Barriers to Rehabilitation in Primary Health Care in Ontario: Funding and Wait Times for Physical Therapy Services

Abstract

Purpose: The purpose of this study was to examine barriers to accessing physical therapy (PT) services in Ontario primary health care with respect to funding sources and wait times. Methods: A stratified random sample of 1100 registered Ontario PTs and 3000 Ontario family physicians were surveyed by mail in 2004. Relationships were examined between PT wait times, funding source, geographical region and caseload composition. Results: Physicians identified the cost of private rehabilitation and long wait times as the most common barriers to referring patients to rehabilitation. Wait times for PT were longer in publicly funded settings than in privately funded practice settings (p, 0.001) and in the North (p, 0.001) and East (p 5 0.010) regions of Ontario compared with the most urban region of Ontario. Patients with chronic musculoskeletal conditions, cardiopulmonary conditions and general debility were at least three times more likely to receive PT services at publicly funded than privately funded practice settings. Furthermore, patients with acute musculoskeletal conditions were less likely to receive PT services in publicly funded practice settings (odds ratio 5 0.11, 95% confidence interval 5 0.05-0.23). Conclusions: Current Ontario health-care structures may affect access to PT services for vulnerable populations such as those with chronic conditions, those lacking private health insurance and those living in less urban regions of Ontario.

Changes in Physiotherapy Utilization in One Workforce: Implications for Accessibility among Canadian Working-Age Adults

“…Recent studies show that access to physiotherapy is impeded in the current system for people with chronic conditions, those lacking private healthcare and those living in less urban regions (Cott et al 2007). Documenting changes before and after the delisting of physiotherapy services in Ontario, Landry and colleagues (2006) showed that 18% of physiotherapy patients discontinued their physiotherapy after delisting because they could not pay for it.…”

Patients' Perceptions of Navigating “The System” for Arthritis Management: Are They Able to Follow Our Recommendations?

“…31 Many people have little or no private insurance coverage for private physiotherapy, 12 which can be prohibitively expensive, while long wait times and ineligibility impede their access to publicly funded physiotherapy. 9,11 Treatment recommendations made at the AC follow best practice treatment guidelines, but there may be a disconnect between these recommendations and the availability of the services recommended. Treatment guidelines may need to be tailored to the local health care context in which they are applied to ensure that they will be helpful to patients.…”

“…Some people suggest that the system is designed to address acute episodes and lacks the necessary funding and structure to prevent and address chronic disease. 7 Historically, gaps in the system that affect people with arthritis have included shortages of orthopaedic surgeons, 8 insufficient access to physiotherapy, [9][10][11][12] and care that does not follow best practice guidelines. 13,14 For example, through research in Ontario, Glazier and colleagues [15][16][17] found that arthritis management provided by primary care physicians has been sub-optimal, with low use of options such as exercise, low rates of referral to other health care providers, and a lack of comprehensive recommendations for therapy.…”

Understanding Physiotherapists' Roles in Ontario Primary Health Care Teams

“…In Ontario, physiotherapists are underrepresented within PHC teams; 2,3 the majority of community physiotherapy services in Ontario are available only through the private health care sector, which translates into limited or no access for many people. [2][3][4] The Canadian Physiotherapy Association contends that inter-professional health care models that integrate physiotherapists ensure continuity of care and effective management, education, and care for all Canadians. 5 Recent research demonstrates that PHC providers support embedding physiotherapists within PHC teams.…”

“…2 Further, exploring current PHC models as costeffective options to expand publicly funded community physiotherapy service within Canada has been recommended. [2][3][4] Thus, an understanding of how physiotherapists currently practise and what roles they are playing within these settings is needed.…”