A pragmatic randomised controlled trial of ‘PhysioDirect’ telephone assessment and advice services for patients with musculoskeletal problems: economic evaluation

Hollinghurst, Sandra; Coast, Joanna; Busby, John; Bishop, Annette; Foster, Nadine E; Franchini, Angelo; Grove, Sean; Hall, Jeanette; Hopper, C; Kaur, Surinder; Montgomery, Alan; Salisbury, Chris

doi:10.1136/bmjopen-2013-003406

Cited by 15 publications

(60 citation statements)

References 34 publications

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“…The qualitative study was nested within PhysioDirect RCT and details of the methods, clinical and economic results of the trial are available elsewhere [ 4 , 9 , 10 ]. Full ethical approval was granted for the study from Southmead Research Ethics Committee, Reference 08/H0102/95 and full PCT Research and Development (R & D) approval was granted by each PCT prior to the start of the RCT.…”

Section: Methodsmentioning

confidence: 99%

The acceptability to patients of PhysioDirect telephone assessment and advice services; a qualitative interview study

Pearson

Richardson

Calnan

et al. 2016

BMC Health Serv Res

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BackgroundIn response to long waiting lists and problems with access to primary care physiotherapy, several Primary Care Trusts (PCTs) (now Clinical Commissioning Groups CCGs) developed physiotherapy-led telephone assessment and treatment services. The Medical Research Council (MRC) funded PhysioDirect trial was a randomised control trial (RCT) in four PCTs, with a total of 2252 patients that compared this approach with usual physiotherapy care. This nested qualitative study aimed to explore the acceptability of the PhysioDirect telephone assessment and advice service to patients with musculoskeletal conditions.MethodsWe conducted 57 semi-structured interviews with adults from 4 PCTs who were referred from general practice to physiotherapy with musculoskeletal conditions and were participating in the PhysioDirect trial. The Framework method was used to analyse the qualitative data.ResultsThe PhysioDirect service was largely viewed as acceptable although some saw it as a first step to subsequent face-to-face physiotherapy. Most participants found accessing the PhysioDirect service straightforward and smooth, and they valued the faster access to physiotherapy advice offered by the telephone service. Participants generally viewed both the PhysioDirect service and the physiotherapists providing the service as helpful. Participants’ preferences and priorities for treatment defined the acceptable features of PhysioDirect but the acceptable features were traded off against less acceptable features. Some participants felt that the PhysioDirect service was impersonal and impaired the development of a good relationship with their physiotherapist, which made the service feel remote and less valuable.ConclusionThe PhysioDirect service was broadly acceptable to participants since it provided faster access to physiotherapy advice for their musculoskeletal conditions. Participants felt that it is best placed as one method of accessing physiotherapy services, in addition to, rather than as a replacement for, more traditional face-to-face physiotherapy assessment and treatment.

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Section: Methodsmentioning

confidence: 99%

The acceptability to patients of PhysioDirect telephone assessment and advice services; a qualitative interview study

Pearson

Richardson

Calnan

et al. 2016

BMC Health Serv Res

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“… 54 Importantly, outcomes are equivalent between remotely and conventionally delivered services, 55 56 but with additional cost saving and time saving benefits. 57 Other potential advantages of remote-delivery models are their ability to overcome issues of quality control, adapt to future changes in both content and delivery due to the small number of staff involved, being more easily scaled up or down, and having potential to improve equity of service (accessible to remote/rural patients and those with mobility or language barriers). The theoretical technological divide is a potential disadvantage both in terms of availability of equipment (all patients need a telephone at the very least), and the need for patients and providers to engage with a non-traditional form of healthcare delivery.…”

Section: Resultsmentioning

confidence: 99%

PARTNER: a service delivery model to implement optimal primary care management of people with knee osteoarthritis: description of development

