DIRECT ACCESS TO PHYSIOTHERAPY – EVALUATING THE IMPLEMENTATION OF NEW REGIONAL MODEL BETWEEN PRIMARY AND SPECIAL HEALTH CARE

E.P. Pelttari¹, S.T. Palamaa¹, M.M. Roine¹

Background: In 2017–2018 Physiotherapists working in primary health care units and special health care in the Hyvinkää Hospital Area completed an education program required for working in direct access practice. The education program was carried out following the national recommendations. A regional model was developed to guide the new policy of referral to treatment for patients with musculoskeletal disord​ers. Direct access was defined as the first visit to physiotherapist without doctor’s referral in case of an acute musculoskeletal symptom. In March 2018, the two health care organizations operating in the area implemented direct access practice in most of their health care units providing physiotherapy services.

Purpose: The purpose of this developmental work was to evaluate the regional direct access model and its effects during 2019. The aim was to observe and assess the process by using available statistics, provide information for management and decision-making and to make a statement of usable measures and indicators for the evaluation of effectiveness and performance. This is the first attempt trying to make the effectiveness of the new direct access model visible in the area.

Methods: The direct access practice in the area was compared with two other Finnish organizations by benchmarking. The supervisors working in rehabilitation units and application specialists provided available statistics. National statistics available online with open access were also used. Qualitative information was collected by interviews and surveys targeting interest groups such as physiotherapists, doctors, nurses and supervisors. Earlier research, developmental work reports and national guidelines were used to gain a deeper understanding of the subject. In November 2019, physiotherapists working in the area collected information on client satisfaction and complementary data regarding the direct access process.

Results: In 2019 altogether 22 physiotherapists were working part time in direct access practice which resulted in 1660 visits documented in the Hyvinkää Hospital Area of 200 000 inhabitants. Utilization rate was 59,9%. A long term goal of 4200 initial visits in direct access could be suggested in the area which could potentially result in savings of over 400 000 euros per year. The FFT score (Friends and Family Test) was 99% indicating high level of client satisfaction (N=106, response rate 63%). Differences in the practices of management and evaluation of the process were identified.

Conclusion(s): The findings indicate that the model and its benefits haven’t yet reached their full potential in the area. The resources should be managed more effectively and structured methods of management and systematic follow-up could be enhanced regionally as well as collaboration between professionals. The competence to assess cost effectiveness is lacking in physiotherapy units. To verify the actual impact on costs or productivity in the area requires further research. Decision-making and management are needed to address the areas of interest in future performance evaluation and the assessment of effectiveness.

Implications: The methods used could be utilized in Finnish health care organizations to assess the direct access practices. Organizations considering the implementation of direct access practice could benefit from Hyvinkää Hospital Area’s experiences in planning a regional model.

Funding, acknowledgements: The development project was funded by Hospital District of Helsinki and Uusimaa.

Keywords: Direct access, Musculoskeletal disorders, Management

Topic: Musculoskeletal

Did this work require ethics approval? No

Institution: N/A

Committee: N/A

Reason: Statistics used are gathered for process evaluation as a normal practice and don't contain any personal data.