Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands.
Department of Human Movement Sciences, Faculty of Behavioral & Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands.
BMC Health Serv Res. 2022 Apr 21;22(1):529. doi: 10.1186/s12913-022-07906-6.
Despite the increased deployment and added value of Advanced Practitioner Physiotherapy (APP) in musculoskeletal care internationally, APP is not yet widely accepted within Dutch primary care. This may be due to specific constraints in the implementation of APP within the Dutch healthcare system. This study aimed to explore the experiences and perceptions of Advanced Practitioner Physiotherapists (APPs) and General Practitioners (GPs) with respect to implementing APP within Dutch primary care.
This explorative and interpretive qualitative study included 12 APPs and 3 GPs who were in various stages of implementing an APP care model. Semi-structured interviews were conducted between January and March 2021. The topic list was based on existing literature, the personal input of researchers, and the Constellation Approach framework. Data were analysed using a thematic inductive approach.
Four main themes emerged from the data; 1) Both GPs' trust in APP and a clear added value of APP are critical for starting implementation, 2) APPs need continuous support from GPs, 3) APPs believe that their position needs strengthening, and 4) Implementation of the APP model creates tension over ownership. These four themes highlight the perceived difficulties in gaining trust, lack of clarity over the added value of APP, ambiguity over APPs' professional profile and positioning, a need on behalf of GPs to maintain authority, lack of reimbursement structure, and the struggle APPs face to strike a balance with current care.
This study demonstrates that implementing an APP model of care is challenging, in part, because the deployment of APP does not sufficiently align with the core values of GPs, while GPs appear reluctant to hand over control of elements of patient care to APPs. APPs do not appear to have ownership over the implementation, given their strong dependence on the practice, values and needs of GPs.
Ethical approval was obtained from the Medical Ethics Committee of VU University Medical Centre in Amsterdam; reference number 2020.17 . All participants were asked to provide written informed consent prior to participating in the study.
尽管高级实践物理治疗师（APP）在国际肌肉骨骼护理中的部署增加并增加了价值，但在荷兰初级保健中，APP 尚未广泛被接受。这可能是由于荷兰医疗保健系统中 APP 的实施存在特定限制。本研究旨在探讨 APP 和全科医生（GP）在荷兰初级保健中实施 APP 方面的经验和看法。
这是一项探索性和解释性的定性研究，包括 12 名 APP 和 3 名 GP，他们处于实施 APP 护理模式的不同阶段。2021 年 1 月至 3 月期间进行了半结构化访谈。主题清单基于现有文献、研究人员的个人投入和星座方法框架。使用主题归纳方法对数据进行分析。
数据中出现了四个主要主题；1）GP 对 APP 的信任和 APP 的明确附加值对于启动实施至关重要，2）APP 需要 GP 的持续支持，3）APP 认为他们的职位需要加强，4）实施 APP 模式会导致所有权紧张。这四个主题突出了获得信任的困难、APP 附加值不明确、APP 专业形象和定位的模糊性、GP 维护权威的需要、缺乏报销结构以及 APP 努力在当前护理和平衡之间取得平衡。
本研究表明，实施 APP 护理模式具有挑战性，部分原因是 APP 的部署与 GP 的核心价值观不完全一致，而 GP 似乎不愿意将患者护理的某些元素交给 APP。由于 APP 对实践、价值观和 GP 需求的强烈依赖，他们似乎对实施没有所有权。
阿姆斯特丹 VU 大学医学中心的医学伦理委员会获得了伦理批准；编号 2020.17。所有参与者在参与研究之前均被要求提供书面知情同意书。
