The impact of direct access physiotherapy compared to primary care physician led usual care for patients with musculoskeletal disorders: a systematic review of the literature

2019 ◽  
pp. 1-12 ◽  
Author(s):  
Anthony Demont ◽  
Aurélie Bourmaud ◽  
Amélie Kechichian ◽  
François Desmeules
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Usual Care ◽  
Musculoskeletal Disorders ◽  
Primary Care Physician ◽  
Care Physician ◽  
Direct Access ◽  
Review Of The Literature ◽  
The Impact

scholarly journals Direct access physiotherapy for patients with musculoskeletal disorders: a systematic review

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A Demont ◽  
A Bourmaud ◽  
A Kechichian ◽  
F Desmeules
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Adverse Events ◽  
Usual Care ◽  
Musculoskeletal Disorders ◽  
Health Care Costs ◽  
Family Physician ◽  
Direct Access ◽  
The Impact ◽  
Care Costs

Abstract Background Although the benefits of physiotherapy is well supported in the literature, the impact of having direct access to physiotherapy is not well established. Update of the current available evidence is warranted. The aim of this systematic review was to update the current evidence regarding the impact of direct access physiotherapy compared to usual care for patients with musculoskeletal disorders. Methods Systematic searches were conducted in 5 bibliographic databases up until May 2018. Two independent raters reviewed studies and used the Quality Assessment Tool for Quantitative Studies to conduct the methodological quality assessment and a data extraction regarding patient outcomes, adverse events, health care utilization and processes, patient satisfaction and health care costs. Results Sixteen studies of weak to moderate quality were included. Five studies found no significant differences in pain reduction between usual family physician led care and direct access physiotherapy. However, three studies reported better clinical outcomes in patients with direct access in terms of function and quality of life. Five studies did not observe any adverse events with direct access physiotherapy. Three studies showed shorter waiting time and four studies reported fewer number of physiotherapy visits with direct access. Three studies showed that patients with direct access were less likely to have medication and imaging tests prescribed compared to usual care. Five studies reported higher levels of satisfaction for direct access. In terms of health care costs, four studies demonstrated that costs were lower with direct access and one study reported similar costs between both types of care. Conclusions Emerging evidence, although of weak to moderate quality, suggest that direct access physiotherapy provides equal or better outcomes than family physician led care models for musculoskeletal disorders patients. More methodologically strong studies are needed. Key messages This review supports the efficacy, safety and cost-effectiveness of direct access PT, while increasing access to care with a more efficient use of resources. There is a need for more methodologically strong studies to evaluate the efficiency of direct access models of care of physiotherapy for patients with MSKD.

scholarly journals Physician-to-Physician Telephone Consultations for Chronic Pain Patients: A Pragmatic Randomized Trial

2015 ◽  
Vol 20 (6) ◽  
pp. 288-292
Author(s):  
Alexander J Clark ◽  
Paul Taenzer ◽  
Neil Drummond ◽  
Christopher C Spanswick ◽  
Lori S Montgomery ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Usual Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Telephone Consultation ◽  
Pain Disability ◽  
Pain Specialist ◽  
The Impact

BACKGROUND: The impact of telephone consultations between pain specialists and primary care physicians regarding the care of patients with chronic pain is unknown.OBJECTIVES: To evaluate the impact of telephone consultations between pain specialists and primary care physicians regarding the care of patients with chronic pain.METHODS: Patients referred to an interdisciplinary chronic pain service were randomly assigned to either receive usual care by the primary care physician, or to have their case discussed in a telephone consultation between a pain specialist and the referring primary care physician. Patients completed a numerical rating scale for pain, the Pain Disability Index and the Short Form-36 on referral, as well as three and six months later. Primary care physicians completed a brief survey to assess their impressions of the telephone consultation.RESULTS: Eighty patients were randomly assigned to either the usual care group or the standard telephone consultation group, and 67 completed the study protocol. Patients were comparable on baseline pain and demographic characteristics. No differences were found between the groups at six months after referral in regard to pain, disability or quality of life measures. Eighty percent of primary care physicians indicated that they learned new patient care strategies from the telephone consultation, and 97% reported that the consultation answered their questions and helped in the care of their patient.DISCUSSION: Most primary care physicians reported that a telephone consultation with a pain specialist answered their questions, improved their patients’ care and resulted in new learning. Differences in patient status compared with a usual care control group were not detectable at six-month follow-up.CONCLUSIONS: While telephone consultations are clearly an acceptable strategy for knowledge translation, additional strategies may be required to actually impact patient outcomes.

