Abstract
This article describes the development and evaluation of a tool to prioritize physiotherapy referrals in a remote, under-serviced region in Canada's eastern Arctic. The Baffin Region of Nunavut is home to approximately 16 000 people dispersed across 12 communities accessible only by air. Physiotherapists are based out of the capital city, but provide services to clients throughout the region. Physiotherapists in the Baffin Region are generalists, treating clients from across the lifespan and from all practice areas. The region is under-serviced with regard to physiotherapy, and long waitlists for service are maintained. No previous physiotherapy prioritization tool existed to manage the diverse caseload. Physiotherapists were dissatisfied with perceived inequities in service delivery among the different communities in the region, and between client types. In response, a tool was created to prioritize physiotherapy referrals based on urgency and need, regardless of client location. The prioritization tool was developed by combining the authors' knowledge of the distinct and unique characteristics of the Baffin Region with background research. Three methods were used to collect background information: (1) a literature search; (2) a review of prioritization policies from other regions; and (3) interviews with physiotherapists working in similar remote areas in Canada. From the background research, common characteristics in prioritizing physiotherapy referrals as 'high priority' emerged. These were combined with the identified characteristics of the Baffin Region to create a tool that could prioritize physiotherapy referrals from multiple client types. The prioritization tool was then implemented and evaluated over a four-month period. Following the implementation of the prioritization tool, a greater percentage of scheduled physiotherapy appointments were devoted to high priority groups, and there was a greater amount of service delivered to clients from the remote communities. Physiotherapists subjectively reported improved job satisfaction knowing that clients over the entire region were being assessed in order of priority, and decreased job stress as a result of reduced therapist time spent triaging referrals. Unanticipated outcomes from using the prioritization tool included subjectively reported improved communication with other health professionals, and changes in physiotherapy service delivery methods in the Baffin Region. Using the prioritization tool prompted increased client travel to the capital city for urgent physiotherapy appointments, increased use of videoconferencing for follow-up physiotherapy appointments, and increased use of a consultative model to deliver physiotherapy services. The tool could be adapted for use by other rural or remote physiotherapists working with multiple client populations in under-serviced areas. The Baffin Region Physiotherapy Prioritization Tool provides an objective method for making triage decisions, and has improved the equity with which physiotherapy services are delivered across the region.
Highlights
Background researchThree methods were used to collect background information to inform the development of the tool: (i) a review of the literature; (ii) interviews with physiotherapists working in other remote areas of Canada, and (iii) a review of other physiotherapy prioritization guidelines and policies in Canada
Service based on urgency Prior to implementing the prioritization tool, the majority of physiotherapists’ caseloads were filled by clients from low priority groups (52% of appointments), while the remaining 48% of physiotherapy appointments were filled by clients from high priority groups
Equity between communities Before implementation of the physiotherapy prioritization tool, physiotherapists’ caseloads consisted mainly of clients from the capital city – 63% of scheduled appointments were for Iqaluit residents, while the remaining 37% were for clients from the remote communities
Summary
Three methods were used to collect background information to inform the development of the tool: (i) a review of the literature; (ii) interviews with physiotherapists working in other remote areas of Canada, and (iii) a review of other physiotherapy prioritization guidelines and policies in Canada. Informants identified various client groups and specific characteristics that result in prioritizing referrals as ‘urgent’. In developing the prioritization tool, the authors identified a number of characteristics specific to the Baffin Region that would influence the order of the prioritization categories:. Children with disabilities and clients with urgent orthopaedic conditions (eg post-surgery, post-fracture complications) were categorized in higher priority groups due to the timelimited window for therapeutic intervention, after which the client may be at risk for long-term delays in gross motor development, contractures, or loss of function. These are the Baffin Region Physiotherapy Prioritization Tool Categories in priority order: 1. Scheduled physiotherapy appointments were counted from the capital city, Iqaluit (population 6600), and compared with the number of appointments for clients from the 11 remote communities (combined population of 9400)[2] during the pilot implementation period and the comparison period
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