No point was awarded for studies that reported qualitative or quantitative data without any form of statistical comparisons or if the statistical tests reported were not appropriate. For the purposes of this evidence-based review, this question was omitted. Heidi A. Ojha, Rachel S. Snyder, Todd E. Davenport, Direct Access Compared With Referred Physical Therapy Episodes of Care: A Systematic Review, Physical Therapy, Volume 94, Issue 1, 1 January 2014, Pages 1430, https://doi.org/10.2522/ptj.20130096. They may not be able to afford time away from work for the physician visit and then for the appointment with the physical therapist. Have the characteristics of patients lost to follow-up been described? PDF Levels of Patient Access to Physical Therapist Services in the U.S. The computerized evaluation data and outcome measures can be easily collected. Have actual probability values been reported (eg, .035 rather than <.05) for the main outcomes, except where the probability value is less than .001? There may be limitations regarding the number of visits you can receive. , Yin J, Giang GM, Fogarty WT. The direct access, as opposed to the indirect access which requires a referral from a general physician, has several merits including better quality, timeliness, cost effectiveness of treatment and better probability of preventing acute conditions from turning into chronic ailments. All authors provided data analysis and consultation (including review of manuscript before submission). Mitchell and de Lissovoy9 reported the largest mean difference, with the direct access group using 20.2 visits compared with the physician referral group using 33.6 (P<.0001); however, this study was conducted in 1997, so it might not reflect more recent practice patterns. A point was awarded if inclusion or exclusion criteria, or both, were indicated. Holdsworth and colleagues12,13 reported no significant difference between groups regarding percentage who achieved goals (the direct access group had, on average, 2% more achieved goals compared with the physician referral group, P=.82). Pendergast 2005;5(8):1-91. Studies had to satisfy all of the following criteria to be included in this review: (1) included patients with greater than 85% musculoskeletal injuries treated by a physical therapist in an outpatient setting, (2) included original quantitative data of at least one group that received physical therapy through direct access or direct allocation to a physical therapist without seeing a physician, (3) included original quantitative data for at least one group that received physical therapy through physician referral, (4) greater than 50% of the patients in both groups had to have received physical therapy, and (5) included assessment of at least one of the following: outcomes of physical therapy (improvement or harm), cost, or outcome measures that would affect cost or outcomes (use of imaging, pharmacological interventions, consultant appointments, and patient satisfaction). CA A map that tracks the states currently participating in the compact is available at the PT Compact website. 2014 Jan;94(1):14-30. doi: 10.2522/ptj.20130096. The Figure displays our search strategy, and Table 1 lists the results of the Ovid/MEDLINE electronic search. Hackett et al15 investigated the frequency of GP visits during the course of physical therapy care and found patients, on average, saw their GP for 2 visits in both groups. Ho-Henriksson CM, Svensson M, Thorstensson CA, Nordeman L. BMC Musculoskelet Disord. Was the randomized intervention assignment concealed from both patients and health care team until recruitment was complete and irrevocable? Psychotherapy, or talk therapy, aims to help an individual identify troubling emotions, thoughts, or behavior using a variety of treatment techniques. The Many Benefits of Direct Access Physical Therapy If claims are date-spanned, as may occur when analyzing outpatient hospital physical therapy claims, determine reasonable number of CPT codes or units of service per visit to calculate the number of visits in the date-spanned period. This benefits patients, insurance companies, and therapists. , Stevens A. Kelly In the event that third-party payers want to calculate differences in cost between direct access and referred episodes of care in their own records, one potential way cited previously. No point was awarded if the proportion of those asked who agreed to participate or responded was not stated. Objectives This study was designed to ascertain whether direct access to physical therapy placed military health care beneficiaries at risk for adverse events related to their management. Identify the ending date as the last physical therapy claim before a 60-day window with no further physical therapy claims (any second initial evaluation within that episode was considered a re-evaluation rather than the start of a new episode). Results of the direct access and physician referral groups from each study were extracted for outcomes of interest at all time frames (most studies collected outcomes during the course of physical therapy, at discharge, or both). Starting therapy sooner can lead to a faster recovery and fewer visits. We can refer to specialists, insurance is the only problem but if they came to you and required a referral for specialists they would need a PCP appt to see you. However, no scientific literature is currently available to support this claim. As what they say, "respect is a two-way street", if you do not show respect then you will not be afforded the same respect. Primary limitations were lack of group randomization, potential for selection bias, and limited generalizability. Physical therapy by way of direct access may contain health care costs and promote high-quality health care. government site. However, in the interim, our review suggests the current basic training and competency requirements are sufficient for physical therapists without this specialized training to function in a direct access capacity. "Side effects" of physical therapy include improved mobility, increased independence, decreased pain, and prevention of other health problems through movement and exercise. Otherwise, classify the episode as self-referred. , Goss DL, Baxter RE, et al. Holdsworth and Webster12 reported the percentage of patients who finished their course of care was 79% in the direct access group compared with 60% in the physician referral group (P=.004), and the percentage of those who achieved their goals was 15% more in the direct access group compared with a control group (P=.079). Are the main outcomes to be measured clearly described in the introduction or "Method" section? One point was awarded if the study indicated that groups were matched for any such demographical variables or if potential confounders were mentioned in the text of the article but not clearly listed in table format. Out of 3 studies12,14,15 reporting on frequency of GP consultation services, only Holdsworth and Webster12 found a significant