Primary Care

Download the Physiotherapy Works briefing as a PDF file.

Physiotherapy offers safe and effective quality services that cut demand, save money and reduce pressure on GPs.

Primary healthcare is the first place people go for health care or wellness advice and programs, treatment of a health issue or injury, or to diagnose and manage a health condition.¹ In Alberta, Primary Care Networks (PCNs) and Family Care Centres (FCCs) offer access to primary healthcare within the community. 

Alberta’s population is aging, and people are working longer and living with more chronic conditions. 30% of Albertans have at least one chronic health condition, and among seniors, the incidence increases to more than 75%.¹  This means the demand for healthcare is growing, resulting in longer wait times and delays in access to care. Increasing the role for physiotherapists in the delivery of primary healthcare can provide an immediate solution. 

Physiotherapy: a profession to drive change

Physiotherapists are autonomous practitioners able to assess, diagnose, and triage or manage and discharge patients with a range of musculoskeletal injuries and conditions. They contribute to chronic disease management and prescribe appropriate activity/rehabilitation programs and assess seniors for risk of falling, provide prevention strategies that improve strength and balance and participate in the management of fall-related injuries.

Physiotherapists are physical function and mobility experts and patients say that they trust the advice they give to support them to lead a healthy lifestyle.² 

The net benefit of using physiotherapists’ skills in primary healthcare settings is to reduce demand on physicians or hospital emergency service. Their skills keep patients well and independent, empowering them to manage their own conditions,³ and reduce unnecessary investigations, hospital admissions and length of stay.⁴

Expanding physiotherapy services within primary healthcare will support Alberta’s ongoing transformation to a sustainable health system tailored to modern population needs.⁵ 

Physiotherapy in general practice

Musculoskeletal conditions (MSK) are among the most common reasons to visit a family physician in both adult and pediatric populations.^{6, 7} Yet 85% of these patients will not require a physician’s care.⁸ This means thousands of appointments could be freed up for other patients each year in Alberta if patients were offered a choice of professional as their first point of contact. 

The potential value and impact of extending this approach to service delivery is significant. Physiotherapists seeing patients at an earlier stage, when they first present with a problem, enables prompt treatment. This is more effective and better value. It also prevents short term problems from becoming long-term conditions, which reduce an individual’s quality of life and contribute to increasing health costs.

Physiotherapists in primary care have a safe record in identifying serious pathologies requiring further investigation.⁹ 

MSK patients report high levels of satisfaction with direct access to physiotherapy. Evidence shows, they are confident in the information they receive and the support to self-manage their conditions.⁹

Physiotherapists working in primary healthcare have been shown to: 

• Reduce referrals to secondary care orthopaedics
• Reduce unrequired investigations (x-ray, MRI, etc.)
• Reduce onward referrals to physiotherapy in the community and secondary care
• Increase the number of patients able to self-manage effectively
• Increase the number of referrals to leisure centres and other forms of physical activity prevention

Direct access to physiotherapy

Albertans can consult a physiotherapist directly, without waiting for a physician’s referral.
The benefits of direct access to physiotherapy for MSK conditions have been evaluated in several international jurisdictions.⁹ There is evidence that direct access to physiotherapy for MSK conditions improves access to care and results in faster recovery. In the UK, direct access was shown to:

• Reduce healthcare costs by over £33 per patient (or $63,2016 CAD), with additional savings from reduced prescription costs⁹
• Cut wait times for care
• Reduce time off work by an average of 58%¹⁰  
• Improve health outcomes – it helps prevent acute problems from becoming chronic and reduces long-term pain and disability
• Enable individuals to manage their own conditions

It isn’t only MSK patients who would benefit from direct access to physiotherapists. Evidence from other practice areas, such as urinary incontinence, also show similar positive outcomes.¹⁰

FACT: In 2011, fall-related injuries cost Alberta $160,000,000 in hospital admissions alone.¹¹ Physiotherapy has been shown to be effective in reducing both falls and risk of falls as much as 31% and 27% respectively.¹² If seniors at risk for falling were referred to physiotherapy, this could translate to savings of over $4,000,000 annually.

Clinical Example

Physiotherapist role in PHCs

Alberta’s Primary Healthcare clinics (PHCs) offer programs and services developed by local physicians and health regions to provide basic primary care and services that are specific to that community’s needs. Programs are led by physicians and delivered in collaboration with a range of healthcare professionals, such as nurses, dieticians, physiotherapists, social workers, and mental health workers.

