DETERMINANTS OF ADHERENCE WITH PHYSIOTHERAPY PROTOCOLS: DOES DISTANCE MATTER?

Nitzan T.¹, Valinsky L.², Hershkowitz F.³, Wolf Y.³

¹Meuhedet Health Care, Physiotherapy, Tel Aviv, Israel, ²Meuhedet Health Care, Clinical Quality, Tel Aviv, Israel, ³Meuhedet Health Care, Medical Division, Tel Aviv, Israel

Background: Physiotherapy treatment has been demonstrated to significantly improve outcomes after catastrophic events, and improve function and quality of life. Treatment is provided in a series of frontal therapy sessions, combined with recommendations for complementary home exercises.
Adherence to treatment protocols is known to vary significantly between patients, and is associated with patient outcomes. Studies that examined patient variables associated with reduced adherence to treatment focus on patient personality and psychological traits, but no studies were found that examine access to care and adherence.
Physiotherapy services within Meuhedet are delivered in 53 clinics employing over 200 physiotherapists, generating 330,000 visits per year throughout the country.
The large number of visits, combined with computerised medical records and advanced technological tools, such as a geographic information system, allow us to explore tha data in order to improve the quality of physiotherapy care.

Purpose: To investigate whether access to treatment, as expressed by distance, is associated with adherence in the physiotherapy clinics in Meuhedet.

Methods: We extracted all adult physiotherapy referrals (282,000) to Meuhedet clinics for the years 2013-2015. Data included patient age, gender, socioeconomic status and population sector (Arab, Jewish ultra-orthodox and Jewish secular). Using a Geographic Information System (GIS) we calculated the distance between the patient’s home address and the closest physiotherapy clinic. We then examined the association between referrals, attendance and completion of a treatment series and all other variables. Attendance was defined as patients who were referred to physiotherapy and arrived at least once. Completion was defined as attending all sessions planned for the patient.

Results: · Only 51.8% of referred patients attended a first appointment. Of these 43.3% completed the treatment series. · There was no difference in attendance between genders, but women were more likely to complete treatment (p 0.005) · There was a positive association in both attendance and completion with Socio-economic status (SES) and age(p 0.005) · There were significant differences between population groups (p 0.005). Ethnic minority groups were less likely complete treatment series. · Distance was significantly associated with both attendance and completion

Conclusion(s): · Distance from the clinic is a determinant of adherence, after adjusting for age, gender, SES, sector and district · Only half the patients referred to physiotherapy arrive at the first appointment · Less than half the patients complete treatment series as recommended

Implications: · Distance from the physiotherapy clinic is a determinant of adherence and needs to be considered when planning services. · The low proportion of patients attending the first visit needs to be further examined, as it indicates a lack of effective communication between the referring physician and the patient. · Efforts need to be made to increase adherence among patients who initiate treatment, particularly among ethnic minorities and populations at risk.

Funding acknowledgements: No external funding was received for this study

Topic: Professional practice: other

Ethics approval: This study was approved by Meuhedet Research Committee and was given an exemption by the IRB.

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