Physiotherapy practices in primary health care

Abstract

Introduction: Physiotherapy was included in primary health care (PHC) in order to expand access and provide comprehensive care to the population. Objective: To understand the routine and tools used by physiotherapists in primary health care and analyze the determining factors in providing care in a municipality where every basic health unit (BHU) has a physiotherapist. Methods: This is a qualitative study of nineteen physiotherapists conducted in a city of Southern Brazil, using a semistructured interview and a methodological framework for discourse analysis. Results: The main tools routinely used in the physiotherapy service are individual appointments, home visits and group work. Physiotherapy practices are influenced by public health, municipal management and BHU policies, physiotherapy profile in addition to the characteristics of the coverage area and the population being treated. Introducing health promotion measures and implementing relational technologies are the main challenges for physiotherapists, and many of these professionals already recognize their importance in promoting comprehensive care. Conclusion: Physio-therapy practices and the tools used are in line with the Primary Care Family Health Support Center (NASF-AB) model of action recommended by public policies and have been effective for many health conditions. Knowing the routine of PHC physiotherapy services may help professional training and service management, with a view to producing physiotherapy care aimed at the principle of comprehensiveness and consolidating the role of physiotherapists at this level of care.

Barriers and facilitators of integrating physiotherapy into primary health care settings: A systematic scoping review of qualitative research

“…After removing duplicates, 483 studies were screened. Next, 138 studies were evaluated based on their full text, and in the end, 44 qualitative studies [ 7 , 16 , 20 , 23 , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] ] were included in the study. Fig.…”

“…This systematic review included 44 qualitative studies conducted in 14 countries, mostly high-income countries: United Kingdom (27.2 %, n = 12) [ 34 , 36 , 39 , 47 , 49 , 52 , 58 , 62 , [64] , [65] , [66] , [67] ], Sweden (13.6 %, n = 6) [ 38 , 43 , 53 , 54 , 59 , 63 ], Ireland (11.3 %, n = 5) [ 32 , 35 , 40 , 44 , 48 ], Canada (11.3 %, n = 5) [ 7 , 20 , 23 , 37 , 68 ], the Netherlands (9.1 %, n = 4) [ 31 , 42 , 46 , 50 ], Norway (6.8 %, n = 3) [ 33 , 41 , 61 ], South Africa (4.5 %, n = 2) [ 60 , 69 ], Brazil (2.2 %, n = 1) [ 16 ], Chile (2.2 %, n = 1) [ 45 ], Germany (2.2 %, n = 1) [ 56 ], Iran (2.2 %, n = 1) [ 51 ], Spain (2.2 %, n = 1) [ 55 ], Australia (2.2 %, n = 1) [ 70 ], and multiple-countries (2.2 %, n = 1) [ 57 ]. Semi-structured interviews, focus group sessions, or both of them were the common data collection methods, respectively.…”

“…Regarding stewardship (leadership/governance), the common barriers were the following: lack of awareness among politicians [ 41 , 69 ]; lack of a national strategy [ 40 , 54 ]; lack of organizational support [ 16 , 32 , 43 , 48 ]; lack of intra- and inter-professional collaboration [ 7 , 20 , 38 , 39 , 46 , 59 ]; ineffective teamwork [ 32 , 33 , [42] , [43] , [44] , 48 , 52 , 67 ]; unclear borders among different professionals [ 31 , 48 , 66 ]; a lack of comprehensive supervision [ 46 ]; inconclusive scientific evidence [ 31 ]; and poor standardization of services [ 40 ]. Participants in included studies also presented several challenges related to the service delivery process, including 1) lack of clarity over the role and knowledge of physiotherapists [ 16 , 20 , 33 , 36 , 39 , 40 , 50 , 55 , 66 , 67 ], 2) poor knowledge of GPs [ 31 , 33 , 39 , 44 , 50 , 55 , 56 , [65] , [66] , [67] ], and 3) unawareness of physiotherapy service users [ 16 , 31 , 37 , 43 , 58 , 59 , 61 , 68 , 69 ]. In addition, time constraints and workload [ …”

“…Participants in included studies also presented several challenges related to the service delivery process, including 1) lack of clarity over the role and knowledge of physiotherapists [ 16 , 20 , 33 , 36 , 39 , 40 , 50 , 55 , 66 , 67 ], 2) poor knowledge of GPs [ 31 , 33 , 39 , 44 , 50 , 55 , 56 , [65] , [66] , [67] ], and 3) unawareness of physiotherapy service users [ 16 , 31 , 37 , 43 , 58 , 59 , 61 , 68 , 69 ]. In addition, time constraints and workload [ 31 , 32 , 35 , 37 , 38 , 41 , 50 , 62 , 67 , 68 ], lack of cohesion and continuity [ 40 , 61 , 62 , 65 ], isolation of physiotherapists [ 7 , 36 , 40 , 66 ], lack of adherence to clinical guidelines [ 42 , 43 , 52 ], undesirable referral mechanisms [ 20 , 31 , 40 , 44 , [65] , [66] , [67] ], language barriers [ 36 , 37 , 43 ], lack of attention to the quality of services [ 16 ,…”

“…Physiotherapy is recommended to be included in PHC to expand access and provide comprehensive care to the population. The predominance and multi-causality of chronic health conditions and their repercussions on the functional capacity of individuals reinforce the importance of including physiotherapists in PHC policies [ 16 ]. The evolving primary care practice in physiotherapy is a direct consequence of the first contact/direct-access privilege in physiotherapy.…”