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Advanced practice physiotherapy-led triage in Irish orthopaedic....pdf (1.64 MB)

Advanced practice physiotherapy-led triage in Irish orthopaedic and rheumatology services: national data audit

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posted on 2022-11-25, 09:58 authored by Orna Fennelly, Catherine Blake, Oliver FitzGerald, Roisin Breen, Jennifer AshtonJennifer Ashton, Aisling Brennan, Aoife Caffrey, François Desmeules, Caitriona Cunningham

Background: Many people with musculoskeletal (MSK) disorders wait several months or years for Consultant Doctor appointments, despite often not requiring medical or surgical interventions. To allow earlier patient access to orthopaedic and rheumatology services in Ireland, Advanced Practice Physiotherapists (APPs) were introduced at 16 major acute hospitals. This study performed the first national evaluation of APP triage services.

Method: Throughout 2014, APPs (n = 22) entered clinical data on a national database. Analysis of these data using descriptive statistics determined patient wait times, Consultant Doctor involvement in clinical decisions, and patient clinical outcomes. Chi square tests were used to compare patient clinical outcomes across orthopaedic and rheumatology clinics. A pilot study at one site identified re-referral rates to orthopaedic/rheumatology services of patients managed by the APPs.

Results: In one year, 13,981 new patients accessed specialist orthopaedic and rheumatology consultations via the APP. Median wait time for an appointment was 5.6 months. Patients most commonly presented with knee (23%), lower back (22%) and shoulder (15%) disorders. APPs made autonomous clinical decisions regarding patient management at 77% of appointments, and managed patient care pathways without onward referral to Consultant Doctors in more than 80% of cases. Other onward clinical pathways recommended by APPs were: physiotherapy referrals (42%); clinical investigations (29%); injections administered (4%); and surgical listing (2%). Of those managed by the APP, the pilot study identified that only 6.5% of patients were re-referred within one year.

Conclusion: This national evaluation of APP services demonstrated that the majority of patients assessed by an APP did not require onward referral for a Consultant Doctor appointment. Therefore, patients gained earlier access to orthopaedic and rheumatology consultations in secondary care, with most patients conservatively managed.

Funding

National Clinical Programmes for Orthopaedics and for Rheumatology

Health Service Executive (HSE)

History

Comments

The original article is available at https://bmcmusculoskeletdisord.biomedcentral.com/

Published Citation

Fennelly O. et al. Advanced practice physiotherapy-led triage in Irish orthopaedic and rheumatology services: national data audit. BMC Musculoskelet Disord. 2018;19(1):181.

Publication Date

1 June 2018

PubMed ID

29859072

Department/Unit

  • Beaumont Hospital

Publisher

BioMed Central

Version

  • Published Version (Version of Record)