Differences in patient characteristics and use of physiotherapy between direct access patients and referred patients

Abstract

Background In 2006, direct access to physiotherapy (self-referral) was introduced in the Netherlands. Ten years after the introduction of direct access, the differences between patients who used direct access and patients who were referred to the physiotherapist have not been studied. Objective To explore differences in patient characteristics and physiotherapy care between patients who used direct access and patients who are referred to a physiotherapist in the Dutch primary care setting. Methods Data for this retrospective database study were obtained from electronic health service data of patients who were registered by physiotherapists and general practitioners (GPs) participating in the Nivel Primary Care Database in 2016. Data from medical files as registered by GPs and physiotherapists were linked at patient level. Differences in patient characteristics and physiotherapy care between direct access patients and referred patients were analyzed using multilevel analyses with a three-level structure (general practice, physiotherapy practice and patient level). Results Analyses were performed with data of 4185 patients which were registered by 245 physiotherapists and 158 GPs. The majority (57%) of the included patients used direct access. Patients with more musculoskeletal episodes presented to the GP, more GP visits, complaints lasting for more than one month and patients who were older, were more likely to be referred. Compared to referred patients, patients who used direct access had less physiotherapy visits within one episode, a shorter treatment duration and completed their treatment more often. Conclusions Referred patients received more care from the GP and physiotherapist, compared to self-referred patients. These differences may be a consequence of more severe and chronic complaints by referred patients who need a referral from the GP for their health insurance. Policy makers should take these differences into account in future health care policy development to ensure that patients receive the appropriate care at the right time and the right place.