Abstract
In the context of long waiting time to access rehabilitation services, a large majority of settings use referral prioritization to help manage waiting lists. Prioritization practices vary greatly between settings and there is little consensus on how best to prioritize referrals. This paper describes the prioritization processes for physiotherapy services in Québec and its potential implications in terms of equity in access to services. This is a secondary analysis of a survey of outpatient physiotherapy departments (n=98; proportion of participation was 99%) conducted in 2015 across publicly funded hospitals in Québec. In many settings, persons with acute orthopaedic conditions were prioritized while chronic conditions were given a lower priority. There were 72 different combinations of prioritization criteria used in outpatient physiotherapy departments. Variability was also observed in the type of personnel involved in the prioritization process, the number of priority levels used to rank the referrals and the source of information used to prioritize referrals. These results highlight potential issues regarding equity in access to physiotherapy services: the prioritization of persons with acute conditions to the detriment of those with chronic conditions, the lack of consensus on a fair prioritization process and the importance to adequately assess patients’ needs for treatment. Further research and interventions on prioritization criteria and processes are needed to ensure equitable access to physiotherapy services, especially in the public sector.
Highlights
Demand for physiotherapy services is expected to increase in the decades due to the aging of the population and the increasing prevalence of chronic conditions [1]
We assessed the combination of criteria used in each setting and found 72 different combinations used among the 94 outpatient physiotherapy departments that prioritized their referrals
We identified three potential issues of equity in access that will be discussed below: the priority given to clienteles with acute conditions to the detriment of others, the lack of consensus on a fair prioritization process and the need to adequately assess patients’ needs for treatment
Summary
Demand for physiotherapy services is expected to increase in the decades due to the aging of the population and the increasing prevalence of chronic conditions [1]. In Canada, demand for publicly funded outpatient physiotherapy services is already exceeding supply and access to services is often limited by extensive waiting lists [2,3]. Our research team found the median waiting time for publicly funded physiotherapy services in Québec, the second most populous province in Canada, to be 140 days [3], which is higher than the reported waiting time in Ontario [2]. In 2015, there were a total of 18,245 patients on the waiting lists for these services across Québec [3]. One of the most frequently used strategies is referral prioritization [5,6,7]
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