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

Abstract

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.

An evaluation of the effectiveness of a telephone assessment and advice service within an ED Physiotherapy clinic: A single-site cohort study

“…This between group difference was small however (0.19 points on a six point scale ranging from 'very poor' to 'excellent'), with the authors questioning the meaningfulness of this result. Another explanation for this difference may be that our telephone assessment and advice service operated alongside a usual face to face care pathway, representing one method of accessing physiotherapy services rather than a replacement of face-to-face care pathways, in line with conclusions from qualitative research nested within the 'PhysioDirect' study that reported that many participants felt this service model was a useful option for accessing early physiotherapy advice for their musculoskeletal conditon [19].…”

“…Furthermore, a nested qualitative study [19] concluded that a telephone assessment and advice service was broadly acceptable to participants, due to more timely access to advice. This patient care pathway re ects the evidence about the effectiveness of different modalities within physiotherapy for various conditions.…”

Use of virtual consultations in an orthopaedic rehabilitation setting: how do changes in the work of being a patient influence patient preferences? A systematic review and qualitative synthesis

“…Patients were selected from a pool of participants from the experimental arm of a RCT for in-home telerehabilitation. 49 Pearson et al 25 Telephone-based physiotherapy between a patient and a senior physiotherapist (England) To describe key variables that determined patient acceptability of the PhysioDirect service and to understand how the patient experience differed from those accessing usual physiotherapy care…”

“…Participants were recruited from the PhysioDirect Study. 50 Hinman Open access 24 26 and phone call 25 and face an increased reliance on them to communicate information. 6 In the absence of hands-on treatment, more emphasis is placed on patients completing exercises.…”

“…22 Patients may be encouraged to self-monitor improvements more than if they were seen face to face. 25 ► Brief and support patients on the changes in style of communication.…”