Background Despite the increased deployment and added 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. 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 12 APPs and 3 GPs who were in various stages of implementing an APP care model. Semi-structured interviews were 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’ professional profile and positioning, a need on behalf of GPs to maintain authority, lack of reimbursement structure, and the struggle APPs face to strike a balance with current care. Conclusion 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 over control 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. Trial registration Ethical approval was obtained from the Medical Ethics Committee of VU University Medical Centre in Amsterdam; reference number 2020.17 . All participants were asked to provide written informed consent prior to participating in the study.
Background: Despite the increasing deployment and added value of Advanced Practitioner in Physiotherapy (APP) in musculoskeletal care internationally, APP is not widely accepted in Dutch primary care yet. This may be due to constraints in the implementation of APP within the Dutch health care system. The aim of this study was to explore experiences and perceptions of APP and General Practitioners (GP) in implementing APP in Dutch primary care. Methods: This was an explorative and interpretive qualitative study among 13 APPs and 3 GPs that were in various stages of implementing an APP care model. Semi-structured interviews were conducted from January to March 2021. The topic list was based on existing literature, 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) The start-up of an APP practice requires trust and clear added value for the GP, 2) Starting APP must be strongly supported by GP, 3) Positioning of APP is still unclear, and 4) Ownership of patients with musculoskeletal complaints. These four themes put forward perceived difficulties in gaining trust, lack of clarity regarding the added value of APP, ambiguity of the APP’s professional profile and positioning, lack of reimbursement structure, and APP’s struggle in seeking balance with current care. Conclusion: This study shows that the implementation of an APP model of care is challenging. The deployment of APP does not sufficiently align with the core values of GPs, and GPs seem reluctant to hand-over some control over patient care to APPs. APP does not appear to have ownership of the implementation, given its strong dependence on the practice, values and needs of the GP.Trial registration: Ethical approval is obtained from the Medical Ethics Committee of the VU University Medical Centre in Amsterdam; reference number 2020.17. All participants were asked written informed consent before participating in this study.
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