Reducing strain on primary healthcare systems through innovative models of care:the impact of direct access physiotherapy for musculoskeletal conditions—an interrupted time series analysis  

作　　者：James Henry Zouch Bjørnar Berg Are Hugo Pripp Kjersti Storheim Claire E Ashton-James Manuela L Ferreira Margreth Grotle Paulo H Ferreira 

机构地区：[1]Sydney Musculoskeletal Health,Faculty of Medicine and Health,The University of Sydney,Sydney,New South Wales,Australia [2]Centre for Intelligent Musculoskeletal Health,Oslo Metropolitan University Faculty of Health Sciences,Oslo,Norway [3]Oslo Metropolitan University Faculty of Health Sciences,Oslo,Norway [4]Oslo Centre of Biostatistics and Epidemiology,Oslo University Hospital,Oslo,Norway [5]Department of Rehabilitation Science and Health Technology,Oslo Metropolitan University Faculty of Health Sciences,Oslo,Norway [6]Department of Research and Innovation,Oslo University Hospital Division of Clinical Neuroscience,Oslo,Norway [7]Sydney Medical School,Kolling Institute,The University of Sydney Faculty of Medicine and Health,Sydney,New South Wales,Australia [8]The George Institute for Global Health,Sydney,New South Wales,Australia [9]Department of Research and Innovation,Oslo University Hospital,Oslo,Norway [10]Department of Rehabilitation and Technology,Oslo Metropolitan University Faculty of Health Sciences,Oslo,Norway [11]Charles Perkins Centre,Sydney Musculoskeletal Health,The University of Sydney Faculty of Medicine and Health,Sydney,New South Wales,Australia

出　　处：《Family Medicine and Community Health》2024年第3期1-12,共12页家庭医学与社区卫生（英文）

基　　金：funded by Norwegian Research Council(324915).

摘　　要：Objectives To evaluate the longitudinal impact of introducing a national,direct access physiotherapy model of care on the rates of primary and secondary care consultations for musculoskeletal(MSK)conditions.Design Interrupted time series analysis using segmented linear regression.Setting Norway primary care Participants A cohort of 82072 participants was derived from 3 population-based health surveys conducted across separate geographical regions in Norway.All participants surveyed were eligible for inclusion as a national representative sample of the Norwegian population.Registered MSK consultations were linked to the Norwegian Control and Payment of Health Reimbursement database and the Norwegian Patient Register using the International Classification of Primary Care diagnostic medical codes L-chapter for MSK conditions and spine related International Classification of Diseases,10th Revision,codes.Intervention Direct access to physiotherapy model of care introduced nationally in Norway in 2018.This model allowed Norwegians to consult directly with qualified physiotherapists for MSK conditions(eg,back pain,knee osteoarthritis)without the need for a medical referral in order to claim a social security reimbursement.Main outcomes measured Rates of primary care consultations per 10000 population(general practitioner(GP)and physiotherapist consultations)and secondary care(specialist consultations and surgical procedures)measured from 2014 to 2021.Results The introduction of the direct access physiotherapy model was associated with an immediate stepped reduction of 391 general practice consultations per 10000 population,(95%CI:−564 to−216),without an associated change in physiotherapy consultations.Subgroup analyses suggested there was an associated reduction in physiotherapy consultations for those in the lowest education group of 150 consultations per quarter(95%CI:−203 to−97),70 consultations per quarter in the intermediate education group(95%CI:−115 to−27)and a stepped reduction of 2 spinal surgical p

关 键 词：impact analysis STRAIN 

分 类 号：R68[医药卫生—骨科学]