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E.J. Gorgon1,2, C. Cayco2, A. Labro2, A.-N. Bandong2, A.C. Domingo2, A. Leaver1
1The University of Sydney, Faculty of Medicine and Health, Sydney, Australia, 2University of the Philippines Manila, Department of Physical Therapy, Manila, Philippines
Background: In the Philippines, most healthcare expenditures are financed out-of-pocket and this has negative ramifications for the majority who belong to low-income groups, particularly those with chronic health conditions. A student-led physiotherapy service was developed at the University of the Philippines Manila to meet the rehabilitation needs of children with developmental disabilities from low socioeconomic backgrounds. It is the two-pronged goal of the service to deliver high-quality patient care whilst also providing high-value educational opportunities to students in the field of paediatric physiotherapy.
Purpose: This study aimed to examine physiotherapy processes of care to understand how these processes might support or hinder best practice in the student-led clinic. It forms part of a needs assessment to identify areas where best practice elements could be integrated to help achieve the therapy centre’s service delivery and student training goals.
Methods: This study involved retrospective review of clinical records of children receiving physiotherapy care at the clinic from 2011-2015 (n=237). Data extracted included demographic characteristics, clinical diagnoses, parameters of the episode of care, therapy goals, interventions, and outcome measures. Trained researchers extracted and coded the data using a systematic procedure and standardized electronic form. Inconsistencies were referred to a third researcher and resolved by consensus. Data were analysed descriptively.
Results: The majority of the children were referred from the public hospital system (n=171, 72%) and had developmental conditions (n=229, 97%). The most frequent clinical diagnoses were Down syndrome (n=74, 31%), cerebral palsy (n=64, 27%), and hydrocephalus (n=57, 24%). The duration of the episode of care was highly variable with a range of 1-139 months (median=16). Almost all the children (n=230, 97%) commenced with weekly therapy sessions, but the total number of sessions varied from 1-150 (median=15). There was evidence of routine reporting of therapy goals (n=236, 99%). Activity- and exercise-based interventions were almost universally employed (n=236, 99%) and self-management plans appeared in majority of the records (n=161, 68%). Objective measures were routinely recorded at baseline (n=209, 88%), but not at follow-up (n=136, 57%). There was no consistent time point for outcome assessment, with re-assessment occurring from less than a month to 36 months after initial assessment.
Conclusion(s): Some elements of physiotherapy care at the student-led clinic were consistent with best practice. However, there were aspects of service delivery that could be better structured and formalised, and where caregiver involvement in decision making could be better integrated. These results will contribute in the ‘idea generation’ for a translational research program that seeks to promote better longitudinal care for children with developmental disabilities in the Philippines.
Implications: This retrospective review of routinely-collected healthcare data highlights the need for a more defined approach to longitudinal management for children with developmental disabilities. Particularly, there is a need to monitor how therapy goals are achieved at predetermined times and using validated measures consistently. Developing patient-centred and evidence-based care pathways with formalised aspects of management planning and shared decision making can be an important focus of service redesign. This will require collaborative input from the different stakeholders at strategic points in the redesign process.
Funding, acknowledgements: This study was funded by a University of the Philippines Professorial Chair awarded to Edward Gorgon.
Keywords: Health service delivery, Knowledge translation, Evidence-based practice
Topic: Paediatrics
Did this work require ethics approval? Yes
Institution: University of the Philippines Manila
Committee: Research Ethics Board
Ethics number: UPMREB 2014-503-01
All authors, affiliations and abstracts have been published as submitted.
