Determining priority of access to physiotherapy at Victorian community health services

Abstract

Prioritisation of clients requesting physiotherapy in Victorian community health services has occurred in the absence of a uniform evidence-based prioritisation process. The effect of the varying prioritisation procedures on client outcomes is unknown. This two-part study sought to answer two questions: what are the current prioritisation practices? And what is the evidence for prioritisation? Staff of Victorian community health services offering physiotherapy (n = 67) were sent a structured questionnaire regarding their prioritisation practices. The questionnaire data revealed a wide range of poorly defined criteria and methods of assessment for prioritisation. The evidence for prioritisation and the use of specific prioritisation criteria were examined via a literature search. The literature suggested the use of acute severe pain, interference with activities of daily living and falls as indicators of need for priority service. The lack of uniformity found in determining priority of access reflects the complexity of determining need and the lack of research and validated tools to assist decision making. Further research into prioritisation criteria is required to determine their validity and if their use in a prioritisation tool would actually improve outcomes for clients. What is known about the topic? Although there is some research on medical prioritisation of clients awaiting surgery little is known about prioritisation practices in allied health in general and physiotherapy in particular. There is also little known about client outcomes when clients are either not prioritised or have been incorrectly prioritised. The literature provides expert opinion on the potential usefulness of prioritisation criteria in determining client need. What does this paper add? This paper highlights the discrepancy between the various poorly defined and complex physiotherapy prioritisation practices that occurred in Victorian Community Health Services at the time of the study and the literature regarding the assessment of need. The underpinning evidence base for uniform prioritisation criteria is explored. Further research is required into the risks and effect on client outcomes of prioritisation. What are the implications for practitioners? Although practitioners, in the absence of any guidelines, have developed their own prioritisation protocols, the Victorian Department of Health has recently mandated the use of a uniform community health prioritisation procedure for physiotherapy and other allied health services, developed from the findings of this research. This study provides practitioners with an understanding of the evidence base for prioritisation criteria and approaches for assessing criteria in practice.