Adeosun C1,2, Nwodo C2,3
1Ministry of Defence, Abuja, Nigeria, 2Military Hospital, Port Harcourt, Nigeria, 3University of Benin Teaching Hospital, Benin, Nigeria

Background: Rehabilitation care coordination across multiple settings, medical rehabilitation professionals (MRPs) and patient groups with diverse rehabilitation needs is one of the key elements of providing quality patient-centred care. The need to provide access to patients in need of rehabilitation care is now high among persons with disability coupled with the increasing ageing population around the world. Efforts are ongoing in developed countries to achieve care coordination and integration. However, available evidence indicates a lack of coordination, low proportion of MRPs and high cost of care in many developing countries.

Purpose: As part of a larger study on rehabilitation care coordination, this study explores rehabilitation professionals' awareness of other MRPs, facilitating factors and barriers to patients' referral among MRPs in Nigeria.

Methods: Using a descriptive research methodology, a survey was distributed to MRPs at their annual national conferences in September and October 2017. A convenience method of distribution was utilised. Data were collected on demographics and awareness of other MRPs. The qualitative data were collected using structured self-reported questions on perceived facilitators and barriers to patients' referrals among MRPs. Out of 250 surveys distributed, a total of 149 surveys were returned and deemed fit for analysis. A thematic framework analysis and descriptive statistical analysis were applied to the data. Participant codes were assigned to each survey. Using a thematic framework analytical method, the researchers identified codes, themes or categories that were integrated into higher themes that helped the overall research questions. The coding process was done manually and recorded in Microsoft Excel. The framework was flexible, codes and themes were reassessed as new codes or themes emerged.

Results: The descriptive analysis revealed that all the participants (N=149; F=57%, M=43%) are aware of the role of other MRPs in rehabilitation care. Following the initial analysis, ten facilitating and nine hindering factors emerged respectively. These were integrated into higher themes. The major facilitators of patients' referral were: patient's condition, availability of the required MRPs, practice setting, health system structure and patient's compliance to referral. Lack of access, physiotherapy professional dominance, cost of care, quackery, and non-availability of MRPs like speech and occupational therapists were the major barriers.

Conclusion(s): The study suggests the need for government intervention in the deployment of relevant MRPs to health care facilities to meet patient needs. It reveals the need for adequate MRPs database to provide interprofessional access. Future work on relational coordination and communication among MRPs in Nigeria is advocated.

For policy makers: The Federal Ministry of Health should demonstrate leadership in policy development and implementation to encourage the integration of rehabilitation care into all levels of care within the health system.
For educational institutions and regulatory bodies: Efforts should be geared towards improving patient access to rehabilitation care through training of MRPs. The need to create a conducive environment for practice for all MRPs is emphasised.
For practitioners: Provision of qualitative physiotherapy and rehabilitation care through the engagement of other MRPs when necessary is encouraged.

Keywords: Care coordination, Rehabilitation professionals, Qualitative study

Funding acknowledgements: None.

Topic: Service delivery/emerging roles; Professional practice: other

Ethics approval required: No
Institution: The two conference organisers approved the survey distribution.
Ethics committee: None
Reason not required: This was a survey research study with no experiment or internvention intended at any stage. However, participants consent was obtained.

All authors, affiliations and abstracts have been published as submitted.

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