Exploring Wait List Prioritization and Management Strategies for Publicly Funded Ambulatory Rehabilitation Services in Ontario, Canada: Further Evidence of Barriers to Access for People with Chronic Disease

Passalent, Laura; Landry, Michel D.; Cott, Cheryl

doi:10.12927/hcpol.2013.21739

Cited by 30 publications

(38 citation statements)

References 29 publications

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“…29 Another challenge to access is that many physiotherapy clinics have wait lists that are prioritized by acuity, meaning that people with chronic conditions experience excessive wait times. 10 In 2005, the Ontario government partially de-listed community physiotherapy services from OHIP; therefore, many people are not eligible for any OHIP-covered physiotherapy: only people who are less than 19 or greater than 65 years of age, or who live in Long-Term Care facilities, or who require physiotherapy post-hospitalization, or who are receiving social services are eligible for any OHIP physiotherapy at all. 30 A prospective cohort study by Landry and colleagues looked at 118 patients before and after the partial de-listing and found that 17.7% who required physiotherapy were no longer able to access it after they were made ineligible for OHIP physiotherapy in 2005.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

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

Cola

Juma

Kennedy

et al. 2014

Physiotherapy Canada

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Purpose: To understand whether a visit to a Hip/Knee Arthritis Assessment Centre (AC), where non-surgical candidates with arthritis are directed toward community resources and provided with a conservative treatment ''prescription,'' contributes to patients' self-management and ability to access community resources. Methods: A purposive sample of non-surgical patients was contacted 3-10 months after their AC visit. Three focus groups (n ¼ 20) and 20 semi-structured telephone interviews were conducted. Transcripts were systematically coded and analyzed using a qualitative descriptive research methodology. Results: While participants generally reported that the AC visit improved self-management, analysis identified an emergent theme about the inadequacy of conservative management in general, subdivided into two sub-themes related to (1) limited access to high-quality, non-surgical treatment, such as physiotherapy and (2) health care providers' attitudes and approaches, which do not embrace chronic disease prevention and management. Conclusions: An AC visit contributes to arthritis self-management; however, the current health care system does not adequately support conservative treatment of chronic conditions. Treatment guidelines need to be tailored to the local health care context in which they are applied.Key Words: disease management; health services accessibility; osteoarthritis; survey. RÉ SUMÉObjectif: Pour comprendre si une visite à un centre d'é valuation de l'arthrite de la hanche ou du genou, où des personnes qui ne sont pas candidates a grave; une intervention chirurgicale et ont de l'arthrite sont dirigé es vers des ressources communautaires et reç oivent une « ordonnance » portant sur un traitement de conservation, contribue à l'autoprise en charge par les patients et à leur capacité d'avoir accè s aux ressources communautaires. Mé thodes: On a communiqué , pendant 3 à 10 mois aprè s leur visite au centre d'é valuation, avec un é chantillon choisi à dessein de patients non candidats à une intervention chirurgicale. On a organisé trois groupes de discussion (n ¼ 20) et procé dé à 20 entrevues té lé phoniques semi structuré es. Les comptes rendus ont é té codé s systé matiquement et analysé s au moyen d'une mé thodologie de recherche descriptive qualitative. Ré sultats: Les participants ont signalé en gé né ral que les visites au centre d'é valuation amé lioraient l'autoprise en charge, mais l'analyse a dé gagé un thè me é mergent au sujet de l'insuffisance de la prise en charge conservatrice en gé né ral, subdivisé en deux sous-thè mes portant sur (1) l'accè s limité à un traitement non chirurgical de grande qualité comme la physiothé rapie et (2) les attitudes et les approches des fournisseurs de soins de santé qui n'adoptent pas la pré vention et la prise en charge des maladies chroniques. Conclusions: Une visite à un centre d'é valuation contribue à l'autoprise en charge de l'arthrite, mais le systè me de santé actuel n'appuie pas adé quatement un traitement conservateur des problè mes chroni...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Cola

