Fennelly Orna, Blake Catherine, FitzGerald Oliver, Breen Roisin, O'Sullivan Cliona, O'Mir Marie, Desmeules François, Cunningham Caitriona
School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
Department of Rheumatology, St Vincent's University Hospital, Dublin, Ireland.
Musculoskeletal Care. 2018 Dec;16(4):425-432. doi: 10.1002/msc.1351. Epub 2018 Jun 21.
Since 2011, advanced practice physiotherapists (APPs) have triaged the care of patients awaiting orthopaedic and rheumatology consultant/specialist doctor appointments in Ireland. APP services have evolved across the major hospitals (n = 16) and, after 5 years, profiling and evaluation of APP services was warranted. The present study profiled the national musculoskeletal APP services, focusing on service, clinician and patient outcome factors.
An online survey of physiotherapists in the allocated APP posts (n = 25) explored: service organization; clinician profile and experience of the advanced role; and patient wait times and outcome measures. Descriptive statistics were used to analyse hospital- and clinician-specific data, and a content analysis was performed to explore APP experiences.
A 68% (n = 17) response from 13 sites was achieved, whereby 20 whole-time APP posts existed in services led by 91 consultant doctors. Co-location of APP and consultant clinics at 11 sites facilitated joint medical-APP processes, with between-site differences in autonomy to screen referral letters, and arrange investigations, injections and surgery. Although 83% had postgraduate qualifications, APPs also availed themselves of informal role-specific training. Positive APP experiences related to learning opportunities and clinical support networks but experiences were consultant dependent, with further service developments and formal training required to manage workloads. APPs reported reduced wait times and most commonly chose to capture function/disability in future evaluations.
Variances existed in the organizational design and operating of APP services. Although highly experienced and qualified, APPs welcomed additional formal training and support, due to the complex, more medical nature of APP roles. Further formal evaluation, capturing patient outcomes, is proposed.
自2011年以来，高级执业物理治疗师（APPs）一直在爱尔兰对等待骨科和风湿病顾问/专科医生预约的患者的护理进行分诊。APP服务已在各大医院（共16家）得到发展，5年后，对APP服务进行概况分析和评估很有必要。本研究对全国肌肉骨骼APP服务进行了概况分析，重点关注服务、临床医生和患者结果因素。
对分配到APP岗位的物理治疗师（共25名）进行在线调查，内容包括：服务组织；临床医生概况及高级角色的经验；患者等待时间和结果指标。使用描述性统计分析特定医院和临床医生的数据，并进行内容分析以探究APP的经验。
13个地点的回复率为68%（共17份），在由91名顾问医生主导的服务中共有20个全职APP岗位。11个地点的APP诊所与顾问诊所同处一处，促进了医疗-APP联合流程，在筛选转诊信、安排检查、注射和手术的自主权方面存在地点差异。尽管83%的APP拥有研究生学历，但他们也接受了非正式的特定角色培训。APP的积极经验与学习机会和临床支持网络有关，但经验因顾问而异，需要进一步的服务发展和正式培训来管理工作量。APP报告称患者等待时间减少，并且在未来评估中最常选择获取功能/残疾情况。
APP服务的组织设计和运营存在差异。尽管APP经验丰富且资质合格，但由于APP角色具有复杂性和更强的医疗性质，他们欢迎更多的正式培训和支持。建议进行进一步的正式评估，以获取患者结果。
