaluate patients’ perceived quality of care in a physiotherapist-led orthopaedic triage in primary care compared with standard practice. Furthermore, we wanted to evaluate outcome-related aspects: whether patients’ expectations were met, and patients’ intention to follow advice and instructions.

Source BioMed Central

art3A10.11862Fs12891-016-1112-x
Perceived quality of physiotherapist-led orthopaedic triage compared with standard practice in primary care: a randomised controlled trial, Karin S. Samsson, Susanne Bernhardsson and Maria E. H. Larsson. BMC Musculoskeletal Disorders, BMC series – open, inclusive and trusted201617:257 DOI: 10.1186/s12891-016-1112-x