File
T. Orozco1, A. Hudon1, S. Bernatsky2, F. Desmeules1, J. Légaré3, K. Perreault4, A.K. Tawiah5, L. Woodhouse6, M. Zummer7, D.E. Feldman1
1Université de Montréal, École de Réadaptation, Montreal, Canada, 2McGill University, Department of Medicine, Montreal, Canada, 3Retired, Quebec, Canada, 4Université Laval, Département de Réadaptation, Quebec, Canada, 5University of Alberta, Faculty of Rehabilitation Medicine, Edmonton, Canada, 6University of Alberta, Department of Physical Therapy, Edmonton, Canada, 7Université de Montréal, Faculté de Médecine, Montreal, Canada
Background: Early referral to rheumatology of persons with suspected inflammatory arthritic conditions is associated with better outcomes. Typically, patients are first seen by a family physician who would assess the need for referral to a rheumatologist. However, many people who do not have a regular family physician may consult a physiotherapist where no physician referral is required. Enabling direct referral from a physiotherapist to a rheumatologist could enhance early access to a rheumatologist; recent evidence indicates that physiotherapists can appropriately identify patients with inflammatory arthritis.
Purpose: Our objective was to explore perceptions of professionals and patients regarding enabling physiotherapists to refer patients with inflammatory arthritis directly to rheumatologists.
Methods: We conducted 5 focus groups with a total of 29 participants. There were 4 groups with:
1) 5 rheumatologists,
2) 7 family physicians,
3) 6 physiotherapists and
4) 6 patients.
The fifth group included 3 physiotherapists and 2 patients. We used purposive and snowball sampling to recruit participants. All 8 patients with inflammatory arthritis were recruited via the Arthritis Society of Canada. The meetings were audio-taped and transcripts were analyzed using a thematic analysis approach.
1) 5 rheumatologists,
2) 7 family physicians,
3) 6 physiotherapists and
4) 6 patients.
The fifth group included 3 physiotherapists and 2 patients. We used purposive and snowball sampling to recruit participants. All 8 patients with inflammatory arthritis were recruited via the Arthritis Society of Canada. The meetings were audio-taped and transcripts were analyzed using a thematic analysis approach.
Results: The focus groups lasted an average of 60 minutes (ranging from 48 to 91 minutes). Two common core themes were identified from all the focus groups:
1) difficulties accessing care, and
2) interprofessional relationships (or lack thereof).
The first theme included aspects such as waiting times to consult rheumatologists and physiotherapists in the public sector, as well as financial barriers related to consulting physiotherapists in the private sector. The second theme included perceptions of physiotherapists’ roles and abilities, appropriateness of referrals, multidisciplinary vs. solo practitioners, communication pathways and traditionalist vs. contemporary style of practice by family physicians. Besides these two main themes, several groups discussed other issues. The health care groups (rheumatologists, family physicians and physiotherapists) talked about the lack of awareness of the new agreement that physiotherapists can directly refer to rheumatologists. In the physician groups (rheumatologist and family physician focus groups), two other issues were discussed: professional responsibilities (e.g. scope of practice, gatekeeping and coordination of care) and the consult fee for rheumatologists. In the physiotherapist focus group, self-confidence in identifying inflammatory vs. non-inflammatory conditions was also raised.
1) difficulties accessing care, and
2) interprofessional relationships (or lack thereof).
The first theme included aspects such as waiting times to consult rheumatologists and physiotherapists in the public sector, as well as financial barriers related to consulting physiotherapists in the private sector. The second theme included perceptions of physiotherapists’ roles and abilities, appropriateness of referrals, multidisciplinary vs. solo practitioners, communication pathways and traditionalist vs. contemporary style of practice by family physicians. Besides these two main themes, several groups discussed other issues. The health care groups (rheumatologists, family physicians and physiotherapists) talked about the lack of awareness of the new agreement that physiotherapists can directly refer to rheumatologists. In the physician groups (rheumatologist and family physician focus groups), two other issues were discussed: professional responsibilities (e.g. scope of practice, gatekeeping and coordination of care) and the consult fee for rheumatologists. In the physiotherapist focus group, self-confidence in identifying inflammatory vs. non-inflammatory conditions was also raised.
Conclusion(s): Regarding difficulties accessing care, waiting time to see a rheumatologist remains the biggest barrier for patients with new-onset inflammatory arthritis followed by the lack of access to physiotherapists and family physicians.
Implications: Further developing the relationship among the health professionals involved in the shared care of these patients could optimize patient care. This could be done through education about everyone’s role, building new and efficient communication pathways and creating opportunities for interprofessional connections. In addition, professional regulatory bodies should increase awareness about the new agreement regarding direct referral by physiotherapists to rheumatologists.
Funding, acknowledgements: We received funding from the Canadian Initiative for Outcomes in Rheumatology Care (CIORA).
Keywords: Advanced practice, Rheumatology, Physiotherapy
Topic: Professional practice: other
Did this work require ethics approval? Yes
Institution: Université de Montréal
Committee: Comité d'Éthique de la Recherche en Santé (CERES)
Ethics number: 17-137-CERES-D
All authors, affiliations and abstracts have been published as submitted.
