Disparities in Service and Clinical Outcomes in State-Wide Advanced Practice Physiotherapist-Led Services.

Maree Raymer,Tracy Comans,Peter Window,Louise Mitchell,Michelle Cottrell,Shaun O’Leary

doi:10.3390/healthcare9030278

Abstract

This study explored variations in the primary service and clinical outcomes of a state-wide advanced practice physiotherapist-led service embedded in public medical specialist orthopaedic and neurosurgical outpatient services across Queensland, Australia. An audit of the service database over a six-year period was taken from 18 service facilities. The primary service and clinical outcomes were described. Variations in these outcomes between facilities were explored with a regression analysis adjusting for known patient- and service-related characteristics. The findings showed substantial positive impacts of the advanced practice model across all facilities, with 69.4% of patients discharged without a need for medical specialist review (primary service outcome), consistent with 68.9% of patients reporting clinically important improvements in their condition (primary clinical outcome). However, 15 facilities significantly varied from the state average for the primary service outcome (despite only three facilities varying in the primary clinical outcome). While this disparity in the primary service outcomes appears to be influenced by potentially modifiable differences in the service-related processes between facilities, these process differences only explained part of the variation. This study described the subsequent development of a new, more comprehensive set of service evaluation metrics to better inform future service planning.

Highlights

Introduction published maps and institutional affilThe Neurosurgical and Orthopaedic Physiotherapy Screening Clinic and Multi-disciplinaryService (N/OPSC & MDS) is an advanced practice physiotherapist-led model of care embedded in public hospital specialist orthopaedic and neurosurgical outpatient services across Queensland, Australia [1]
The primary clinical outcome was dichotomised as achieving (Responder) or not achieving (Non-Responder) a clinically meaningful change in the presenting condition based on an 11-point Global Rating of Change (GROC) scale, with scores between +2 to +5 reflecting a Responder and scores between −5 to +1 reflecting a Non-Responder [10]
These are notable primary service and clinical outcomes given the generally high levels of pain severity and disability and low levels of function (PSFS 4/10) reported by patients at the initial consultation. These state-wide findings are consistent with earlier studies demonstrating the substantial impact the N/OPSC & MDS model of care delivers in managing orthopaedic and neurosurgical demands in Queensland’s public hospitals [7,33]

Summary

Introduction

Service (N/OPSC & MDS) is an advanced practice physiotherapist-led model of care embedded in public hospital specialist orthopaedic and neurosurgical outpatient services across Queensland, Australia [1]. Referrals considered appropriate to be directed to the physiotherapistled service are usually patients with nonurgent musculoskeletal conditions (including neurosurgical patients with musculoskeletal conditions, e.g., neck and back disorders) potentially amenable to nonsurgical management. These eligible patients are referred to the N/OPSC & MDS for an initial assessment with the service leader. Depending on the initial assessment findings, a review by a medical specialist may be recommended iations.

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