INTRODUCTION OF ADVANCED PRACTICE PHYSIOTHERAPY IN DUTCH PRIMARY CARE: A QUALITATIVE STUDY AMONG ADVANCED PRACTICE PHYSIOTHERAPIST AND GENERAL PRACTITIONERS

S. Pellekooren¹, M. Donker², E. Reijnders³, L. Boutalab², R. Ostelo², M.v.T. van Tulder¹, A. Pool-Goudzwaard¹

¹Vrije Universiteit Amsterdam, Department of Human Movement Sciences, Faculty of Behavioral & Movement Sciences, Amsterdam, Netherlands, ²Vrije Universiteit Amsterdam, Department of Health Sciences, Faculty of Science, Amsterdam, Netherlands, ³Amsterdam UMC, Location VUmc, Huisartsopleiding VUmc, Amsterdam, Netherlands

Background: Despite the increased deployment andadded value of Advanced Practitioner Physiotherapy (APP) in musculoskeletal care internationally, APP is not yet widely accepted within Dutch primary care. This may be due to specific constraints in the implementation of APP within the Dutch healthcare system.

Purpose: This study aimed to explore the experiences and perceptions of Advanced Practitioner Physiotherapists (APPs) and General Practitioners (GPs) with respect to implementing APP within Dutch primary care.

Methods: This explorative and interpretive qualitative study included 13 APPs and 3 GPs who were in various stages of implementing an APP care model. Semi-structured interviewswere conducted between January and March 2021. The topic list was based on existing literature, the personal input of researchers, and the Constellation Approach framework. Data were analysed using a thematic inductive approach.

Results: Four main themes emerged from the data; 1) Both GPs’ trust in APP and a clear added value of APP are critical for starting implementation, 2) APPs need continuous support from GPs, 3) APPs believe that their position needs strengthening, and 4) Implementation of the APP model creates tension over ownership. These four themes highlight the perceived difficulties in gaining trust, lack of clarity over the added value of APP, ambiguity over APPs’ professionalprofile and positioning, a need on behalf of GPs to maintain authority, lackof reimbursement structure, and the struggle APPs face to strike a balance with current care.

Conclusions: This study demonstrates that implementing an APP model of care is challenging, in part, because the deployment of APP does not sufficiently align with the core values of GPs, while GPs appear reluctant to hand overcontrol of elements of patient care to APPs. APPs do not appear to have ownership over the implementation, given their strong dependence on the practice, values and needs of GPs.

Implications: Many steps still need to be taken to successfully implement an APP model of care, in terms of structural, practical, and cultural aspects.

Funding acknowledgements: The authors received financial support for the research, authorship, and publication from the Dutch Association for Manual Therapy

Keywords:
Advanced Practice Physiotherapy
Extended Scope Practitioners
Primary health care

Topics:
Professional issues
Primary health care
Musculoskeletal

Did this work require ethics approval? Yes

Institution: VU University Medical Centre

Committee: Medical Ethics Committee of VU University Medical Centre in Amsterdam

Ethics number: 2020.17