Pendergast et al,11 who included the largest number of participants (direct access group, N=17,362; physician referral group, N=44,755) of the 6 studies, reported a mean difference of 1.1 visits between groups (P<.001). However, no scientific literature is currently available to support this claim. Hackett et al15 showed 9% more of the participants in the direct access group evaluated management of their condition as average or above average, although it was difficult to conclude whether the level of significance (P<.01) would have been the same if only direct access and physician referral groups were compared because the study ran these tests among 3 groups (including one group for which data was not extracted). . The site is secure. Are the interventions of interest clearly described? There are three main disk space or file allocation methods. , Bruinvels DJ, Elbers NA, et al. The sample sizes in that study were quite large, with 50,799 patients included in the direct access group and 61,854 patients included in the physician referral group. A point was awarded if no retrospective unplanned (at the outset of the study) subgroup analyses were reported. Although this information reflects characteristics that may be over-represented in the direct access group, these findings also provide valuable information that can be used to guide preparation for physical therapists to function in a direct access environment. Dr Ojha and Dr Davenport provided concept/idea/research design, writing, data collection, project management, and fund procurement. SJ No point was awarded if the proportion of those asked who agreed to participate or responded was not stated. 2. And, insurance companies spend, on average, 30% less for patients who used direct access physical therapy. Paid claims for all services/drugs per episode of care. The Downs and Black checklist scores are reported in Table 4 and ranged from 13 to 22 out of a total of 26 points. Contrary to this conception, Moore et al cited samples of diagnoses identified by physical therapists in the study, which included Ewing sarcoma, Charcot-Marie tooth disease, fractures, nerve injuries (long thoracic, suprascapular, and spinal nerve root injuries), posterior lateral corner sprain, osteochondritis dessicans, ankylosing spondylitis, tarsal coalition, compartment syndrome, and scapholunate instability. While it has been achieved in some form across the country, APTA continues to advocate for unrestricted direct access everywhere. The potential benefit of direct access to physical therapy in other practice settings should be further explored, as well as alternate pathways for providing health services that take advantage of the safety, efficacy, and cost-effectiveness of direct access physical therapy. Oxford University Press is a department of the University of Oxford. Identify the ending date as the last physical therapy claim before a 60-day window with no further physical therapy claims (any second initial evaluation within that episode was considered a re-evaluation rather than the start of a new episode). Six articles compared mean number of physical therapy visits per patient episode of care with 4 studies (levels 3 and 4)8,9,11,12 reporting that patients in the direct access group had significantly fewer visits and 2 studies (level 3)13,15 reporting no significant difference between groups. CA , McMillian DJ, Rosenthal MD, Weishaar MD. Physiotherapist or physician as primary assessor for patients with suspected knee osteoarthritis in primary care - a cost-effectiveness analysis of a pragmatic trial. Opioid side effects include depression, overdose, addiction, and withdrawal symptoms. Unauthorized use of these marks is strictly prohibited. Data from the included studies supported a grade B recommendation that costs to patient or insurance companies per physical therapy episode of care were less when patients saw a physical therapist directly versus through physician referral, likely due to less imaging ordered, injections performed, and medications prescribed. Two reviewers independently selected eligible studies, extracted the data, and assessed methodological quality using the Newcastle-Ottawa Scale for cohort studies. The purpose of this study was to conduct a systematic review of the literature on patients with musculoskeletal injuries and compare health care costs and patient outcomes in episodes of physical therapy by direct access compared with referred physical therapy. Validation that the sample was representative would include demonstrating that the distribution of the main confounding factors was the same in the study sample and the source population (eg, if the demographics and diagnoses of the patients were considered representative of a typical outpatient moo practice, the study was awarded a point). Essentially, direct access cuts out the middle man, or the referral from another healthcare professional, before receiving service. Direct selection. If the majority of articles showed a statistically significant difference between groups, the results were considered consistent across studies for that outcome measure. The study was done on patients who use direct access to physical therapist and referred patients. Find Out More Finally, although Holdsworth et al13 did not run statistical analyses, patients in the direct access group had approximately 22 ($34) less cost (not including cost to patients), which we extrapolated would amount to an average cost benefit to the National Health Service of Scotland of approximately 2 million per year ($3,107,400). Similarly, all studies (level 34 evidence) showed the same or better discharge outcomes (grade C), achieved in fewer physical therapy visits (grade C), with increased satisfaction (grade B) in the direct access group and without any evidence of increased risk of harm to the patient (grade C). , Bundred P, Hutton J, et al. There were no reported adverse events in either group resulting from physical therapist diagnosis and management, no credentials or state licenses modified or revoked for disciplinary action, and no litigation cases filed against the US government in either group over a 40-month observation period. Finally, despite self-referring for physical therapy, it appears that patients continue to be engaged with physicians throughout their course of care; thus, it is unlikely that widespread implementation of direct access to physical therapy will reduce demand for seeking care from other practitioners. Austin, TX 78737. The computerized evaluation data and outcome measures can be easily collected. "Health organizations are providing virtual appointments and are expanding their . doi: 10.1093/ptj/pzac026. The findings suggest that DA to physiotherapy is feasible considering the clinical and economic point of view. For the purpose of this review, we interpreted "clear and specific" to mean direct mention of groups being