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 Effect of Two Major Health Reforms on Health Care Cost and Utilization in Fars Province of Iran: Family Physician Program and Health Transformation Plan

2020 ◽  
Author(s):  
Mohsen Bayati ◽  
Khosro Keshavarz ◽  
Farhad Lotfi ◽  
Abbas KebriaeeZadeh ◽  
Omid Barati ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Family Physician ◽  
Laboratory Tests ◽  
Fars Province ◽  
Short Term ◽  
Utilization Of Services ◽  
The Impact ◽  
Care Costs

Abstract Background: Family physician program (FPP) and health transformation plan (HTP) are two major reforms that have been implemented in Iran's health system in recent. The present study was aimed at evaluating the impact of these two reforms on the level of service utilization and cost of health care services. Methods: This longitudinal study was conducted on people insured by social security organization in Fars province during 2009-2016. The data on the utilization of services and costs of general practitioner visits, specialist visits, medications, imaging, laboratory tests, and hospitalization were collected. Interrupted time series analysis was used to analyze the effect of the two mentioned reforms. Results: FPP resulted in a significant reduction in the number of specialist visits, imaging, and laboratory tests in the short term, and in the number of radiology services, laboratory tests, and hospitalization in the long term. In contrast, HTP significantly increased the utilization of radiology services and laboratory tests both in the short term and long term. Concerning the costs, FPP resulted in a reduction in costs in short and long term except general practitioners' and specialist visit, and medication in long term. However, HTP resulted in an increase in health care costs in both of the studied time periods. Conclusions: FPP has been successful in rationalizing the utilization of services. On the other hand, HTP has improved people’s access to services by increasing the utilization; but it has increased health care costs. Therefore, policymakers must adopt an agenda to revise and re-design the plan.

scholarly journals Direct Access Compared With Referred Physical Therapy Episodes of Care: A Systematic Review

2014 ◽  
Vol 94 (1) ◽  
pp. 14-30 ◽  
Author(s):  
Heidi A. Ojha ◽  
Rachel S. Snyder ◽  
Todd E. Davenport
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Physical Therapy ◽  
Patient Outcomes ◽  
Health Care Costs ◽  
Third Party ◽  
Direct Access ◽  
Physician Referral ◽  
Episodes Of Care ◽  
Care Costs

Background Evidence suggests that physical therapy through direct access may help decrease costs and improve patient outcomes compared with physical therapy by physician referral. Purpose The purpose of this study was to conduct a systematic review of the literature on patients with musculoskeletal injuries and compare health care costs and patient outcomes in episodes of physical therapy by direct access compared with referred physical therapy. Data Sources Ovid MEDLINE, CINAHL (EBSCO), Web of Science, and PEDro were searched using terms related to physical therapy and direct access. Included articles were hand searched for additional references. Study Selection Included studies compared data from physical therapy by direct access with physical therapy by physician referral, studying cost, outcomes, or harm. The studies were appraised using the Centre for Evidence-Based Medicine (CEBM) levels of evidence criteria and assigned a methodological score. Data Extraction Of the 1,501 articles that were screened, 8 articles at levels 3 to 4 on the CEBM scale were included. There were statistically significant and clinically meaningful findings across studies that satisfaction and outcomes were superior, and numbers of physical therapy visits, imaging ordered, medications prescribed, and additional non–physical therapy appointments were less in cohorts receiving physical therapy by direct access compared with referred episodes of care. There was no evidence for harm. Data Synthesis There is evidence across level 3 and 4 studies (grade B to C CEBM level of recommendation) that physical therapy by direct access compared with referred episodes of care is associated with improved patient outcomes and decreased costs. Limitations Primary limitations were lack of group randomization, potential for selection bias, and limited generalizability. Conclusions Physical therapy by way of direct access may contain health care costs and promote high-quality health care. Third-party payers should consider paying for physical therapy by direct access to decrease health care costs and incentivize optimal patient outcomes.

scholarly journals Effect of Two Major Health Reforms on Health Care Cost and Utilization in Fars Province of Iran: Family Physician Program and Health Transformation Plan

2020 ◽  
Author(s):  
Mohsen Bayati ◽  
Khosro Keshavarz ◽  
Farhad Lotfi ◽  
Abbas KebriaeeZadeh ◽  
Omid Barati ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Family Physician ◽  
Laboratory Tests ◽  
Fars Province ◽  
Short Term ◽  
Utilization Of Services ◽  
The Impact ◽  
Care Costs

Abstract Background: Family physician program (FPP) and health transformation plan (HTP) are two major reforms that have been implemented in Iran's health system in recent. The present study was aimed at evaluating the impact of these two reforms on the level of service utilization and cost of health care services. Methods: This longitudinal study was conducted on people insured by social security organization in Fars province during 2009-2016. The data on the utilization of services and costs of general practitioner visits, specialist visits, medications, imaging, laboratory tests, and hospitalization were collected. Interrupted time series analysis was used to analyze the effect of the two mentioned reforms. Results: FPP resulted in a significant reduction in the number of specialist visits, imaging, and laboratory tests in the short term, and in the number of radiology services, laboratory tests, and hospitalization in the long term. In contrast, HTP significantly increased the utilization of radiology services and laboratory tests both in the short term and long term. Concerning the costs, FPP resulted in a reduction in costs in short and long term except general practitioners' and specialist visit, and medication in long term. However, HTP resulted in an increase in health care costs in both of the studied time periods. Conclusions: FPP has been successful in rationalizing the utilization of services. On the other hand, HTP has improved people’s access to services by increasing the utilization; but it has increased health care costs. Therefore, policymakers must adopt an agenda to revise and re-design the plan.

