EXPLORATION OF DRIVERS AND BARRIERS TO ADVANCED PHYSIOTHERAPY PRACTITIONER ROLES IN NEW ZEALAND

L. Naik¹, D. Reid¹, S. White¹, S. Neville¹

¹Auckland University of Technology, School of Clinical Science, Auckland, New Zealand

Background: The current model of musculoskeletal care in New Zealand (NZ) is a complex web creating long waiting lists for a specialist opinion. Musculoskeletal complaints affect one in four New Zealanders, accounting for 25% of its total annual health spending. Internationally, Advanced Physiotherapy Practitioner (APP) roles have demonstrated the ability to impact orthopaedic waiting lists and improve timely patient access to specialist care and services. In 2011, Health Workforce New Zealand recommended up-skilling physiotherapists into APP roles to work in collaboration with multidisciplinary teams to deliver future musculoskeletal healthcare. Nevertheless, these roles have not gained traction in NZ.

Purpose: This study investigated the drivers and barriers to APP role development in the NZ context.

Methods: An exploratory single embedded case study design was used. Document analysis, qualitative survey data analysis, and semi-structured interviews were utilised as data sources. A purposive sampling strategy was used. Data were analysed using qualitative content analysis and triangulated to ensure rigour.

Results: This research identified unique NZ specific drivers related to legislative and surgeon-led drivers. Other drivers relate to fiscal constraints, lack of access to care, and profession-led drivers. Interviewees identified that key APP role development barriers relate to NZ’s unique dual healthcare system with split funding streams between the Ministry of Health and Accident Compensation Corporation. Additional barriers include a lack of recognition, lack of training, lack of career pathways, and inter-professional barriers. A rare driver was intra-professional barrier.

Conclusions: Currently, the Advanced Physiotherapy Practitioner roles in New Zealand are ad-hoc and opportunistic, dependent on the reactive needs of the organisation. There is an identified niche for the Advanced Physiotherapy Practitioner role to improve patient outcomes, improve patient flow and add value to the clinical and operational demands of health care. This research has explored the reasons for the limited uptake of these roles in the New Zealand context despite these strong drivers. These findings need to be considered by the stakeholders when considering the implementation of Advanced Physiotherapy Practitioner roles in the New Zealand context.

Implications: The development of the APP role has implications for patients, practice, profession, universities, and legislative body. A change in practice and delivery of a new model of care with APP as a first-contact practitioner working in collaboration with the orthopaedic surgeon is recommended. Advocacy of the APP role by the professional body is advised to improve its recognition. Further research is recommended to be carried out into existing APP delivery models in NZ in varied specialities, clinical and cost-effectiveness, and their education needs. Development of tailored post-graduate courses is recommended. Finally, to overcome the intra-professional barrier, cohesion of the physiotherapy profession is recommended to implement APP roles across sectors. To ensure its promising future, APP roles must be tailored to meet NZ’s unique healthcare drivers and reduce the barriers.

Funding acknowledgements: Unfunded

Keywords:
Advanced Physiotherapy Practitioners
Qualitative study
New Zealand

Topics:
Service delivery/emerging roles
Musculoskeletal
Professional practice: other

Did this work require ethics approval? Yes

Institution: The Auckland University of Technology

Committee: The Auckland University of Technology Ethics Committee

Ethics number: 19/141