Canberra Health Services and the University of Canberra researchers collaborated to facilitate and evaluate the implementation of advanced practice physiotherapist (APP) services into an orthopaedic clinic to improve the standard of care pathway for patients with knee osteoarthritis in the ACT.
Data were retrospectively collected pre-implementation (T1: March to September 2022) and post (T2: March to September of 2023), manually for T1 and prospectively via the digital health record (DHR) for T2. Changes implemented during T2 included APP being resourced to review all patients with KOA, the implementation of the DHR, community services increasing access to education and exercise classes (GLA:D). Data included: the number of patients, their demographic details, ‘wait 1’ management status by APP alone or by surgeon, and surgeon clinical decisions.
(Ethics approval ACTH # LRE.00185).
271 and 208 patients were included at T1 and T2, respectively. 59% and 65% were female, with a mean (SD) age of 62 (11.8) and 65 (10.5) respectively. 32% and 12% cancelled their appointment in 2022, and 2023, leaving 184 in each reporting period. 9% and 7% of the remaining cohort were not seen during either reporting period. Fewer patients were seen by a surgeon during T2 (56%) than T1 (77%) (p0.0001). The wait time to see a surgeon reduced from 438 (486) to 69 (38) days, mean change (SE) -369 (35.9) days (p0.0001). In 2023, 37% of patients were managed by APP (2022 data not available). The mean (SD) wait time to be seen by an APP was 47 (25) days.
In 2023 surgeons discharged fewer patients than 2022, 10% vs 27% (p=0.001); placed a similar proportion on the surgical waiting list (wait 2) 64% vs 55% (p=0.08); and planned to review a similar proportion 26% vs 18% (p=0.06) of patients.
Implementing APP services can facilitate patients to be seen by highly qualified clinicians within 8 weeks of referral, reducing ‘wait 1’; direct a significant proportion away from surgical services into non-surgical management when surgical consult is not yet required; and allow surgeons to see a higher proportion of patients that need surgical opinions.
Public clinical services should consider upskilling and providing appropriate resources to physiotherapists to work at the top of their scope of practice as APPs, allowing surgeons to focus on surgery and reducing wait times to receive expert advice and appropriate care. A public health campaign to highlight non-surgical management of KOA should be considered.
Advanced practice
wait times
