Impact of the inter-professional team approach in the development of person-centered health care within an orthopaedic out-patient clinic

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Published: Sep 30, 2011
DOI: https://doi.org/10.5750/ijpcm.v1i3.112

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Stephen J Edmondston
Associate Professor of Musculoskeletal Physiotherapy, School of Physiotherapy & Curtin Health Innovation Research Institute, Curtin University, Western Australia
Stuart Waters
Senior Physiotherapist, Physiotherapy Department, Fremantle Hospital, Western Australia
Robyn Timms
Physiotherapist in Charge, Physiotherapy Department, Fremantle Hospital, Western Australia
Piers J Yates
Professor of Orthopaedic Surgery, University of Western Australia and Head of Orthopaedic Surgery Department, Fremantle Hospital, Western Australia.

Abstract

Rationale, aims and objectives: High demand for orthopaedic specialist consultation has resulted in long waiting lists in public hospital out-patient clinics. This prospective study with a retrospective cohort analysis was conducted to evaluate the impact of a combined orthopaedic surgeon and physiotherapy triage clinic on waiting time and outcome of the initial consultation.Methods: Two hundred and thirty-nine patients were assessed in the triage clinic, while the reference group consisted of 136 patients from the same catchment who attended the same outpatient clinic in the previous year. Comparisons in waiting list time and initial clinic outcome were conducted and patient satisfaction with the triage clinic was assessed through a questionnaire.Results: Mean waiting time over the first 6 weeks of the triage clinic was 10 weeks compared to 4 weeks over the final 6 weeks (p<0.05, 95%CI:1.0 to 11.0). The mean waiting time for the triage clinic patients was 8 (SD=6) weeks, compared to 12 (SD=11) weeks for the control group patients (p<0.0001, 95%CI:2.5 to 6.0). Clinic outcomes were not significantly different between groups (p=0.43-0.92). About one-third of all patients seen in the triage clinic were referred for further consultation with an orthopaedic surgeon (triage 32%, control 36%). Patients reported high levels of satisfaction with the triage clinic.Conclusion: An inter-professional triage clinic model can significantly reduce orthopaedic outpatient clinic waiting times. Two-thirds of patients attending the clinic were managed without direct consultation with an orthopaedic surgeon. Patient support for the triage clinic was strong based on satisfaction survey responses.

Article Details

Issue
Vol. 1 No. 3 (2011): September
Section
Regular Articles

References

The State of Our Public Hospitals. June 2009 report. Department of Health and Aging, http://www.health.gov.au/ahca

Hourigan, P.G. & Weatherley, C.R. (1994). Initial assessment and follow-up by a physiotherapist of patients with back pain referred to a spinal clinic. Journal of the Royal Society of Medicine 87, 213-214.

Oldmeadow, L., Bedi, H.S., Burch, H.T., Smith, J.S., Leahy, E.S. & Goldwasser, M. (2007). Experienced physiotherapists as gatekeepers to hospital orthopaedic outpatient care. Medical Journal of Australia 186, 625 – 628.

Blackburn, M.S., Cowan, S.M., Cary, B. & Nall, C. (2009). Physiotherapy-led triage clinic for low back pain. Australian Health Review 33, 663-670.

Draker-White, G., Carr, A.J., Harvey, I., Woolhead, G., Bannister, G., Nelson, I. & Kammerling, M. (1999). A randomised controlled trial. Shifting boundaries of doctors and physiotherapists in orthopaedic outpatient clinics. Journal of Epidemiology and Community Health 53, 643-650.

Weale, A.E. & Bannister, G.C. (1995). Who should see orthopaedic outpatients - physiotherapists or surgeons? Annals of the Royal College of Surgeons of England 77 (Supplement 2), 71-73.

Pearse, E.O., Maclean, A. & Bicketts, D.M. (2006). The extended scope physiotherapist in orthopaedic out-patients – an audit. Annals of the Royal College of Surgeons of England 88, 653-655.

Durrell, S. (1996). Expanding the scope of physiotherapy: clinical physiotherapy specialist in consultants’ clinics. Manual Therapy Journal 1, 210-213.

D’Amour, D., Ferrada-Videla, M, San Martin Rodriguez, L. & Beaulieu, M.D. (2005). The conceptual basis for inter-professional collaboration: core concepts and theoretical frameworks. Journal of Interprofessional Care 19 (Supplement 1), 116-131.

Redfern, S. & Christian, S. (2003). Achieving change in health care practice. Journal of Evauation in Clinical Practice 9, 225-238.

Hudak, P.L. & Wright, J.G. (2000). The characteristics of patient satisfaction measures. Spine 25, 3167-3177.

Gasquet, I., Villeminot, S., Estaquino, C., Durieux, P., Ravaud, P. & Falissard, B. (2004). Construction of a questionnaire measuring outpatients’ opinion of quality of hospital consultation departments. Health Quality Life Outcomes 2, 43-56.

Thistlethwaite, J., Lee, A., Dunston, R., Nisbet, G., Matthews, L. & Pockett, R. (2009). Interprofessional developments in Australia - L-TIPP (Aus) and the Way Forward. Journal of Interprofessional Care 23, 315-317.

Zwarenstein, M. & Reeves, S. (2006). Knowledge translation and interprofessional collaboration: Where the rubber of evidence-based care hits the road of teamwork. Journal of Continuing Education in the Health Professions 26, 46–54.

Rogers, B.A., Kabir, C. & Bradley, N. (2008). An audit of orthopaedic referrals via multi-professional triage teams. Annals of the Royal College of Surgeons of England 90, 671–674.

Hattam, P. & Smeatham, A. (1999). Evaluation of an orthopaedic screening service in primary care. Clinical Performance and Quality Health Care 7, 121-124.

Rymaszewski, L.A., Sharma, S., McGill, P.E., Murdoch, A., Freeman, S. & Loh, T. (2005). A team approach to musculoskeletal disorders. Annals of the Royal College of Surgeons of England 87, 174-180.

Aharony, L. & Strasser, S. (1993). Patient satisfaction: what we know about and what we still need to explore. Medical Care Research and Review 50, 49-79.

Thompson, A.G. & Sunol, R. (1995). Expectations as determinants of patient satisfaction: concepts, theory, evidence. International Journal for Quality in Health Care 7, 127-141.

Neilsen, D.M., Gill, K. & Ricketts, D.M. (2005). Satisfaction levels in orthopaedic out-patients. Annals of the Royal College of Surgeons of England 87, 106-108.

Robarts, S., Kennedy, D., MacLeod, A.M., Findlay, H. & Gollish, J. (2008). A framework for the development and implementation of an advanced practice role for physiotherapists that improves access and quality of care for patients. Healthcare Quarterly 11, 67-75.

Weatherley, C.R. & Hourigan, P.G. (1998). Triage of back pain by physiotherapists in orthopaedic clinics. Journal of the Royal Society of Medicine 91, 377-379.

Baruch, Y. (1999). Response rate in academic studies - a comparative analysis. Human Relations 52, 421-438.