Matifat E, Perreault K, Roy J-S, Aiken A, Gagnon E, Mequignon M, Lowry V, Décary S, Hamelin B, Ambrosio M, Farley N, Pelletier D, Carlesso L, Desmeules F
Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montréal, Québec, Canada.
CIUSSS Est-de-l'Île-de-Montréal, Québec, Canada.
BMC Emerg Med. 2019 Nov 10;19(1):67. doi: 10.1186/s12873-019-0277-7.
Overcrowding in emergency departments (ED) is a major concern worldwide. To answer increasing health care demands, new models of care including advanced practice physiotherapists (APP) have been implemented in EDs. The purpose of this study was to assess diagnostic, treatment and discharge plan concordance between APPs and ED physicians for patients consulting to the ED for minor musculoskeletal disorders (MSKD).
Patients presenting to two EDs in Montréal (Canada) with a minor MSKD were recruited and independently assessed by an APP and ED physician. Both providers had to formulate diagnosis, treatment and discharge plans. Cohen's kappa (κ) and Prevalence and Bias Adjusted Kappas (PABAK) with associated 95%CI were calculated. Chi Square and t-tests were used to compare treatment, discharge plan modalities and patient satisfaction between providers.
One hundred and thirteen participants were recruited, mean age was 50.3 ± 17.4 years old and 51.3% had an atraumatic MSKD. Diagnostic inter-rater agreement between providers was very good (κ = 0.81; 95% CI: 0.72-0.90). In terms of treatment plan, APPs referred significantly more participants to physiotherapy care than ED physicians (κ = 0.27; PABAK = 0.27; 95% CI: 0.07-0.45; p = 0.003). There was a moderate inter-rater agreement (κ = 0.46; PABAK = 0.64; 95% CI: 0.46-0.77) for discharge plans. High patient satisfaction was reported with no significant differences between providers (p = 0.57).
There was significant agreement between APPs and ED physicians in terms of diagnosis and discharge plans, but more discrepancies regarding treatment plans. These results tend to support the integration of APPs in ED settings, but further prospective evaluation of the efficiency of these types of models is warranted.
急诊科过度拥挤是全球主要关注的问题。为了应对不断增长的医疗保健需求，包括高级实践物理治疗师（APP）在内的新型护理模式已在急诊科实施。本研究的目的是评估因轻度肌肉骨骼疾病（MSKD）到急诊科就诊的患者，APP与急诊科医生之间在诊断、治疗和出院计划方面的一致性。
招募到加拿大蒙特利尔两家急诊科就诊的患有轻度MSKD的患者，并由一名APP和一名急诊科医生进行独立评估。两位医护人员都必须制定诊断、治疗和出院计划。计算科恩kappa系数（κ）以及患病率和偏差调整kappa系数（PABAK）及其相关的95%置信区间。使用卡方检验和t检验比较医护人员之间的治疗、出院计划方式以及患者满意度。
招募了113名参与者，平均年龄为50.3±17.4岁，51.3%患有非创伤性MSKD。医护人员之间的诊断评分者间一致性非常好（κ = 0.81；95%置信区间：0.72 - 0.90）。在治疗计划方面，APP将更多参与者转诊至物理治疗护理，这一比例显著高于急诊科医生（κ = 0.27；PABAK = 0.27；95%置信区间：0.07 - 0.45；p = 0.003）。出院计划的评分者间一致性为中等（κ = 0.46；PABAK = 0.64；95%置信区间：0.46 - 0.77）。报告显示患者满意度较高，医护人员之间无显著差异（p = 0.57）。
APP与急诊科医生在诊断和出院计划方面存在显著一致性，但在治疗计划方面存在更多差异。这些结果倾向于支持将APP纳入急诊科设置，但有必要对这类模式的效率进行进一步的前瞻性评估。
