A study of direct access to physiotherapy in a primary care setting
The ability of a patient to access physiotherapy directly (patient self-referral),
although used widely in the private sector, is not the mechanism in use within the
NHS where there exists a system of open access controlled by doctors. This study
aimed to develop, implement and investigate a direct access physiotherapy service
within a primary care setting in a health district of Scotland. The service was
introduced and compared to the existing system of open access over a twelve-month
Demographic and clinical data was collected relating to two samples: Control Year
Group: All GP referrals for a year prior to the study year collected retrospectively.
Study Year Group: General practitioner (GP) and direct access (DA) referrals. All
patients were followed up one-month after discharge, and the number of associated
GP consultations collated together with patient, physiotherapist, general practitioner
and service non-user views of physiotherapy generally and direct access specifically.
There were similar numbers of referrals (339 vs. 340) with no significant differences
with regard to patient age or gender between the Control and Study Year Groups.
The Study Year Group however revealed significant differences between DA and GP
referrals. DA referrals, all of which were appropriate, accounted for 22.4% of total
referrals in comparison to 77.6% GP referrals. DA patients were more likely to have
been: male, younger, suffering from conditions of a shorter duration, in paid
employment with less work absence, who were more compliant with attendance, had
fewer physiotherapy contacts, lower reporting of symptom severity at discharge and
were more highly satisfied with their physiotherapy care. This group also
demonstrated a greater confidence in knowing when to access physiotherapy and
were highly supportive of the effectiveness of physiotherapy. DA patients also
consulted their general practitioner significantly less often than GP referrals (p =
0.001). Support for direct access was strongly expressed by service users and nonusers,
physiotherapists and general practitioners.
Direct access to physiotherapy is an example of an innovative, flexible approach to
primary care service provision encouraged by current health policy.