scholarly journals Effect of Two Major Health Reforms on Health Care Cost and Utilization in Iran: Family Physician Program and Health Transformation Plan

2019 ◽  
Author(s):  
Mohsen Bayati ◽  
Khosro Keshavarz ◽  
Farhad Lotfi ◽  
Abbas KebriaeeZadeh ◽  
Omid Barati ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Family Physician ◽  
Laboratory Tests ◽  
Fars Province ◽  
Short Term ◽  
Utilization Of Services ◽  
The Impact ◽  
Care Costs

Abstract Background: Family physician program (FPP) and health transformation plan (HTP) are two major reforms that have been implemented in Iran's health system in recent. The present study aimed at evaluating the impact of these two reforms on the level of service utilization and cost of health care services. Methods: This longitudinal study was conducted on people insured by social security organization in Fars province during 2009-2016. The data on the utilization of services and costs of general practitioner visits, specialist visits, medications, imaging, laboratory tests, and hospitalization were collected. Interrupted time series analysis was used to analyze the effect of the two mentioned reforms. Results: FPP resulted in a significant reduction in the number of specialist visits, imaging, and laboratory tests in the short term, and in the number of radiology services, laboratory tests, and hospitalization in the long term. In contrast, HTP significantly increased the utilization of radiology services and laboratory tests both in the short term and long term. Concerning the costs, FPP resulted in a reduction in costs in the short term, but in an increase in costs in the long term. However, HTP resulted in an increase in health care costs in both of the studied time periods. Conclusions: FPP has been successful in rationalizing the utilization of services. On the other hand, HTP has improved people’s access to services by increasing the utilization; but it has increased health care costs. Therefore, policy makers must adopt an agenda to revise and re-design the plan.

scholarly journals The impact of adverse events on health care costs for older adults undergoing nonelective abdominal surgery

2016 ◽  
Vol 59 (3) ◽  
pp. 172-179 ◽  
Author(s):  
Jonathan G. Bailey ◽  
Philip J.B. Davis ◽  
Adrian R. Levy ◽  
Michele Molinari ◽  
Paul M. Johnson
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Adverse Events ◽  
Abdominal Surgery ◽  
Health Care Costs ◽  
The Impact ◽  
Care Costs

scholarly journals Effect of Two Major Health Reforms on Health Care Cost and Utilization in Fars Province of Iran: Family Physician Program and Health Transformation Plan

2020 ◽  
Author(s):  
Mohsen Bayati ◽  
Khosro Keshavarz ◽  
Farhad Lotfi ◽  
Abbas KebriaeeZadeh ◽  
Omid Barati ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Family Physician ◽  
Laboratory Tests ◽  
Fars Province ◽  
Short Term ◽  
Utilization Of Services ◽  
The Impact ◽  
Care Costs

Abstract Background: Family physician program (FPP) and health transformation plan (HTP) are two major reforms that have been implemented in Iran's health system in recent. The present study was aimed at evaluating the impact of these two reforms on the level of service utilization and cost of health care services. Methods: This longitudinal study was conducted on people insured by social security organization in Fars province during 2009-2016. The data on the utilization of services and costs of general practitioner visits, specialist visits, medications, imaging, laboratory tests, and hospitalization were collected. Interrupted time series analysis was used to analyze the effect of the two mentioned reforms. Results: FPP resulted in a significant reduction in the number of specialist visits, imaging, and laboratory tests in the short term, and in the number of radiology services, laboratory tests, and hospitalization in the long term. In contrast, HTP significantly increased the utilization of radiology services and laboratory tests both in the short term and long term. Concerning the costs, FPP resulted in a reduction in costs in short and long term except general practitioners' and specialist visit, and medication in long term. However, HTP resulted in an increase in health care costs in both of the studied time periods. Conclusions: FPP has been successful in rationalizing the utilization of services. On the other hand, HTP has improved people’s access to services by increasing the utilization; but it has increased health care costs. Therefore, policymakers must adopt an agenda to revise and re-design the plan.

The Impact of Physical Activity on Mitigation of Health Care Costs Related to Diabetes Mellitus: Findings from Developed and Developing Settings

2016 ◽  
Vol 12 (4) ◽  
pp. 307-311 ◽  
Author(s):  
Bruna Camilo Turi ◽  
Henrique Luiz Monteiro ◽  
Rômulo Araújo Fernandes ◽  
Jamile Sanches Codogno
Keyword(s):  
Physical Activity ◽  
Diabetes Mellitus ◽  
Health Care ◽  
Health Care Costs ◽  
The Impact ◽  
Care Costs ◽  
Developing Settings
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