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An overview of 5 years of patient self-referral for physical therapy in the Netherlands.

Swinkels, I.C.S., Kooijman, M.K., Spreeuwenberg, P.M., Bossen, D., Leemrijse, C.J., Dijk, C.E. van, Verheij, R., Bakker, D.H. de, Veenhof, C. An overview of 5 years of patient self-referral for physical therapy in the Netherlands. Physical Therapy: 2014, 94(12), 1785-1795
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Background: Self-referral to physical therapy was introduced in 2006 in the Netherlands. Internationally, debate on self-referral is still ongoing. Objective: To evaluate the effects of self-referral to physical therapy in the Netherlands, focusing on volume of general practice and physical therapy care (incidence rates and utilization of services). Design: The study is based on monitoring data from existing data sources. Methods: Longitudinal electronic medical record data from general practitioners (GPs) and physical therapists participating in the NIVEL Primary Care Database were used, as well as public data from Statistics Netherlands. Descriptive statistics and Poisson multilevel regression analyses were used for analyzing the data. Results: Incidence rates of (low) back, shoulder, and neck pain in general practice declined slightly from 2004 to 2009. No linear trends were found for number of contacts in GP care for (low) back and neck pain. The number of patients visiting physical therapists and the proportion of self-referrers is growing. Self-referrers receive less often treatment after initial intake than referred patients and the mean number of visits is lower. Limitations: This study was based on data of various patient populations from existing data sources. Conclusions: The current study indicates that self-referral in the Netherlands has fulfilled most expectations held prior to its introduction, although no changes to the workload of GP care have been found. Use of physical therapy grew, but due to population aging and increasing prevalence of chronic diseases, it remains unclear whether self-referral affects health care utilization. Therefore, cost-benefit analyses are recommended. (aut.ref.)