“…In terms of costs, it appears that existing funding models are not sufficiently responsive to fluctuations in service demands, because funding is either fixed or not received in a timely way. This study contributes to the call for new funding models for health care delivery in primary care [32] , and supports the findings from the linked component studies (blinded for review [15] , [16] ).…”
Section: Analysis and Discussionsupporting
confidence: 80%
“…Finally, our data highlight a reliance on traditional models of doctor-patient relationship and support the need for a new model of patient empowerment as a shared, iterative process creating a greater sense of health ownership in patients [33]. They also point to the need for patient education in terms of the GP as the first contact [6].…”
Purpose Musculoskeletal problems are the leading cause of chronic disability. Most patients in the UK seek initial care from general practitioners (GPs), who are struggling to meet demand. Patient direct access to National Health Service physiotherapy is one possible solution. The purpose of this study was to understand the experiences of patients, GPs, physiotherapists and clinical commissioners on direct access in a region in England with it commissioned. Methods The study was informed by Normalisation Process Theory (NTP). Data collection was via semi-structured individual face-to-face and telephone interviews with 22 patients and 20 health care professionals (HCPs). Data were analysed thematically using NPT. Results Three themes emerged: understanding physiotherapy and the direct access pathway; negotiating the pathway; making the pathway viable. HCPs saw direct access as acceptable. Whilst patients found the concept of direct access, those with complex conditions continued to see their GP as first point of contact. Some GPs and patients reported a lack of clarity around the pathway, reflected in ambiguous paperwork and inconsistent promotion. Operational challenges emerged in cross-disciplinary communication and between HCPs and patients, and lack of adequate resources. Conclusion Direct access to NHS musculoskeletal physiotherapy is acceptable to patients and HCPs. There is need to ensure: effective communication between HCPs and with patients, clarity on the scope of physiotherapy and the direct access pathway, and sufficient resources to meet demand. Patient direct access can free GPs to focus on those patients with more complex health conditions who are most in need of their care.
“…In terms of costs, it appears that existing funding models are not sufficiently responsive to fluctuations in service demands, because funding is either fixed or not received in a timely way. This study contributes to the call for new funding models for health care delivery in primary care [32] , and supports the findings from the linked component studies (blinded for review [15] , [16] ).…”
Section: Analysis and Discussionsupporting
confidence: 80%
“…Finally, our data highlight a reliance on traditional models of doctor-patient relationship and support the need for a new model of patient empowerment as a shared, iterative process creating a greater sense of health ownership in patients [33]. They also point to the need for patient education in terms of the GP as the first contact [6].…”
Purpose Musculoskeletal problems are the leading cause of chronic disability. Most patients in the UK seek initial care from general practitioners (GPs), who are struggling to meet demand. Patient direct access to National Health Service physiotherapy is one possible solution. The purpose of this study was to understand the experiences of patients, GPs, physiotherapists and clinical commissioners on direct access in a region in England with it commissioned. Methods The study was informed by Normalisation Process Theory (NTP). Data collection was via semi-structured individual face-to-face and telephone interviews with 22 patients and 20 health care professionals (HCPs). Data were analysed thematically using NPT. Results Three themes emerged: understanding physiotherapy and the direct access pathway; negotiating the pathway; making the pathway viable. HCPs saw direct access as acceptable. Whilst patients found the concept of direct access, those with complex conditions continued to see their GP as first point of contact. Some GPs and patients reported a lack of clarity around the pathway, reflected in ambiguous paperwork and inconsistent promotion. Operational challenges emerged in cross-disciplinary communication and between HCPs and patients, and lack of adequate resources. Conclusion Direct access to NHS musculoskeletal physiotherapy is acceptable to patients and HCPs. There is need to ensure: effective communication between HCPs and with patients, clarity on the scope of physiotherapy and the direct access pathway, and sufficient resources to meet demand. Patient direct access can free GPs to focus on those patients with more complex health conditions who are most in need of their care.
“…In the current era, health professionals are required to practice through great collaboration. As the number of patients with medical conditions like low back pain, neck pain, and other musculoskeletal conditions is continuously increasing, so referring them to trained physiotherapist or rheumatologist through proper triage system would prevent the backlog of waiting patients for a single specialist clinic [3]. There are many potential reasons for this issue; for example, lack of recognition of orthopedic disorders by OPD receptionists as most of the patients visited orthopedic surgeons as a walk-in patient.…”
Section: Discussionmentioning
confidence: 99%
“…While, rheumatologists are internal medicine physicians who focus on autoimmune conditions and the non-surgical treatment of diseases, such as different types of arthritis, where medications alone or with physical therapy can provide the proper management [1]. While a physiotherapist is a medical professional who can treat the general joint pain by physical therapy [3].…”
To identify the frequency of misdirected patients in orthopedic outpatient clinics. Methodology This was a retrospective study done in a private hospital of Jeddah. Computer records of patients attending the orthopedic outpatient department (OPD) during the period of 2013-2017 were collected. Data were analysed using IBM SPSS version 23 (IBM Corp, Armonk, NY). Descriptive statistics are presented as frequency and percentages. Results Out of the 23435 cases, 6944 (29.6%) cases should not be seen primarily in orthopedic clinic, 13638 (58.2%) were the cases that may or may not be seen primarily in orthopedic clinic, whereas, there were 2853 (12.2%) who must be seen mainly by orthopedic specialist. Conclusion This study revealed that a huge number of patients who visited orthopedic OPD does not need primarily orthopedic consultation. So, it is recommended to direct the patients to the right specialist in outpatient clinics to avoid the unnecessary burden on orthopedic clinics. The triage of referrals or walk-in patients may help to prevent this issue.
“…Thus, there is a need to describe international best practice in the specialist areas in chiropractic including “wellness”. A model for this training exists in other allied health professions [ 112 , 113 ]. Fig.…”
The chiropractic profession is 125 years old and has evolved a culture beset with internal conflict. The internal ructions have been particularly noticeable during the last 20 years. These polarising viewpoints are worsening to the degree that there are calls for the profession to break into two separate entities. Key to the recognition of the differences within the profession is the recognition of title for particular sub populations of patients presenting to chiropractors. For many of the sub populations such as sport or paediatrics there has grown appropriate post professional specialist educational training sometimes leading to a protected title. However, this is not occurring in that group of practitioners that choose to focus on wellness care. A recommendation is made that wellness chiropractic be viewed as a post professional specialty program within chiropractic, as it is in medicine and elsewhere, and that recognition follow after appropriate post professional educational programs have been completed, as is customary in the other special interest groups. In order to do so, consensus will be required from all stakeholders within the profession on the level, scope and depth of such programs. Furthermore, it is possible that different jurisdictions around the world may require different post graduate educational levels based on local competitive, legal and professional circumstances. In such cases, transitioning to the higher level over a period of time may be undertaken. Recognition of the wellness specialty by the profession would allow for vertical integration with other healthcare providers as well as help bridge a gap between the entrepreneur and academic groups that would be responsible for creating these programs at tertiary education institutions. Finally, should these programs acquire evidence to underpin them, a process that would be taught within the programs, it is likely that recognition of an extended scope of practice would occur increasing the appeal of chiropractic to the public.
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