Four years of self-referral to physiotherapy in the Netherlands.

Swinkels, I., Kooijman, M., Dijk, C. van, Verheij, R., Bossen, D., Leemrijse, C., Veenhof, C. Four years of self-referral to physiotherapy in the Netherlands. Physiotherapy: 2011, 97(suppl. 1), p. s1197-s1198. Abstract. World Physical Therapy Congress, 22 juni 2011, Amsterdam.
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Purpose: The purpose was to study the 4-year effects of selfreferral to physiotherapy (PT) for physiotherapists, referrers and patients in the Netherlands. Questions that were answered were (1) to what extent the use of general practitioner’s (GPs) care has changed; (2) to what extent self- referralwas used and what the characteristics of the users were; (3) to what extent the volume of PT care has changed; (4) what the effects of self-referral on the treatment were; (5) what the experiences of physiotherapists with self-referral were; (6) what patients’ motives were for self-referral. Relevance: In 2006 self-referral to PT was introduced in the Netherlands. Long-term evaluation from a broad perspective is lacking. Internationally, self-referral is under discussion for some time and some countries are considering its’ establishment. Evaluation studies can help them in making policy. Participants: Question 1 was answered using extractions from the electronic medical records (EMRs) from about 180 randomly selected GPs. Questions 2–4 were answered using extractions from theEMRsfrom about 100 randomly selected physiotherapists. For question 5, over 400 randomly selected physiotherapists completed a postal survey. For question 6, 504 PT patients completed a postal survey. Methods: Data from the National Information Service for Allied Health Care (LiPZ), the Netherlands Information Network of General Practice (LINH) and a postal survey were used. LINH is a longitudinal database holding data on morbidity, prescribing and referrals in General Practice since 1992. LiPZ is a longitudinal database holding data on physiotherapists’ patients, referrals, diagnoses, treatment and evaluation since 2001. In 2006, 24 of the LiPZ-therapists asked during five months all newpatients to complete a postal survey about their motives to use self-referral. Analysis: Different kinds of analysis were used for answering the questions. Among them were chi-square tests and multivariate linear and logistic regression analysis. Results: The number of GPs’ referrals to PT declined from 67 per 1000 patients in 2005 to 42 in 2009. The percentage of patients choosing self-referral has grownfrom29%in 2006 to 38% in 2009. Younger patients, patients with neck complaints and higher educated patients were more likely to choose selfreferral than other patients. Volume effects did not seem to be large. More patients visited a physiotherapist, but their treatment period was shorter. Treatment procedures differed as well between referred patients and users of self-referral. Goals were more often reached in users of self-referral. Physiotherapists had positive experiences with self-referral. Most important motive for patients to use self-referralwas that they were familiar with their complaint or physiotherapy practice. Conclusions: From our research it appeared that self-referral is a good development for the profession. The results show a growing use of self-referral to PT together with a decline in the referrals by GPs. Patients appreciate the option of self-referral as well as physiotherapists. However, also some negative experiences were found. Implications: Further research is needed into the quality of care and cost-effectiveness. Furthermore, attention is needed for communication between physiotherapists and Gps and for the increase in administrative burden. (aut. ref.)