difference (P=.0113), with 29% of the direct access group having at least one contact with their GP for the same diagnosis 3 months after physical therapy versus 46% in the physician referral group (for other mean differences, see Tab. Researchers believe that PTs help to dial back acute LBP patients' catastrophizing thoughts, which may reduce disability and pain. Criterion 27 (Did the study have sufficient power to detect a clinically important effect where the probability value for a difference being due to chance is less than 5%?) also was not scored because we consulted a statistician who believed that significance found should not be influenced by post hoc power analyses and a difference between groups is either significant or not at study end, regardless of how much power was assumed a priori.21 The maximum score on the scale was 26, as one item had a potential of 2 points and we omitted 2 criteria (Tab. Direct access is the removal of the physician referral. Patients were more satisfied with the service in comparison to the group referred by the physician. G Cons of Direct Access? : r/physicaltherapy - reddit Databases of CINAHL (EBSCO) (restricted to humans, January 1990July 2013), Web of Science (restricted to articles, 1990 and later), and PEDro (1990 and later) were searched last on July 5, 2013. A systematic review was carried out through MEDLINE, CINAHL, and EMBASE databases from their inceptions until March 2018 using keywords related with DA. Direct Access Physical Therapy: What is it and how can it benefit you? In the analysis, account for any medical or payment policy that influences referral patterns by physicians or ability of patients to self-refer for physical therapy. Titles and abstracts were screened by the authors (H.A.O. Was an attempt made to blind study participants to the intervention they received? From the results of the logistic regression conducted by Holdsworth and Webster,12 individuals in a single health district (n=679) in Scotland who engaged in direct access utilization of physical therapist services were significantly more likely to report male sex, younger age, shorter symptom duration, and engagement in paid employment than individuals who received physical therapy in physician-referred episodes of care. I=intervention group, C=comparison group, D&B=Downs and Black checlist (see Appendix 1 for criteria), NH =National Health Service, BCBS=Blue Cross Blue Shield, pts=patients, CEBM=Centre for Evidence- Based Medicine, dx=diagnosis, DC=discharge, PT=physical therapist, msk=musculoskeletal, peds=pediatrics, 95% CI=95% confidence interval, GP-general practitioner, NR=not reported, NS=not significant. Are the main findings of the study clearly described? Some studies have suggested that early or direct access to physical therapy can reduce waiting time, improve convenience, reduce costs for the patient and health care system, and improve recovery time.46 The results of these studies directly support recent health care reform efforts in which legislators and health care providers have sought to provide efficient care through cost reduction and optimizing patient outcomes. And, insurance companies spend, on average, 30% less for patients who used direct access physical therapy. and R.S.S.) Finishing treatment in fewer visits results in less therapy copays and more savings in your pocket. All 50 States Achieve Some Form of Direct Access. However, more research is still needed due to the low evidence of the reviewed studies and to explore the clinical safety of DA. , DiAngelis T. Modified Downs and Black Criteria and Scoring Guidelinesa, For original criteria, refer to Downs and Black.17, One Method of Calculating Differences in Cost Between Direct Access and Physician-Referred Episodes of Care. BM Were losses of patients to follow-up taken into account? This also cuts costs of unnecessary doctor's appointments and gives the patient additional time . Percent satisfied=percent satisfied or very satisfied. 2). The advantages and disadvantages of using technology in hand injury evaluation. Study Design Nonexperimental, retrospective, descriptive design. Opioid side effects include depression, overdose, addiction, and withdrawal symptoms. Contrary to this conception, Moore et al cited samples of diagnoses identified by physical therapists in the study, which included Ewing sarcoma, Charcot-Marie tooth disease, fractures, nerve injuries (long thoracic, suprascapular, and spinal nerve root injuries), posterior lateral corner sprain, osteochondritis dessicans, ankylosing spondylitis, tarsal coalition, compartment syndrome, and scapholunate instability. There was no evidence for harm. CJ Of the 1,501 articles that were screened, 8 articles at levels 3 to 4 on the CEBM scale were included. Direct Access to Physical Therapy In order to provide physical therapy without a prior referral, a physical therapist must meet the requirements of Tenn. Code Ann. All included studies involved an outpatient orthopedic practice environment, so other practice areas were under-represented. PDF Originally published online September 12, 2013 - APTA Wi (PDF) Direct Access To Physical Therapy Services Is Safe in a Included articles were hand searched for additional references. Direct Access Compared With Referred Physical Therapy Episodes of Care , Webster V, McFadyen A. Webster SH 2022 Apr 12;19(8):4620. doi: 10.3390/ijerph19084620. Mitchell and de Lissovoy9 found that paid claims per episode of care were $1,232 less in the direct access group for all services and drugs per episode of physical therapy care (P<.001). Benefits of Telemedicine. Epub 2013 Sep 12. Criteria 17 and 27 were omitted due to reasons explained in the Quality Assessment section. Wand G Physical Therapy is the one of the most important thing a person may need when recovering from an injury or disease. A point was awarded unless the effect of the main confounders was not investigated or confounding was demonstrated, but no adjustment was made in the final analyses. JM Despite . Results: Moore and colleagues10 retrospectively compared harm between direct access and physician referral groups. One reason for this limitation is that most third-party payers do not compensate physical therapists for evaluation and management of patients who self-refer for physical therapy. In addition, direct access is unrecognized as a covered route of access to physical therapy in the United States at the federal level. Findings include the influence of direct access on the health care system: cost-benefit analysis, advantages and challenges, as well as the perspective of main stakeholders: physicians, physical therapists and patient-clients. Starting September 1, 2019, it will be easier to get Physical Therapy in Texas, thanks to local San Antonio State Representative, Ina Minjarez (D) who drafted HB29, a handful of other State Reps who co-sponsored the bill, the Texas Medical Association, and the Texas Orthopedic Association.

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