et al. 2020

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ObjectiveImplementation strategies, such as new models of service delivery, are needed to address evidence practice gaps. This paper describes the process of developing and operationalising a new model of service delivery to implement recommended care for people with knee osteoarthritis (OA) in a primary care setting.MethodsThree development stages occurred concurrently and iteratively. Each stage considered the healthcare context and was informed by stakeholder input. Stage 1 involved the design of a new model of service delivery (PARTNER). Stage 2 developed a behavioural change intervention targeting general practitioners (GPs) using the behavioural change wheel framework. In stage 3, the ‘Care Support Team’ component of the service delivery model was operationalised.ResultsThe focus of PARTNER is to provide patients with education, exercise and/or weight loss advice, and facilitate effective self-management through behavioural change support. Stage 1 model design: based on clinical practice guidelines, known evidence practice gaps in current care, chronic disease management frameworks, input from stakeholders and the opportunities and constraints afforded by the Australian primary care context, we developed the PARTNER service-delivery model. The key components are: (1) an effective GP consultation and (2) follow-up and ongoing care provided remotely (telephone/email/online resources) by a ‘Care Support Team’. Stage 2 GP behavioural change intervention: a multimodal behavioural change intervention was developed comprising a self-audit/feedback activity, online professional development and desktop software to provide decision support, patient information resources and a referral mechanism to the ‘Care Support Team’. Stage 3 operationalising the ‘care support team’—staff recruited and trained in evidence-based knee OA management and behavioural change methodology.ConclusionThe PARTNER model is the result of a comprehensive implementation strategy development process using evidence, behavioural change theory and intervention development guidelines. Technologies for scalable delivery were harnessed and new primary evidence was generated as part of the process.Trial registration number ACTRN12617001595303 (UTN U1111-1197-4809)

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“…Only one study 18 satisfied all of the costing criteria reported by Graves et al 7 The lowest conforming study satisfied 7 of the 12 costing criteria (58%), 17 which could imply errors in costing methods. 7 In all, 14/22 (64%) of studies, however, satisfied at least 10 or more criteria.…”

Section: Quality Of Costing Methodsmentioning

confidence: 93%

“…Methods for quantities of resources used by patients (Q5) were largely based on patient self-report cost diaries either collected through a questionnaire or through interview that detailed resource utilization such as clinical visits to GP (general practitioner), practice nurse, physiotherapist, hospital outpatient appointment, day case and other hospital admissions, A&E (accidents and emergencies), and prescriptions, 19 (21/22 studies used some form of self-report questionnaire). Other methods included using clinician inputted data 18 and extracting data from medical databases. 16,20 The study by Pinto et al 21 used the Osteoarthritis Cost and Consequences Questionnaire (OCC-Q) to collect cost data from patients, and then cross-checked this information against national GP and health information databases.…”

Section: Category 2: Methods Used To Determine the Quantity Of Resourmentioning

confidence: 99%

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Costing Methodology and Key Drivers of Health Care Costs Within Economic Analyses in Musculoskeletal Community and Primary Care Services: A Systematic Review of the Literature

Burgess

Hall

Bishop

et al. 2020

J Prim Care Community Health

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Background: Identifying variation in musculoskeletal service costs requires the use of specific standardized metrics. There has been a large focus on costing, efficiency, and standardized metrics within the acute musculoskeletal setting, but far less attention in primary care and community settings. Objectives: To ( a) assess the quality of costing methods used within musculoskeletal economic analyses based primarily in primary and community settings and ( b) identify which cost variables are the key drivers of musculoskeletal health care costs within these settings. Methods: Medline, AMED, EMBASE, CINAHL, HMIC, BNI, and HBE electronic databases were searched for eligible studies. Two reviewers independently extracted data and assessed quality of costing methods using an established checklist. Results: Twenty-two studies met the review inclusion criteria. The majority of studies demonstrated moderate- to high-quality costing methods. Costing issues included studies failing to fully justify the economic perspective, and not distinguishing between short- and long-run costs. Highest unit costs were hospital admissions, outpatient visits, and imaging. Highest mean utilization were the following: general practitioner (GP) visits, outpatient visits, and physiotherapy visits. Highest mean costs per patient were GP visits, outpatient visits, and physiotherapy visits. Conclusion: This review identified a number of key resource use variables that are driving musculoskeletal health care costs in the community/primary care setting. High utilization of these resources (rather than high unit cost) appears to be the predominant factor increasing mean health care costs. There is, however, need for greater detail with capturing these key cost drivers, to further improve the accuracy of costing information.

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A pragmatic randomised controlled trial of ‘PhysioDirect’ telephone assessment and advice services for patients with musculoskeletal problems: economic evaluation

Cited by 15 publications

References 34 publications

The acceptability to patients of PhysioDirect telephone assessment and advice services; a qualitative interview study

The acceptability to patients of PhysioDirect telephone assessment and advice services; a qualitative interview study

PARTNER: a service delivery model to implement optimal primary care management of people with knee osteoarthritis: description of development

Costing Methodology and Key Drivers of Health Care Costs Within Economic Analyses in Musculoskeletal Community and Primary Care Services: A Systematic Review of the Literature

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