Physiotherapists who work in PHCs primarily treat individuals with MSK conditions, but may also be involved in the care of people with cardio-respiratory or neurological conditions. They work in collaboration with other members of the healthcare team to deliver a comprehensive healthcare approach to their patients. They may recommend a patient be referred for physical rehabilitation, suggest non-pharmacological approaches to care, recommend further investigations (e.g. diagnostic imaging) or assess the results of current rehabilitation interventions.

FACT: Physiotherapists run pulmonary rehabilitation classes for COPD patients. COPD patients in these services are less likely to be admitted to hospital, spend less time in hospital and are 26% less likely to be readmitted following discharge.¹³

Clinical Example

Physiotherapist role in FCCs

Alberta Health’s three Family Care Centres (FCC) have provided primary healthcare to individuals and families in the community since 2012. FCC patients can consult a healthcare provider directly, without a physician’s referral.

At the Calgary East FCC physiotherapists practice in an interdisciplinary care team that sees between 6000 and 8000 patients annually. They treat people with a range of conditions - from MSK injuries to chronic or complex health conditions. In the Chronic Pain program, physiotherapists teach patients strategies for self-management in collaboration with care offered by social workers, mental health workers and dieticians. This approach has resulted in self-reports of better quality of life and reduced reliance on medication.  Patients on orthopedic wait lists are prescribed exercise programs that, in some cases, have successfully offset the need for surgery. In other cases, the physiotherapist may refer a patient to a program or service in the community that will meet their needs, and follow up to ensure the program’s effectiveness for that individual. They work closely with the other providers on the team, often participating in ‘real time’ consultations when appropriate.

Patients at the FCC benefit from this integrated care model of primary healthcare. Feedback from the quarterly review consistently shows they feel well taken care of and they have been able to make positive changes in their own health. 

FACT: Physiotherapists in primary care transform people’s lives by: reversing conditions, improving quality of life, keeping people out of hospital and reducing disability.

References

1. Alberta Health Services. 2010 -2015 health Plan: Improving Health for all Albertans.http://www.albertahealthservices.ca/publications/ahs-pub-2010-2015-healthplan.pdf
2. Bath, B and Janzen, B. Patient and referring healthcare provider satisfaction with a physiotherapy spinal triage assessment service. Journal of Multidisciplinary healthcare 2012:5, 1-15
3. Richardson et al. Rehabilitation in a primary care setting for persons with chronic illness – a randomized controlled trial. Primary Healthcare Research & Development 2010; 11:382-395. Doi:10.1017/S1463423610000113
4. Bath B et al. A Spinal Triage Programme delivered by Physiotherapists in Collaboration with Orthopedic Surgeons. Physiotherapy Canada 2012;64(4);356-366. Doi:10.3138/ptc.2011-29
5. Jurisdictional profiles on healthcare renewal: an appendix to Progress report 2013-Alberta,pp. 9-14 www.healthcouncilcanada/progress
6. Petrella, RJ and Davis, P. Improving Management of musculoskeletal disorders in primary care: the Joint Adventures Program. Clin Rheumatol (2007)26:1061-1066. Doi 10.1007/s10067-006-0446-4
7. Gunz et al. Magnitude of impact and healthcare use for musculoskeletal disorders in the pediatric: a population-based study. BMC Musculoskeletal Disorders 2012 2012:13:98. DOI: 10.1186/1471-2474-13-98
8. Ludvigsson ML and Enthoven P. Evaluation of Physiotherapists as primary assessors of patients with musculoskeletal disorders seeking primary health care. Physiotherapy 2012;98 (2):131-137
9. Holdsworth LK et al. What are the costs to NHS Scotland of self-referral to physiotherapy? Results of a national trial. Physiotherapy, 2007;93(1):3-11
10. The Chartered Society of Physiotherapy. Project to evaluate patient self-referral to women’s health physiotherapy pilot sites. London: The Chartered Society of Physiotherapy;2013. URL:  http://www.csp.org.uk/publications/project-evaluate-patientself-referral-womens-health-physiotherapy-pilot-sites
11. Finding Balance. Injuries in Alberta. Seniorsfallsdata2011.pdf 
12. Sherrington C, Teidmann A. Physiotherapy in the Prevention of Falls in Older People. Journal of Physiotherapy, 2015, 61:54-60
13. Seymour JM, Moore L, Jolley CJ, et al. Outpatient pulmonary rehabilitation following acute exacerbations of COPD. Thorax. 2010;65(5):423 8

Acknowledgement

Adapted and used with permisssion of the Chartered Society of Physiotherapy