Pilot Project for Direct Access to Physical Therapy
试验速览
- 阶段
- 不适用
- 发起方
- 入组人数
- 2,427
- 试验地点
- 2
- 主要终点
- Consultations in general practice
研究概览
简要总结
The aim of this pilot study is to evaluate the effect of publicly subsidized physiotherapy for all patients receiving general treatment in physiotherapy clinics with an official provider number. This study will evaluate effects on physical and mental health, number of consultations in physiotherapy; number of contacts with general practitioner; referrals to diagnostic imaging; number of contacts with specialists within rheumatology, neurology and orthopedics and patient satisfaction.
详细描述
In Denmark, patients in physiotherapy with a referral from their general practitioner (GP) get 40% of their expenses paid by public subsidy. This study aims to test the effects of direct access to physiotherapy with public subsidy without a referral from the GP.
GPs are by default the gatekeeper to all public health care services in Denmark. However, increasing demand in terms of task complexity and patient volume is putting pressure on GPs. In this study, physiotherapists may become the first point of access for patients with musculoskeletal problems.
The hypothesis is, that direct access may decrease use of health services and increase patient satisfaction by shortening the time between occurrence of symptoms and beginning treatment in physiotherapy a) by eliminating the time needed to get a referral from the GP and b) by making access to physiotherapy easier, thus encouraging patients to seek and begin treatment earlier.
The effect of direct access to physiotherapy with public subsidy will be tested in a controlled design. Four similar municipalities located in the Capital Region of Denmark were selected to participate in the study. The four municipalities have been grouped in pairs to ensure similarity on size, health utilization, urbanization and commuting patterns. Two grouped municipalities have been assigned to the intervention group by lottery; the matching pair of municipalities have been assigned to the control group.
From November 2020 to November 2021, citizens living in the two intervention municipalities can get public subsidy for general physiotherapy without a GP referral. For all citizens in the control group access to physiotherapy is provided as usual; thus, public subsidy physiotherapy is only provided for patients with a GP referral. The study includes all physiotherapy clinics in all four municipalities. All included clinics must have an official provider number, i.e. be approved to offer services with public subsidy.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Begin treatment in general physiotherapy within the four municipalities included
排除标准
- •Pregnancy
- •Have a GP referral to home treatment
结局指标
主要结局
Consultations in general practice
时间窗: Six months after intervention period
Number of consultations in general practice
Change from baseline physical functioning at 6 months
时间窗: Six months
Physical functioning will be measured by a validated Danish Short Form 12 instrument. The questionnaire consists of six items weighted, summed and transformed to provide physical health score. The score of 50 represents the median score of a reference population. 10 points equals 1 standard deviation. Higher score equal better physical health.
次要结局
- Consultations with specialists within rheumatology(Six months after intervention period)
- Consultations with specialists within neurology(Six months after intervention period)
- Change from baseline physical functioning at six weeks(Six months)
- Change from baseline mental health at six months(Six months)
- Change in use of pharmaceuticals(Six months)
- Consultations with specialists within orthopedics(Six months after intervention period)
- Referrals to diagnostic imaging(Six months after intervention period)
- Change from baseline mental health at six weeks(Six weeks)
- Change from baseline pain intensity at 6 months(Six months)
- Trust in collaboration between physiotherapist and general practitioner(Six months)
- Cancer diagnoses(Five years after intervention period)
- Patient satisfaction(Six months)
- Change in sickness absence(Six months)
研究者
Ulla Toft
Head of Department, Lecturer Ph.D, MSc Human Nutrition
Frederiksberg University Hospital