This study aimed to explore patients’ preferences and estimate specific trade-offs patients are willing to make in treatment choices when they are treated by physiotherapists and physiotherapy support workers in musculoskeletal outpatient physiotherapy services.
A discrete choice experiment was conducted using an online questionnaire. Participants were adult patients with musculoskeletal conditions who were recruited from a physiotherapy service (from one NHS (National Health Service) Trust, in the United Kingdom) over a four-month-period. Respondents completed eight choice tasks describing different physiotherapy services. Choice data analyses were conducted using a multinomial logit model. Results were used to estimate the trade-offs of service features in terms of additional waiting time and travel distance to clinic. A statistical model was built to estimate the probability of choosing between two distinct physiotherapy service options under different scenarios.
382 patient questionnaires were completed; 302 participants were treated by physiotherapists and 80 by physiotherapists and support workers. On average, patients preferred being seen by a physiotherapist, have more follow-up treatments, to wait less time for the first follow-up appointment, to be seen one-to-one, to see the same clinician, to travel a shorter distance to get to the clinic and to go to clinics with ample parking. Participants treated by physiotherapists were willing to wait an additional waiting time of 8.76 weeks and/or to travel an additional travelling distance of 7.57 miles to be treated by a physiotherapist instead of a support worker for their follow up treatment. Participants with experience of being treated by support workers were more likely to choose a service where follow up treatments are provided by a support worker as long as the characteristics of the physiotherapy service are as good or favourable compared to a service where follow up treatments are provided by physiotherapists.
Findings highlight the trade-offs patients are willing to make for different physiotherapy services. Patients treated by physiotherapists prefer to be treated by physiotherapists for their follow up treatments. On the other hand, patients who have experience of being treated by support workers are likely to choose to be treated by support workers again if the other physiotherapy service characteristics are as good or better compared to a service where treatment is provided only by physiotherapists.
Findings have implications for the design of physiotherapy services to enhance patient experience when patients are offered treatment by physiotherapy support workers. The findings will contribute to the development of “best practice” recommendations to guide physiotherapists in delegating clinical work to physiotherapy support workers for patients with musculoskeletal conditions.
delegation
skill-mix
