Is Physiotherapy Self‐Referral with Telephone Triage Viable, Cost‐effective and Beneficial to Musculoskeletal Outpatients in a Primary Care Setting?

Mallett, Ross; Bakker, Edward; Burton, Maria

doi:10.1002/msc.1075

Cited by 31 publications

(109 citation statements)

References 25 publications

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“…physiotherapists). However, the fact is that open access or selfreferral is not always the routine pathway into pain management services in the National Health Service (Mallett et al 2014).…”

Section: Healthcare Servicementioning

confidence: 99%

Patient-professional partnerships and chronic back pain self-management: a qualitative systematic review and synthesis

McNichol

Marczewski

et al. 2015

Health Soc Care Community

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Chronic back pain is common, and its self‐management may be a lifelong task for many patients. While health professionals can provide a service or support for pain, only patients can actually experience it. It is likely that optimum self‐management of chronic back pain may only be achieved when patients and professionals develop effective partnerships which integrate their complementary knowledge and skills. However, at present, there is no evidence to explain how such partnerships can influence patients' self‐management ability. This review aimed to explore the influence of patient–professional partnerships on patients' ability to self‐manage chronic back pain, and to identify key factors within these partnerships that may influence self‐management. A systematic review was undertaken, aiming to retrieve relevant studies using any research method. Five databases were searched for papers published between 1980 and 2014, including Cochrane Library, CINAHL, Medline, EMBASE and PsycINFO. Eligible studies were those reporting on patients being supported by professionals to self‐manage chronic back pain; patients being actively involved for self‐managing chronic back pain; and the influence of patient–professional partnerships on self‐management of chronic back pain. Included studies were critically appraised for quality, and findings were extracted and analysed thematically. A total of 738 studies were screened, producing 10 studies for inclusion, all of which happened to use qualitative methods. Seven themes were identified: communication, mutual understanding, roles of health professionals, information delivery, patients' involvement, individualised care and healthcare service. These themes were developed into a model suggesting how factors within patient–professional partnerships influence self‐management. Review findings suggest that a partnership between patients and professionals supports patients' self‐management ability, and effective communication is a fundamental factor underpinning their partnerships in care. It also calls for the development of individualised healthcare services offering self‐referral or telephone consultation to patients with chronic conditions.

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Section: Healthcare Servicementioning

confidence: 99%

Patient-professional partnerships and chronic back pain self-management: a qualitative systematic review and synthesis

McNichol

Marczewski

et al. 2015

Health Soc Care Community

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“…Despite reported benefits from observational research such as reduction in GP workload particularly for repeat consultations,5 improved access for patients,6 7 and reductions in costs,8 9 progress towards widespread provision of patient direct access to NHS physiotherapy has been slow.…”

Section: Introductionmentioning

confidence: 99%

STEMS pilot trial: a pilot cluster randomised controlled trial to investigate the addition of patient direct access to physiotherapy to usual GP-led primary care for adults with musculoskeletal pain

et al. 2017

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IntroductionAround 17% of general practitioner (GP) consultations are for musculoskeletal conditions, which will rise as the population ages. Patient direct access to physiotherapy provides one solution, yet adoption in the National Health Service (NHS) has been slow.SettingA pilot, pragmatic, non-inferiority, cluster randomised controlled trial (RCT) in general practice and physiotherapy services in the UK.ObjectivesInvestigate feasibility of a main RCT.ParticipantsAdult patients registered in participating practices and consulting with a musculoskeletal problem.Interventions4 general practices (clusters) randomised to provide GP-led care as usual or the addition of a patient direct access to physiotherapy pathway.OutcomesProcess outcomes and exploratory analyses of clinical and cost outcomes.Data collectionParticipant-level data were collected via questionnaires at identification, 2, 6 and 12 months and through medical records.BlindingThe study statistician and research nurses were blinded to practice allocation.ResultsOf 2696 patients invited to complete study questionnaires, 978 participated (intervention group n=425, control arm n=553) and were analysed. Participant recruitment was completed in 6 months. Follow-up rates were 78% (6 months) and 71% (12 months). No evidence of selection bias was observed. The direct access pathway was used by 90% of patients in intervention practices needing physiotherapy. Some increase in referrals to physiotherapy occurred from one practice, although waiting times for physiotherapy did not increase (28 days before, 26 days after introduction of direct access). No safety issues were identified. Clinical and cost outcomes were similar in both groups. Exploratory estimates of between group effect (using 36-item Short Form Health Survey (SF-36) Physical Component Summary (PCS)) at 6 months was −0.28 (95% CI −1.35 to 0.79) and at 12 months 0.12 (95% CI −1.27 to 1.51).ConclusionsA full RCT is feasible and will provide trial evidence about the clinical and cost-effectiveness of patient direct access to physiotherapy.Trial registration numberISRCTN23378642.