Primary care physician services and the frequency of comorbidities in patients with acute myocardial infarction

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
R King ◽  
D Giedrimiene
Keyword(s):  
Myocardial Infarction ◽  
Primary Care ◽  
Acute Myocardial Infarction ◽  
Primary Care Physician ◽  
Care Physician ◽  
Adverse Outcomes ◽  
Coronary Syndrome ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Background The management of patients with multiple comorbidities represents a significant burden on healthcare each year. Despite requiring regular medical care to treat chronic conditions, a large number of these patients may not receive proper care. Significant disparities have been identified in patients with multiple comorbidities and those who experience acute coronary syndrome or acute myocardial infarction (AMI). Only limited data exists to identify the impact of comorbidities and utilization of primary care physician (PCP) services on the development of adverse outcomes, such as AMI. Purpose The primary objective was to analyze how PCP services utilization can be associated with comorbidities in patients who experienced an AMI. Methods This study was based on retrospective data analysis which included 250 patients admitted to the Hartford Hospital Emergency Department (ED) for an AMI. Out of these, 27 patients were excluded due to missing documentation. Collected data included age, gender, medications and recorded comorbidities, such as hypertension, hyperlipidemia, diabetes mellitus (DM), chronic kidney disease (CKD) and previous arrhythmia. Each patient was assessed regarding utilization of PCP services. Statistical analysis was performed in order to identify differences between patients with documented PCP services and those without by using the Chi-square test. Results The records allowed for identification of documented PCP services for 172 out of 223 (77.1%) patients. The most common comorbidities were hypertension and hyperlipidemia: in 165 (74.0%) and 157 (70.4%) cases respectively. The most frequent comorbidity was hypertension: 137 out of 172 (79.7%) in pts with PCP vs 28 out of 51 (54.9%) without PCP, and significantly more often in patients with PCP, p< 0.001. Hyperlipidemia was the second most frequent comorbidity: in 130 out of 172 (75.6%) vs 27 out of 51 (52.9%) accordingly, and also significantly more often (p< 0.002) in patients with PCP services. The number of comorbidities ranged from 0-5, including 32 (14.3%) patients without comorbidities: 16 (9.3%) with a PCP and 16 (31.4%) without PCP services. The majority of patients - 108 (48.5% of 223), had 2-3 documented comorbidities: 89 (51.8%) had two and 19 (34.6%) had three. The remaining 40 (17.9%) patients had 4-5 comorbidities: 37 (21.5%) of them with a PCP and 3 (10.3%) without, with a significant difference (p < 0.001) found for patients with a higher number of comorbidities who utilized PCP services. Conclusions Our study shows that the majority of patients who presented with an AMI had one or more comorbidities. Furthermore, patients who did not utilize PCP services had fewer identified comorbidities. This suggests that there may be a significant number of patients who experienced AMI with undiagnosed comorbidities due to not having access to PCP services.

scholarly journals 3164 Do cancer survivors understand their risk factors for recurrence and the value of coordinated care between an oncologist and a primary care physician? A survey of endometrial and cervical cancer patients

