First point of contact physiotherapy; a qualitative study

Rob Goodwin, Fiona Moffatt, Paul Hendrick, Stephen Timmons, Neil Chadborn, Pip Logan, Rob Goodwin, Fiona Moffatt, Paul Hendrick, Stephen Timmons, Neil Chadborn, Pip Logan

Abstract

Objectives: First point of contact physiotherapy (FPCP) provides patients direct access to a physiotherapist. Literature demonstrates efficacy of FPCP. Evidence has highlighted the need for cultural shifts from both patient and professional perspectives to optimise FPCP. This study explored stakeholder perceptions of patient awareness and understanding of FPCP to better inform FPCP implementation.

Design, setting, participants: A qualitative methodology utilised semi-structured interviews and focus groups. Findings from a previous realist review were used to generate a priori topic guides. Participants included patients, physiotherapists, GPs, administration staff, and commissioners. A thematic analysis was undertaken.

Results: Four themes emerged that are described: level of patient awareness of the FPCP role situated against the GP as first contact practitioner, patients attain an awareness of FPCP from a variety of sources, patient understanding of physiotherapy arises from several sources and is poorly aligned with the FPCP model, characteristics and behaviours of patients influence access to FPCP services. Patient awareness and understanding was poor. Patients tended to view the GP as the default first contact practitioner. Traditional advertising approaches appeared on the whole invisible to patients and there was a reliance on signposting to facilitate patient access.

Conclusion: Findings from this study can inform implementation of FPCP. Several obstacles to the optimisation of FPCP were highlighted. Improved marketing of physiotherapy generally and FPCP specifically may increase patient awareness and understanding. However, it is likely further time will be required to bring about the cultural shift in public perception required to optimise the potential of FPCP.

Keywords: Musculoskeletal physiotherapy first contact practitioner.

Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

References

    1. NHS England, 2019. [Online] . [Accessed 15.03, 11 January 2019].
    1. England NH, British Medical Association . 2019. Investment and evolution: a five-year framework for GP contract reform to implement The NHS long term plan.
    1. Goodwin R.W., Hendrick P.A. Physiotherapy as a first point of contact in general practice: a solution to a growing problem? Prim Health Care Res Dev. 2016;17(5):489–502.
    1. Martini K., Kelly R. The provision of first contact physiotherapy in GP surgeries with non-advanced practice clinicians: a service evaluation. Physiotherapy. 2017;103:e31.
    1. Downie F., McRitchie C., Monteith W., Turner H. Physiotherapist as an alternative to a GP for musculoskeletal conditions: a 2-year service evaluation of UK primary care data. Br J Gen Pract. 2019;69(682):e314–e320.
    1. CSP, 2018. . [Accessed 15.03, 27 August 2019].
    1. Moffatt F., Goodwin R., Hendrick P. Physiotherapy-as-first-point-of-contact-service for patients with musculoskeletal complaints: understanding the challenges of implementation. Prim Health Care Res Dev. 2018;19(2):121–130.
    1. Tong A., Sainsbury P., Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–357.
    1. Goodwin R. First point of contact physiotherapy: a realist review and evaluation (Doctoral dissertation, University of Nottingham).
    1. Wong G. Getting to grips with context and complexity—the case for realist approaches. Gac Sanit. 2018;32(2):109–110.
    1. Wong G. Making theory from knowledge syntheses useful for public health. Int J Public Health. 2018;63(5):555.
    1. Pawson R. Sage; 2006. Evidence-based policy: a realist perspective. April 7.
    1. Pawson R. Sage; 2013. The science of evaluation: a realist manifesto. February 1.
    1. Palinkas L.A., Horwitz S.M., Green C.A., Wisdom J.P., Duan N., Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health Ment Health Serv Res. 2015;42(5):533–544.
    1. Manzano A. The craft of interviewing in realist evaluation. Evaluation. 2016;22(3):342–360.
    1. Robson C. Wiley; Chichester: 2011. Real world research.
    1. Nyumba T.O., Wilson K., Derrick C.J., Mukherjee N. The use of focus group discussion methodology: insights from two decades of application in conservation. Methods Ecol Evol. 2018;9(1):20–32.
    1. Fereday J., Muir-Cochrane E. Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development. Int J Qual Methods. 2006;5(1):80–92.
    1. Braun V., Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.
    1. Maidment I., Booth A., Mullan J., McKeown J., Bailey S., Wong G. Developing a framework for a novel multi-disciplinary, multi-agency intervention (s), to improve medication management in community-dwelling older people on complex medication regimens (MEMORABLE)––a realist synthesis. Syst Rev. 2017;6(1):125.
    1. Akpala C.O., Curran A.P., Simpson J. Physiotherapy in general practice: patterns of utilisation. Public Health. 1988;102(3):263–268.
    1. Dennis S., Watts I., Pan Y., Britt H. The likelihood of general practitioners referring patients to physiotherapists is low for some health problems: secondary analysis of the bettering the evaluation and care of health (BEACH) observational study. J Physiother. 2018;64(3):178–182.
    1. Swinkels I.C., Kooijman M.K., Spreeuwenberg P.M., Bossen D., Leemrijse C.J., van Dijk C.E. An overview of 5 years of patient self-referral for physical therapy in the Netherlands. Phys Ther. 2014;94(12):1785–1795.
    1. Holdsworth L.K., Webster V.S. Direct access to physiotherapy in primary care: now?—And into the future? Physiotherapy. 2004;90(2):64–72.
    1. Webster V.S., Holdsworth L.K., McFadyen A.K., Little H., Scottish Physiotherapy Self Referral Study Group Self-referral, access and physiotherapy: patients’ knowledge and attitudes—results of a national trial. Physiotherapy. 2008;94(2):141–149.
    1. Ogiwara S., Nozoe M. Knowledge of physiotherapy: a study of Ishikawa High School students. J Phys Ther Sci. 2005;17(1):9–16.
    1. Dissanayaka T.D., Banneheka S. Awareness in physiotherapy among high school students. Int J Sci Res Publ. 2014;4(7):1–5.
    1. Zadro R., O'Keeffe M., Maher C.G. Evidence-Based physiotherapy needs evidence-based marketing. Br J Sports Med. 2019;53:528–529.
    1. Fiscella K., Franks P., Gold M.R., Clancy C.M. Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. JAMA. 2000;283(19):2579–2584.
    1. Corscadden L., Levesque J.F., Lewis V., Strumpf E., Breton M., Russell G. Factors associated with multiple barriers to access to primary care: an international analysis. Int J Equity Health. 2018;17(1):28.
    1. Stokoe E., Sikveland R.O., Symonds J. Calling the GP surgery: patient burden, patient satisfaction, and implications for training. Br J Gen Pract. 2016;66(652):e779–85.
    1. Brant H.D., Atherton H., Bikker A., Porqueddu T., Salisbury C., McKinstry B. Receptionists’ role in new approaches to consultations in primary care: a focused ethnographic study. Br J Gen Pract. 2018;68(672):e478–86.
    1. Moffat J., Hinchliffe R., Ironmonger L., Osborne K. Identifying anticipated barriers to help-seeking to promote earlier diagnosis of cancer in Great Britain. Public Health. 2016;141:120.
    1. Freidson E. University of Chicago press; 2001. Professionalism, the third logic: on the practice of knowledge.
    1. Benoit C., Zadoroznyj M., Hallgrimsdottir H., Treloar A., Taylor K. Medical dominance and neoliberalisation in maternal care provision: the evidence from Canada and Australia. Soc Sci Med. 2010;71(3):475–481.

Source: PubMed

3
Prenumerera