This project assesses the evolution of CDT in Estonia over the past 10 years, with a particular focus on the role of physiotherapists. It also highlights service gaps, including specialist shortages and geographic disparities, proposing strategies to improve accessibility and care quality.
This retrospective study analyzes CDT data from NEMC and the Estonian Health Insurance Fund from 2014 to 2023. Quantitative data on patient numbers, therapy sessions, and service distribution were collected. International training standards were compared with local practices, and challenges such as workforce shortages and service disparities were identified.
From 2014 to 2023, CDT patients in Estonia increased from 75 to over 1000 annually, with therapy sessions rising from 572 to 8533. NEMC emerged as the largest provider, delivering over 16,000 sessions and treating 1052 patients. While the number of providers grew from 4 in 2014 to 14 in 2022, specialist shortages and long wait times remain. Of the 25 trained CDT specialists at NEMC, only 16 remain in practice, with 10 actively performing lymphedema therapy; others are unavailable due to different reasons.
CDT development at NEMC has been supported by a holistic approach. At NEMC, patsients who received CDT also received physiotherapy and occupational therapy, including a focus on self-management education. In 2023, NEMC expanded services to include scar therapy, broadening the scope of care and addressing diverse patient needs.
Since 2002, physiotherapists in Estonia have been able to receive specialized training in lymphedema therapy, with the first certification exam held in 2015. Despite the availability of training, only 20 specialists hold valid certification, while more therapists practice in the field. Workforce fluctuations and the physical demands of CDT impact service sustainability, highlighting the need for support and retention strategies.
While CDT is integrated into Estonia’s healthcare system, service provision remains below international standards due to workforce limitations. Increasing the number of trained physiotherapists and addressing geographic disparities are essential to improving care quality. Implementing mandatory certification for lymphedema therapists is crucial to ensuring consistent service quality.
Policy adjustments, such as mandatory certification and a more systematic approach to training, following best practices from other countries, could standardize care and improve quality. Further research and innovations, like scar therapy, will help meet patient needs and enhance service delivery.
Lymphedema management
Healthcare service development