2019 ◽  
Vol 3 (s1) ◽  
pp. 121-121
Author(s):  
Subhjit Sekhon ◽  
Lindsay Kuroki ◽  
Graham Colditz
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Cervical Cancer ◽  
Cancer Risk ◽  
Cancer Survivors ◽  
Primary Care Physician ◽  
Care Physician ◽  
Cancer Site ◽  
Care Plans ◽  
The Impact

OBJECTIVES/SPECIFIC AIMS: To evaluate gaps in knowledge for women who are cancer survivors regarding the impact of comorbidities and lifestyle behaviors on endometrial and cervical cancer risk, and to assess prevalence of established care with a primary care physician (PCP) among patients and evaluate acceptability of referral to a PCP METHODS/STUDY POPULATION: Single institution cross-sectional study examining all women aged 18 or older with a diagnosis of cervical or endometrial cancer who present for care by a gynecologic oncologist at Barnes-Jewish Hospital/Washington University in St. Louis School of Medicine. Patients will be invited to complete a survey specific to cancer diagnosis that includes questions on participant background and sociodemographic information, knowledge of risk factors for their specific cancer site, and whether or not the patient has a primary care provider and the acceptability of referring RESULTS/ANTICIPATED RESULTS: Majority of women will be unaware of how comorbidities affect cancer risk and treatment outcomes. For women without a PCP, we anticipate that they will be accepting towards the notion of being referred to one for establishing care. DISCUSSION/SIGNIFICANCE OF IMPACT: Pilot information from this study will 1. Allow providers to improve cancer survivorship care plans by increasing collaboration between PCPs and oncologists to provide ongoing care, and 2. Afford information for providers on where gaps in knowledge exist so as to better education patients.

Elderly African-Americans and the Influenza Vaccine: The Impact of the Primary Care Physician

2001 ◽  
Vol 2 (2) ◽  
pp. 56-59 ◽  
Author(s):  
A NICOLEAU ◽  
C NICOLEAU ◽  
J BALZORA ◽  
A OBOH ◽  
N SIDDIQUI ◽  
...  
Keyword(s):  
Primary Care ◽  
African Americans ◽  
Influenza Vaccine ◽  
Primary Care Physician ◽  
Care Physician ◽  
The Impact

scholarly journals Systematic review of integrated models of health care delivered at the primary–secondary interface: how effective is it and what determines effectiveness?

2015 ◽  
Vol 21 (4) ◽  
pp. 391 ◽  
Author(s):  
Geoffrey K. Mitchell ◽  
Letitia Burridge ◽  
Jianzhen Zhang ◽  
Maria Donald ◽  
Ian A. Scott ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Service Delivery ◽  
Disease Control ◽  
Usual Care ◽  
Clinical Outcomes ◽  
Secondary Care ◽  
Design Elements ◽  
Primary Care Practitioners ◽  
The Impact

Integrated multidisciplinary care is difficult to achieve between specialist clinical services and primary care practitioners, but should improve outcomes for patients with chronic and/or complex chronic physical diseases. This systematic review identifies outcomes of different models that integrate specialist and primary care practitioners, and characteristics of models that delivered favourable clinical outcomes. For quality appraisal, the Cochrane Risk of Bias tool was used. Data are presented as a narrative synthesis due to marked heterogeneity in study outcomes. Ten studies were included. Publication bias cannot be ruled out. Despite few improvements in clinical outcomes, significant improvements were reported in process outcomes regarding disease control and service delivery. No study reported negative effects compared with usual care. Economic outcomes showed modest increases in costs of integrated primary–secondary care. Six elements were identified that were common to these models of integrated primary–secondary care: (1) interdisciplinary teamwork; (2) communication/information exchange; (3) shared care guidelines or pathways; (4) training and education; (5) access and acceptability for patients; and (6) a viable funding model. Compared with usual care, integrated primary–secondary care can improve elements of disease control and service delivery at a modestly increased cost, although the impact on clinical outcomes is limited. Future trials of integrated care should incorporate design elements likely to maximise effectiveness.

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