Academic journal article Australian Health Review

Determining Priority of Access to Physiotherapy at Victorian Community Health Services

Academic journal article Australian Health Review

Determining Priority of Access to Physiotherapy at Victorian Community Health Services

Article excerpt

Introduction

Demand is high for low-cost allied health services in the Victorian primary care setting. In 2005 there was a median waiting time of 20 days for physiotherapy services in metropolitan Victorian community health centres (Victorian Department of Human Services, Primary and Community Health Branch, Demand Management Survey 2005, unpubl. data). In the absence of a sector-agreed process for prioritisation, individual community health services (CHS) have employed a range of approaches to waiting list management that include the first come-first served approach, and risk assessment and prioritisation based on professional judgment or formalised prioritisation tools. The variation in practice reflects a lack of information in the physiotherapy literature regarding the criteria that should be considered when allocating priority to physiotherapy clients.

It is unknown what effect the differing prioritisation practices have on the longer term outcome for the client while they are on waiting lists. However, the development of varied prioritisation protocols reflects the recognition of the risk of delaying access to service for clients who may deteriorate while on a waiting list.

The potential benefit of using an agreed set of prioritisation criteria, based on best available evidence, may be in the timely delivery of services to those in greatest need across the sector. Developments in service coordination in the Victorian community health sector mean that a range of staff with varying qualifications perform needs identification and service prioritisation. The need has arisen for a standardised evidence-based approach to client prioritisation.

There are three main ethical approaches to the general management of waiting list demand:first come-first served, priority on the basis of clinical need and priority on the basis of ability to benefit. In a discussion on the ethical dilemmas physiotherapists face when making decisions about who to treat, Purtilo1 highlights that the 'first come, first served' approach to service access is only equitable if patients' conditions or needs are comparable. As presenting conditions vary greatly, some form of prioritisation of patients is required. The determination of 'capacity to benefit' at the service prioritisation level and without a comprehensive assessment of the client's problem would be extremely difficult. Therefore prioritisation of physiotherapy clients based on need is the most ethical approach. This stance is consistent with the literature on the ethics of medical prioritisation.2

The study described in this paper seeks to address the following question:

'Is an evidence-based approach to physiotherapy prioritisation used in Victorian community health services?'

The two specific research questions are:

1. What are current practices and what are the criteria commonly used for physiotherapy prioritisation in Victorian CHS?

2. What is the evidence for prioritisation practices in health and the use of specific prioritisation criteria for physiotherapy services?

Method

Part one of the study that investigated current physiotherapy prioritisation practices utilised a mailed questionnaire. The structured questionnaire required respondents to provide detail of:

* The qualifications of staff conducting prioritisation

* The categories for priority to physiotherapy and waiting times for service

* The criteria used to assess priority and their method of assessment

The questionnaire was developed by the researchers and piloted with four CHS to obtain feedback on the questionnaire design, and modifications were made accordingly. The questionnaire was able to identify different prioritisation practices of individual staff at a site or service.

All Victorian CHS were approached to be involved in the study. Those CHS that prioritised physiotherapy clients were then sent the questionnaire. Victorian CHS are either independently managed or primary care departments of hospitals or regional health services. …

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