Juma

Kennedy

et al. 2014

Physiotherapy Canada

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“…9 One method frequently used to prioritize patients in public physiotherapy departments involves assigning priority categories (e.g., P1-P5). 11,12 Patients with acute conditions, such as those who have recently had surgery or those who have had repetitive falls, are usually considered high priority (P1), while chronic conditions are often considered the lowest priority (P5). 11,12 A recent Ontario study found that some outpatient public physiotherapy departments categorically refused patients with chronic conditions.…”

mentioning

confidence: 99%

“…11,12 Patients with acute conditions, such as those who have recently had surgery or those who have had repetitive falls, are usually considered high priority (P1), while chronic conditions are often considered the lowest priority (P5). 11,12 A recent Ontario study found that some outpatient public physiotherapy departments categorically refused patients with chronic conditions. 12 Ryynänen and colleagues found a prioritization paradigm based on medical severity of the disease that is used among physicians and nurses in Finland who tended to prioritize severe diseases such as emphysema while giving lower priority to patients with comorbid dementia.…”

mentioning

confidence: 99%

“…11,12 A recent Ontario study found that some outpatient public physiotherapy departments categorically refused patients with chronic conditions. 12 Ryynänen and colleagues found a prioritization paradigm based on medical severity of the disease that is used among physicians and nurses in Finland who tended to prioritize severe diseases such as emphysema while giving lower priority to patients with comorbid dementia. 13 Another Finnish study found that attitudes with respect to the prioritization of patients differed between clinicians, administrators, politicians, and the general public.…”

mentioning

confidence: 99%

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Patient Prioritization Preferences among Physiotherapy Entry-Level Students: The Importance of Chronic Pain

Laliberté

Feldman

2013

Physiotherapy Canada

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Purpose: To investigate physiotherapy entry-level students' preferences in prioritizing patients, specifically, patients with chronic pain. Methods: After a group discussion, 249 Canadian entry-level physiotherapy students completed a questionnaire that used five distinct scenarios (fictitious patient cases). Respondents were asked to prioritize the patients (P1 ¼ highest priority, P5 ¼ lowest priority). Results: Physiotherapy students accorded the highest priority to the patient with chronic pain and the post-surgical patients; the elderly patient and the patient with cognitive impairment were given low priority. Conclusions: A diagnosis of chronic pain is given the highest level of priority by physiotherapy students. The literature shows, however, that chronic pain is given the lowest priority in physiotherapy department triage tools. There may be a shift in preferences with respect to patients with chronic pain between the pre-licensure (student) phase and the post-licensure (clinician) phase.Key Words: resource allocation; health priorities; health resources; triage; outpatients; chronic pain. RÉ SUMÉObjectif : É tudier les pré fé rences des é tudiants en physiothé rapie au niveau dé butant sur le plan de l'attribution d'une priorité aux patients, en particulier aux patients vivant avec une douleur chronique. Mé thode : Aprè s une discussion en groupe, 249 é tudiants canadiens en physiothé rapie au niveau dé butant ont rempli un questionnaire basé sur cinq scé narios distincts (cas de patients fictifs). On a demandé aux ré pondants d'attribuer une priorité aux patients (P1 ¼ priorité la plus é levé e, P5 ¼ priorité la plus basse). Ré sultats : Les é tudiants en physiothé rapie ont accordé la priorité la plus é levé e aux patients vivant avec de la douleur chronique et aux patients qui venaient de subir une intervention chirurgicale. Le patient â gé et le patient qui avait un dé ficit cognitif ont reç u une priorité plus basse. Conclusions : Les é tudiants en physiothé rapie accordent la plus grande priorité à un diagnostic de douleur chronique. Les publications montrent toutefois que la douleur chronique constitue la priorité la plus basse dans les outils de triage des dé partements de physiothé rapie. Il pourrait y avoir un virage au niveau des pré fé rences entre la pé riode qui pré cè de la pratique (é tudiants) et celle qui la suit (clinicien) en ce qui a trait aux patients vivant avec une douleur chronique.Questions related to resource allocation are important in the Canadian health care system, including in rehabilitation departments. These questions raise issues of fairness and are a source of ethical dilemmas for clinicians and stakeholders.

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De la recherche à la pratique, en passant par la formation

Mougel¹,

Laliberté

Poquet³

et al. 2015

Kinésithérapie, la Revue

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Exploring Wait List Prioritization and Management Strategies for Publicly Funded Ambulatory Rehabilitation Services in Ontario, Canada: Further Evidence of Barriers to Access for People with Chronic Disease

Cited by 30 publications

References 29 publications

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

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

Patient Prioritization Preferences among Physiotherapy Entry-Level Students: The Importance of Chronic Pain

De la recherche à la pratique, en passant par la formation

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