Abstract
Purpose
The introduction of alternate care provider roles is at the forefront of many new health human resource strategies and is one of the key approaches in reducing orthopaedic wait times in Canada. The present study was part of a formal evaluation of an expanded role for physiotherapists which included referral triage, comprehensive assessment and development of a management plan and post-surgical follow-ups. Specifically, we examined the efficacy and role of an Advanced Practice Physiotherapist (APP) with respect to reduction in wait times to care for patients with shoulder complaints referred to an orthopaedic surgeon with subspecialty in shoulder reconstruction.
Method
We used data of 100 consecutive patients seen by an APP in 2010 to examine the following: 1) type of diagnosis, 2) number of new investigations ordered, percentage of patients who needed a consultation with the surgeon, 3) and indication for surgery. Patients who were sent for a second surgical opinion, had a failed surgery in the affected side, had a motor vehicle accident or were a surgical candidate for stabilization or superior labral repairs were not included in the study and were directly booked for the orthopaedic surgeon. To compare change in waiting times, a random sample of 100 charts of patients seen in 2008 by an orthopaedic surgeon with a subspecialty in shoulder reconstruction were reviewed. The following time frames were compared between the surgeon and APP: T1: time from date of referral to date of consultation, T2: time from date of consultation to date of final diagnostic test, T3: time from date of consultation to confirmed diagnosis. Parametric and non-parametric analyses were performed as indicated by the distribution of data.
Results
The highest pathologies managed by the APP were rotator cuff pathology, osteoarthritis, impingement syndrome, and adhesive capsulitis. The number of investigations ordered was 9%, 12%, and 85% for Magnetic Resonance Imaging, Ultrasound, and plain x-rays respectively. Forty four patients (44%) were referred to the surgeon of which, 10 had a subacromial injection, 17 required surgery and 13 required the surgeons opinion/input. There was a statistically significant difference between the surgeon and APP in all three time points (T1: p=0.02, T2: p=0.02, T3: p=0.007). The APP had shorter wait times despite the fact that patients seen by the APP were actually chosen from the surgeons long waiting list.
Conclusion
The extended role is a viable strategy for reducing waiting times and freeing surgeons time by providing care to patients who do not require surgery or those who have an uncomplicated post-surgical recovery.
