Background & Aims

Access to primary care and evidence-based pain management is a global challenge. When people lack access to care elsewhere, the burden is often experienced in Emergency Departments (EDs) [1], where patients and providers experience overcrowding and long wait times[2]. Musculoskeletal pain conditions are among the most common reasons for presenting to EDs and physicians are typically the first point of contact. New models of care where physiotherapists are first-contact practitioners and collaborate with the ED team when needed for musculoskeletal pain conditions have the potential to improve patient outcomes, reduce wait times, and offload other HCPs[3,4]. This research aimed to explore the experiences of patients with musculoskeletal pain and their health professionals with an advanced practice physiotherapy model of care in an emergency department in Ontario, Canada.

Methods

We conducted a sequential explanatory mixed methods study in two phases with two participant groups. Phase 1 was two cross-sectional surveys to explore the acceptability, satisfaction, and perceived value of the advanced practice model from the perspective of patients and healthcare providers who participated in the new model of care. Phase 2 was a follow-up semi-structured interview with a subset of the patients and providers to capture deeper meanings of patient and provider experiences.

Results

191 patients completed the patient survey (54% women, 55% men) with a mean age of 44 (SD:18). 12 healthcare providers completed the provider survey (10 women, 2 men; 6 physicians, 6 nurses). 91% of patients were satisfied with the treatment they received and 83% perceived that they spent a reasonable amount of time in the UCC. 10/12 (83%) providers agreed or strongly agreed that the model of care improved emergency department efficiency, 10/12 (83%) agreed or strongly agreed that the effectiveness of care was improved.

Interviews were conducted with 13 patients and 7 providers. Themes included improved access to PT, valuable collaboration between PT and physicians, and reduction in time spent in the ED. The potential worry about not getting diagnostic imaging and challenges maintaining patient confidentiality in the presence of space limitations negatively impacted experiences of patient. Providers saw opportunities to improve efficiency through role and process clarification.

Conclusions

Advanced practice physiotherapy models of care in emergency departments have the potential to improve the care and experiences of patients and providers with musculoskeletal pain; however, some challenges need to be addressed to improve patient and provider experiences with this model of care.

References

[1]Vidal Carret ML, Gastal Fassa AC, Rodrigues Domingues M. Inappropriate use of emergency services: a systematic review of prevalence and associated factors. Cad Saude Publica 2009;25(1):7-28.
[2]Varver C. Emergency departments are in crisis now and for the foreseeable future. CMAJ 2023, 195 (24): E851-E852.
[3]Desmeules, F., Roy, JS., MacDermid, J.C. et al. Advanced practice physiotherapy in patients with musculoskeletal disorders: a systematic review. BMC Musculoskelet Disord 2012; 13, 107.
[4]Lafrance, S., Demont, A., Thavorn, K. et al. Economic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses. BMC Health Serv Res 2021; 21, 1214.

Presenting Author

Jordan Miller

Poster Authors

Jordan Miller, BSc, MSc, PhD

PhD

Queen’s University

Lead Author

E-mail

Andrews Tawiah

Western University

Lead Author

E-mail

Mir Sanim Al Mamun

MSc

Queen's University

Lead Author

E-mail

Chad McClintock

Queen's University

Lead Author

E-mail

Amelie Kechichian

Université Grenoble Alpes

Lead Author

E-mail

Francois Desmeules

University of Montreal

Lead Author

E-mail

Robert Brison

Queen's University

Lead Author

E-mail

Topics

  • Access to Care