direct access compared with referral with or without further descriptors of what this constituted. Out of 3 studies12,14,15 reporting on frequency of GP consultation services, only Holdsworth and Webster12 found a significant difference (P=.0113), with 29% of the direct access group having at least one contact with their GP for the same diagnosis 3 months after physical therapy versus 46% in the physician referral group (for other mean differences, see Tab. J Finally, publication bias and selective reporting within each study could have introduced risk of bias to our summary of evidence. Cost Savings - Direct access eliminates unnecessary physician visits and copays. Epub 2013 Sep 12. A point was awarded unless the study specifically stated that patients were treated by a therapist who received specialized training or the direct access or physician referral group received treatment in a specialized facility defined by advanced training or focus of intervention in niche areas of physical therapy (eg, pediatrics). Direct access puts power into the hands of the patient when deciding if they would like to receive physical therapy. Were losses of patients to follow-up taken into account? There was no evidence for harm. For example, in the early 1990s the following limitations on practice in physical therapy (physiotherapy) direct access models applied in different US states: diagnosis requirements, eventual . The purpose of direct access is to expedite this process and allow a physical therapist to properly treat patients. We developed guidelines, specific to our study type, to improve agreement between raters (Appendix 1). Subsequently, Leemrijse and colleagues8 reported as the results of a logistic regression analysis that individuals in the Netherlands (n=10,519) who are younger, with higher educational attainment, nonspecific spine symptoms, recurrent symptoms, and prior treatment by a physical therapist were significantly more likely to have direct access to physical therapist services than individuals who were referred by a physician. Abstracts of initially identified articles (n=1,501) were screened for eligibility. Imaging rules depend on the state. and R.S.S.) Given that patients in the direct access group received fewer medications and less imaging while achieving similar or superior discharge outcomes, the results from this review suggest a relative decreased risk of harm in the direct access group, potentially due to fewer side effects of medication or less exposure to imaging radiation. If claims are date-spanned, as may occur when analyzing outpatient hospital physical therapy claims, determine reasonable number of CPT codes or units of service per visit to calculate the number of visits in the date-spanned period. Criteria are based on Downs and Black checklist (Appendix 1): Y (yes)=criterion met, N (no) =criterion not met P=criterion partially met, and U=criterion unable to determine from the study manuscript. Criteria 17 and 27 were omitted due to reasons explained in the Quality Assessment section. One point was awarded if the study indicated that groups were matched for any such demographical variables or if potential confounders were mentioned in the text of the article but not clearly listed in table format. However, more research is still needed due to the low evidence of the reviewed studies and to explore the clinical safety of DA. Was adherence to the intervention reliable? 2022 May 5;102(5):pzac026. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Da Ros A, Paci M, Buonandi E, Rosiello L, Moretti S, Barchielli C. Bull World Health Organ. Was the randomized intervention assignment concealed from both patients and health care team until recruitment was complete and irrevocable? U ratings received zero points. CJ FOIA Description of grades of recommendation are according to the Centre for Evidence-Based Medicine criteria: A, consistent level 1 studies; B, consistent level 2 or 3 studies or extrapolations from level 1 studies; C, level 4 studies or extrapolations from level 2 or 3 studies; D, level 5 evidence or troublingly inconsistent or inconclusive studies of any level. Results: Int J Evid Based Healthc. Kentucky State Board of Physical Therapy 9110 Leesgate Road, Suite 6 Louisville, KY 40222-5159 502/327-8497 Fax: 502/423-0934 . Webster et al14 found that the number of GP consultations 1 month after physical therapy was approximately the same in both groups (not significant, P=.219). A patient was already diagnosed by a physician and has received physical therapy for that same diagnosis within the past 60 days. 1593 articles were initially identified, and thirteen studies met the inclusion criteria. was not awarded if a study made no mention of the presence or absence of adverse events (eg, loss of license of a therapist, minor or serious side effects of intervention) in the direct access or physician referral groups. The aim of this study is to explore the evidence regarding feasibility, effectiveness, costs, safety and patient satisfaction through DA compared to other organizational models. Grooving evidence suggests that patients could have Direct Access (DA) to physiotherapy. The law, Chapter 298 of the Laws of 2006, allows physical . A point was awarded if the primary outcome measures were thought to be valid and reliable (eg, number of physical therapy visits per chart report), regardless of whether reliability or validity was reported. Direct access means the removal of the physician referral mandated by state law to access physical therapists' services for evaluation and treatment. and T.E.D.). Not to mention the opportunity that each patient is given with direct access when it comes to choosing who their physical therapy provider should be. The chart indicates that 33 states allow direct access to physical therapists for both evaluation and treatment. File activity specifies percent of actual records which proceed in a single run. A platform presentation of this research was given at the Combined Sections Meeting of the American Physical Therapy Association; February 2124, 2013; San Diego, California. There is no evidence that self-referral to physical therapy puts patients at increased risk. Because of the conceptual heterogeneity in dependent variable measurements and lack of reports of variability around point estimates, we were unable to pool data and calculate effect sizes. However, in this report, the terms direct access and open access seem to have been defined as expeditious physical therapy referrals from generalist physicians, such as on-demand physical therapy clinics, which reflects a gatekeeping model, with the GP initiating the physical therapy referral. is included to provide an appropriate balance to the patients right to direct access. L 2). Disadvantages: Network dependent; Prone to hacks; Types of Access Control Systems.
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