Advanced practice physiotherapy-led triage in Irish orthopaedic and rheumatology services: national data audit

Aisling Brennan,Catherine Blake,Roisin Breen,François Desmeules,Caitriona Cunningham,Orna Fennelly,Oliver Fitzgerald,Aoife Caffrey,Jennifer Ashton

doi:10.1186/s12891-018-2106-7

Abstract

BackgroundMany people with musculoskeletal (MSK) disorders wait several months or years for Consultant Doctor appointments, despite often not requiring medical or surgical interventions. To allow earlier patient access to orthopaedic and rheumatology services in Ireland, Advanced Practice Physiotherapists (APPs) were introduced at 16 major acute hospitals. This study performed the first national evaluation of APP triage services.MethodThroughout 2014, APPs (n = 22) entered clinical data on a national database. Analysis of these data using descriptive statistics determined patient wait times, Consultant Doctor involvement in clinical decisions, and patient clinical outcomes. Chi square tests were used to compare patient clinical outcomes across orthopaedic and rheumatology clinics. A pilot study at one site identified re-referral rates to orthopaedic/rheumatology services of patients managed by the APPs.ResultsIn one year, 13,981 new patients accessed specialist orthopaedic and rheumatology consultations via the APP. Median wait time for an appointment was 5.6 months. Patients most commonly presented with knee (23%), lower back (22%) and shoulder (15%) disorders. APPs made autonomous clinical decisions regarding patient management at 77% of appointments, and managed patient care pathways without onward referral to Consultant Doctors in more than 80% of cases. Other onward clinical pathways recommended by APPs were: physiotherapy referrals (42%); clinical investigations (29%); injections administered (4%); and surgical listing (2%). Of those managed by the APP, the pilot study identified that only 6.5% of patients were re-referred within one year.ConclusionThis national evaluation of APP services demonstrated that the majority of patients assessed by an APP did not require onward referral for a Consultant Doctor appointment. Therefore, patients gained earlier access to orthopaedic and rheumatology consultations in secondary care, with most patients conservatively managed.

Highlights

Many people with musculoskeletal (MSK) disorders wait several months or years for Consultant Doctor appointments, despite often not requiring medical or surgical interventions
Of those managed by the Advanced Practice Physiotherapist (APP), the pilot study identified that only 6.5% of patients were re-referred within one year
This national evaluation of APP services demonstrated that the majority of patients assessed by an APP did not require onward referral for a Consultant Doctor appointment

Summary

Introduction

Many people with musculoskeletal (MSK) disorders wait several months or years for Consultant Doctor appointments, despite often not requiring medical or surgical interventions. A rising prevalence of musculoskeletal (MSK) disorders [1] has impacted on healthcare expenditure and led to increased wait times for orthopaedic and rheumatology services [2, 3]. Many of these patients with MSK disorders who wait several months or years to see a Consultant Doctor (i.e., Specialist Physician), may not require surgical or medical management. As APP roles vary between settings, even within the same country [11, 12], multi-site research within each local healthcare context is warranted to ensure these variances are captured [10].

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Results

Discussion

Conclusion