Barten D.1,2, Koppes L.1, Verheij R.A.1
1Netherlands Institute for Health Services Research, Utrecht, Netherlands, 2University of Applied Sciences Utrecht, Centre for Innovation in Healthcare, Research group Innovation of Human Movement Care, Utrecht, Netherlands
Background: In 2016, self-referral to physical therapy celebrated its tenth anniversary in The Netherlands. Self-referral was introduced to strengthen patient-centered care, to offer patients more freedom of choice, and to achieve partial substitution of care from general practitioners to physical therapists. Previous research shows that patients increasingly used self-referral in the period 2006-2010.
Purpose: The purpose of the present study is to describe the more recent trend in self-referral, and to answer the question to what extent self-referral differs between subgroups of patients.
Methods: NIVEL Primary Care Database (PCD) was used to achieve the research objectives. This database aims to monitor health and utilisation of health services in a representative sample of the Dutch population. The NIVEL PCD contains routinely recorded data of several, separated primary care health care providers, including physical therapists. Participating physical therapists collect longitudinal data on patient characteristics, mode of access, diagnoses, amount of care, and treatment evaluations. Descriptive statistics were used to describe the use of self-referral in the primary care population treated by the physical therapists. Independent t-tests and non-parametric equivalents were used to determine differences between subgroups of patients, and between the use of self-referral in the periods 2006-2010 respectively 2011-2015.
Results: In total, 107.463 treatment episodes were included belonging to 75.794 unique adult patients who visited about 100 primary care physical therapists between 1st January 2006 and 31th December 2015. The use of self-referral increased in the general population (p 0.001), from 24% in 2006, to 39% in 2010, and 52% in 2015. Overall, self-referral is more often used by younger patients, patients with neck or back complaints, and patients with acute complaints (p 0.05). In less than 5% of the patients who referred themselves, treatment was restricted to one screening visit only. Patients who refer themselves received less treatment sessions compared to patients referred by their doctor. Finally, self-referred patients more often reached their treatment goals completely. Linear trends over time are all statistically significant
(p 0.001).
Conclusion(s): Ten years after the introduction of the Dutch self-referral policy to physical therapy, the turning point is reached. In 2015, the majority of patients visiting a primary care physical therapist referred themselves. Subgroups that prefer to use self-referral in the period 2011-2015 are similar to those in 2006-2010. As the prevalence of patients within these subgroups is expected to raise largely in the next decades, physical therapists responsibility to offer high qualitative care is only set to increase in future.
Implications: Physical therapists should remain alert in performing their gatekeeper role as the majority of patients do not visit a medical doctor anymore prior to physical therapy treatment. Since hardly every self-referred patient was assessed to be eligible for physical therapy treatment, future research could be focused on the effectiveness on physical therapists screening process in self-referred patients.
Funding acknowledgements: The Dutch Miinistry of Health, Walfare, and Sport financially supports data collection by NIVEL Primary Care Database.
Topic: Professional issues
Ethics approval: Ethics approval was not required.
All authors, affiliations and abstracts have been published as submitted.
