Barriers to Rehabilitation in Primary Health Care in Ontario: Funding and Wait Times for Physical Therapy Services

Abstract

Purpose: The purpose of this study was to examine barriers to accessing physical therapy (PT) services in Ontario primary health care with respect to funding sources and wait times. Methods: A stratified random sample of 1100 registered Ontario PTs and 3000 Ontario family physicians were surveyed by mail in 2004. Relationships were examined between PT wait times, funding source, geographical region and caseload composition. Results: Physicians identified the cost of private rehabilitation and long wait times as the most common barriers to referring patients to rehabilitation. Wait times for PT were longer in publicly funded settings than in privately funded practice settings (p, 0.001) and in the North (p, 0.001) and East (p 5 0.010) regions of Ontario compared with the most urban region of Ontario. Patients with chronic musculoskeletal conditions, cardiopulmonary conditions and general debility were at least three times more likely to receive PT services at publicly funded than privately funded practice settings. Furthermore, patients with acute musculoskeletal conditions were less likely to receive PT services in publicly funded practice settings (odds ratio 5 0.11, 95% confidence interval 5 0.05-0.23). Conclusions: Current Ontario health-care structures may affect access to PT services for vulnerable populations such as those with chronic conditions, those lacking private health insurance and those living in less urban regions of Ontario.