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Nast I1, Scheermesser M1, Bruderer-Hofstetter M1, Allet L2, Heinzmann C1, Horvath C1, Gafner S3, Keller M1, Müller U1, Saner-Bissig J1, Tschupp K1, Wirz M1, Schämann A1
1Zurich University of Applied Sciences (ZHAW), School of Health Professions, Institute of Physiotherapy, Winterthur, Switzerland, 2Geneva University Hospitals and University of Geneva, Department of Community Medicine, Geneva, Switzerland, 3HES-SO University of Applied Sciences and Arts of Western Switzerland, Physiotherapy, Geneva, Switzerland
Background: In Switzerland, demographic change, rising health care expenditures and an anticipated shortage of physicians require successful adaptation of health care provision. Advanced Practice in Physiotherapy (APP) models may improve access to cost-efficient care, add to professional career perspectives, and potentially increase job retention of physiotherapists. Within a nation-wide initiative, the “Competence Network Health Workforce”, a sub-project aims to develop APP-models for Switzerland, from 2017 to 2020, involving all relevant key stakeholders from Swiss health care.
Purpose: In a first step, the project answered the following research questions: How is APP defined internationally, what roles and tasks are described to define APP? Which experiences with APP have been reported? What barriers and facilitators were identified for the implementation of APP models?
Methods: A systematic literature search was performed on Web of Science and PubMed for the period between January 1996 and December 2017. We also screened the reference lists of identified literature for articles of interest. Articles were considered as relevant if they focus on definitions of and experiences with APP, on APP job profiles, roles and tasks and/or APP implementation.
Results: The search strategy identified 45 references on APP. Most publications origin from Canada (27 %), Australia (24 %) and UK (24 %). Only a few publications origin from more than one country (reviews, 11 %), the USA (7 %), Austria (2 %), Ireland (2 %), and Sweden (2 %). These studies point out that Advanced Practice in physiotherapy and other health professions have been pioneered in the UK, Canada, USA and Australia. APPs are defined as skilled and experienced physiotherapists, who have developed skills relevant to their area of work. However, there is still no broad agreement on the definition of APP roles, and different terms for APP are in use, e.g. 'extended scope of practice' and 'advanced scope of practice'. In some countries, Advanced Practice Physiotherapists may provide direct access to physiotherapy. They work in emergency outpatient clinics, post-operative treatment, triage and pain management, support and management of geriatric and musculoskeletal patients. Their tasks are invasive and non-invasive assessments and interventions, diagnosis, patient referral, medical prescription, initiation of laboratory and radiological tests. The studies suggest a cost-effective and patient-friendly healthcare that could lead to improvements in patient outcomes. Barriers for APP implementation are e.g. legal constraints, and lack of a) formalisation of APP roles, b) knowledge of other health professions on APP competences, and c) educational programs for APP qualification. Facilitators are i.e. the need to improve access to an efficient care and multidisciplinary health care teams.
Conclusion(s): The results from this literature search provide a comprehensive overview on the concept of APP, and serve as a basis for the development of questionnaires and interview guidelines used in the following project phases.
Implications: The results may enhance the development and critical evaluation of future APP roles in Switzerland.
Keywords: Advanced Practice, Physiotherapy, Literature Overview
Funding acknowledgements: This project is a cooperation between the Swiss Universities in Health. Funded by physioswiss & the Foundation for Physiotherapy Science.
Purpose: In a first step, the project answered the following research questions: How is APP defined internationally, what roles and tasks are described to define APP? Which experiences with APP have been reported? What barriers and facilitators were identified for the implementation of APP models?
Methods: A systematic literature search was performed on Web of Science and PubMed for the period between January 1996 and December 2017. We also screened the reference lists of identified literature for articles of interest. Articles were considered as relevant if they focus on definitions of and experiences with APP, on APP job profiles, roles and tasks and/or APP implementation.
Results: The search strategy identified 45 references on APP. Most publications origin from Canada (27 %), Australia (24 %) and UK (24 %). Only a few publications origin from more than one country (reviews, 11 %), the USA (7 %), Austria (2 %), Ireland (2 %), and Sweden (2 %). These studies point out that Advanced Practice in physiotherapy and other health professions have been pioneered in the UK, Canada, USA and Australia. APPs are defined as skilled and experienced physiotherapists, who have developed skills relevant to their area of work. However, there is still no broad agreement on the definition of APP roles, and different terms for APP are in use, e.g. 'extended scope of practice' and 'advanced scope of practice'. In some countries, Advanced Practice Physiotherapists may provide direct access to physiotherapy. They work in emergency outpatient clinics, post-operative treatment, triage and pain management, support and management of geriatric and musculoskeletal patients. Their tasks are invasive and non-invasive assessments and interventions, diagnosis, patient referral, medical prescription, initiation of laboratory and radiological tests. The studies suggest a cost-effective and patient-friendly healthcare that could lead to improvements in patient outcomes. Barriers for APP implementation are e.g. legal constraints, and lack of a) formalisation of APP roles, b) knowledge of other health professions on APP competences, and c) educational programs for APP qualification. Facilitators are i.e. the need to improve access to an efficient care and multidisciplinary health care teams.
Conclusion(s): The results from this literature search provide a comprehensive overview on the concept of APP, and serve as a basis for the development of questionnaires and interview guidelines used in the following project phases.
Implications: The results may enhance the development and critical evaluation of future APP roles in Switzerland.
Keywords: Advanced Practice, Physiotherapy, Literature Overview
Funding acknowledgements: This project is a cooperation between the Swiss Universities in Health. Funded by physioswiss & the Foundation for Physiotherapy Science.
Topic: Professional issues; Professional practice: other; Education: continuing professional development
Ethics approval required: No
Institution: Zurich University of Applied Sciences (ZHAW)
Ethics committee: Ethics Committee Zurich
Reason not required: The project does not fall within the scope of the Human Research Act. Therefore, an authorization from an ethics committee is not required, as stated by the Ethics Committee Zurich in a Clarification of responsibility (swissethics.ch 2018-00667)
All authors, affiliations and abstracts have been published as submitted.