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“…152,153 To date, efforts to expand the primary care workforce have focused on upskilling the non-medical workforce, such as nurses 32,[154][155][156][157] and pharmacists, 32,155,[158][159][160] to substitute or supplement GP consultations. Other innovations in the UK include self-referral to allied health professionals, such as physiotherapists in community settings 32,161,162 and paramedics undertaking home visits. 32,163 Expansion of primary care through the development of new roles in the UK is currently limited to the development of the physician associate role, borrowing from the physician assistant role in the USA.…”

Section: Characteristics Of Community-based Care and Primary Care Accessmentioning

confidence: 99%

“…A cost-effectiveness analysis of the introduction of a self-referral pathway for physiotherapy reported that the service was cost-effective as a result of a reduction in the average number of patients attending and the wasted appointments by patients who do not initiate or actively commit to treatment. 161 The use of physician associates in UK settings has been found to have lower consultation costs than GPs, albeit with limitations, as costs considered only the time spent in consultation and no other factors, such as support time from GPs. 164 Case studies reporting on pharmacists working in general practice have shown some reduction in primary and secondary health-care usage when pharmacists work in general practice, 32 and cost-savings through reduced locum costs.…”

Section: Cost-effectivenessmentioning

confidence: 99%

The international knowledge base for new care models relevant to primary care-led integrated models: a realist synthesis

Turner¹,

Mulla²,

Aldridge³

et al. 2018

Health Serv Deliv Res

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BackgroundThe Multispecialty Community Provider (MCP) model was introduced to the NHS as a primary care-led, community-based integrated care model to provide better quality, experience and value for local populations.ObjectivesThe three main objectives were to (1) articulate the underlying programme theories for the MCP model of care; (2) identify sources of theoretical, empirical and practice evidence to test the programme theories; and (3) explain how mechanisms used in different contexts contribute to outcomes and process variables.DesignThere were three main phases: (1) identification of programme theories from logic models of MCP vanguards, prioritising key theories for investigation; (2) appraisal, extraction and analysis of evidence against a best-fit framework; and (3) realist reviews of prioritised theory components and maps of remaining theory components.Main outcome measuresThe quadruple aim outcomes addressed population health, cost-effectiveness, patient experience and staff experience.Data sourcesSearches of electronic databases with forward- and backward-citation tracking, identifying research-based evidence and practice-derived evidence.Review methodsA realist synthesis was used to identify, test and refine the following programme theory components: (1) community-based, co-ordinated care is more accessible; (2) place-based contracting and payment systems incentivise shared accountability; and (3) fostering relational behaviours builds resilience within communities.ResultsDelivery of a MCP model requires professional and service user engagement, which is dependent on building trust and empowerment. These are generated if values and incentives for new ways of working are aligned and there are opportunities for training and development. Together, these can facilitate accountability at the individual, community and system levels. The evidence base relating to these theory components was, for the most part, limited by initiatives that are relatively new or not formally evaluated. Support for the programme theory components varies, with moderate support for enhanced primary care and community involvement in care, and relatively weak support for new contracting models.Strengths and limitationsThe project benefited from a close relationship with national and local MCP leads, reflecting the value of the proximity of the research team to decision-makers. Our use of logic models to identify theories of change could present a relatively static position for what is a dynamic programme of change.ConclusionsMultispecialty Community Providers can be described as complex adaptive systems (CASs) and, as such, connectivity, feedback loops, system learning and adaptation of CASs play a critical role in their design. Implementation can be further reinforced by paying attention to contextual factors that influence behaviour change, in order to support more integrated working.Future workA set of evidence-derived ‘key ingredients’ has been compiled to inform the design and delivery of future iterations of population health-based models of care. Suggested priorities for future research include the impact of enhanced primary care on the workforce, the effects of longer-term contracts on sustainability and capacity, the conditions needed for successful continuous improvement and learning, the role of carers in patient empowerment and how community participation might contribute to community resilience.Study registrationThis study is registered as PROSPERO CRD42016039552.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Is Physiotherapy Self‐Referral with Telephone Triage Viable, Cost‐effective and Beneficial to Musculoskeletal Outpatients in a Primary Care Setting?

Cited by 31 publications

References 25 publications

Patient-professional partnerships and chronic back pain self-management: a qualitative systematic review and synthesis

Patient-professional partnerships and chronic back pain self-management: a qualitative systematic review and synthesis

STEMS pilot trial: a pilot cluster randomised controlled trial to investigate the addition of patient direct access to physiotherapy to usual GP-led primary care for adults with musculoskeletal pain

The international knowledge base for new care models relevant to primary care-led integrated models: a realist synthesis

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