Academic journal article Journal of Allied Health

Direct Access to Physical Therapy Services Is Safe in a University Student Health Center Setting

Academic journal article Journal of Allied Health

Direct Access to Physical Therapy Services Is Safe in a University Student Health Center Setting

Article excerpt

OBJECTIVES: The purpose of this retrospective descriptive study was to determine if direct access to physical therapy (PT) in a university health center placed patients at risk for adverse events. BACKGROUND: Direct access to PT is underutilized, even though it has been reported to reduce medical costs; however, there is a paucity of evidence on the clinical risks related to this practice. METHODS: The University of Colorado at Boulder instituted a direct access musculoskeletal injury clinic in 2000. A retrospective analysis was performed on patient visits to Wardenburg Student Health Center from January 1, 2001 to December 31, 2011. Descriptive statistics were analyzed for the number of new patients examined with and without a referral, documented patient adverse events, and any disciplinary or legal action against a physical therapist. RESULTS: During the 10-year data collection period, 12,976 patients accessed PT without a referral. There were no reported unidentified cases of serious medical pathology or adverse events and none of the PTs had their credentials or licenses modified or revoked for disciplinary action. CONCLUSIONS: Patients managed through direct access are at minimal to no risk for negligent care when evaluated and treated by PTs in a university student health center setting. J Allied Health 2015; 44(3):164- 168.

DIRECT ACCESS to physical therapy (PT) has been shown to reduce medical costs, lost time from work, number of visits per episode of care, episodes of recurrence, images ordered, and pharmacological intervention and results in greater patient satisfaction.1-8 Direct access to PT is available in some form in all 50 states, with many states still restricting direct access based on PT qualifications, specializations, or condition/diagnostic codes.9 Starting in 1957, Nebraska was the first state to receive direct access. More recently, Indiana became the 50th state to receive the privileges of direct access. Many practice settings require referrals from medical providers for reimbursement from third-party payers, legal constraints, and hospital bylaws, thus limiting the ability of a PT to provide autonomous care for patients.9 Direct access continues to be underutilized as the majority of PT practices report that less than 10% of their episodes of care occur without a referral.10-12

Medical providers have expressed concerns about patient safety, and several professional associations have spoken out against patients having direct access to PT care. For example, the American Academy of Orthopedic Surgeons, on the issue of direct access to PT, has stated: "Physical therapists (PTs) are educated to provide physical therapy treatment for conditions, while medical doctors have a more extensive and broader education and training ... physicians are trained to make these medical diagnoses while physical therapists are not."13 Recently, California Senate Bill 924 passed allowing PTs limited direct access. This bill was opposed by the California Chiropractic Association, California Medical Association, California Orthopaedic Association, and California Society of Anesthesiologists. The California Chiropractic Association stated in its opposition that "physical therapists are not trained to recognize conditions in which a referral is necessary which puts the patient at risk."14

While the body of research supporting the use of direct access is growing, little is known about the risk of examining and treating patients using this model. PTs are highly trained in the examination and treatment of patients with musculoskeletal disorders.1,4,15,16 Child's et al.15 reported that PTs outperformed all physician spe- cialty groups except orthopedic surgeons on a standardized knowledge test for the management of musculoskeletal conditions. Internationally, PT for musculoskeletal disorders has been reported to be more beneficial than usual care by physicians in terms of diagnostic accuracy, treatment effectiveness, use of healthcare resources, economic costs, and patient satisfaction, with many of these PTs trained with only a bachelor's or master's degree. …

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