Background and Purpose
Despite legislative approval of direct access to physical therapy, other regulatory barriers and internal institutional policies often must be overcome before this practice model can be fully adopted. Few institutional initiatives have been published describing strategies designed to change policies restricting direct patient access. This case report describes steps and strategies associated with successful implementation of a direct access physical therapy model at a large academic medical center.
Case Description
The process of obtaining institutional medical board and hospital authority board approval and implementing a pilot program is described. Program details, including therapist qualifications and scope of practice, the required internal training program, and program outcome assessment, are provided. The therapist scope of practice includes the ability to refer patients directly to a radiologist for plain film radiography. Early pilot program findings, including challenges faced and subsequent actions, are described.
Outcomes
Reviewed patient care decisions by therapists participating in the pilot program were deemed appropriate 100% of the time by physician chart reviewers. Approximately 10% of the patients seen were referred to a radiologist for plain film imaging, and 4% and 16% of the patients were referred to physicians for pain medications or medical consultation, respectively. The pilot program's success led to institutional adoption of the direct access model in all physical therapy outpatient clinics.
Discussion
Autonomy is described, in part, as self-determined professional judgment and action. This case report describes such an effort at a large academic medical center. The interdependent, collaborative relationship among physical therapists, physicians, and hospital administrators has resulted in the implementation of a patient-centered practice model based on the premise of patient choice.
The long-term psychosocial and physical functioning impact of an outpatient interdisciplinary pain management program was evaluated by comparison of pain management completors and a no-treatment group. Although pain intensity did not change and there were no significant differences between groups in several aspects of daily activity, the group that completed the program reported a greater sense of control over pain, had a more hopeful outlook on the future, perceived pain as interfering less with their life, and used strategies that are considered adaptive for long-term management of pain. The results suggest that patients with chronic, complex pain problems can improve perceptions regarding pain control and reduce the interference of pain in their lives. Outlook regarding the future was identified as a critical assessment and treatment variable. Individuals who were more optimistic about the future perceived a greater control over pain and endorsed coping strategies that involve diverting attention, ignoring pain sensations, and making coping self-statements. Although pain intensity rating did not differ, individuals who had a more pessimistic outlook on life considered pain to interfere with their work activity, mood, relations with other people, and overall enjoyment of life to a greater extent than individuals who were more optimistic.
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