在澳大利亚初级医疗保健中，针对肌肉骨骼疾病患者，近期毕业的和经验丰富的物理治疗师的转诊实践。

Referral practices of recent graduate and experienced physiotherapists working in Australian primary care for people with musculoskeletal conditions.

机构信息

Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.

Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, The University of Sydney, St Leonards, New South Wales, Australia.

出版信息

Musculoskelet Sci Pract. 2023 Apr;64:102745. doi: 10.1016/j.msksp.2023.102745. Epub 2023 Mar 11.

DOI:10.1016/j.msksp.2023.102745

PMID:36924580

Abstract

BACKGROUND

People with musculoskeletal conditions often seek care from physiotherapists. Some, particularly those at risk of poor outcomes, may benefit from referral to physiotherapists with expertise in managing musculoskeletal conditions and/or multidisciplinary care. Understanding referral practices of physiotherapists, and how experience influences those practices, may assist in implementing optimal care pathways in primary care.

AIMS

Explore (i) current referral practices of recent graduate and experienced physiotherapists who manage musculoskeletal conditions; (ii) opinions about referral to specialist physiotherapists for people at risk of poor outcomes.

METHODS

This qualitative study consisted of 23 semi-structured interviews with recent graduate (n = 9) and experienced physiotherapists (n = 14) working in primary care. Perspectives of participants' current referral practices (to whom, when and why they are referred) and referral to specialist physiotherapists were sought. Interviews were recorded and transcribed verbatim prior to analysis.

RESULTS

Referral practices for both groups were influenced by specific diagnoses, complexity of presentations, confidence, self-awareness, the clinical environment and system-related factors. Experienced physiotherapists were more confident and specific in their referrals and had established trusted networks compared with new graduates. Early referral to specialist physiotherapists was more likely when therapists were co-located. Barriers to early referral were lack of awareness, health system factors and impact on the patient (e.g., financial, time, continuity of care).

CONCLUSION

Understanding factors influencing referral decisions may improve both intra- and interprofessional care for people with musculoskeletal conditions. Referral of people at risk of poor outcomes to specialist physiotherapists may be improved by greater intraprofessional awareness and clarity of roles.

摘要

背景

患有肌肉骨骼疾病的人经常向物理治疗师寻求治疗。一些人，特别是那些预后不良风险较高的人，可能会受益于转介给擅长管理肌肉骨骼疾病和/或多学科治疗的物理治疗师。了解物理治疗师的转诊实践以及经验如何影响这些实践，可能有助于在初级保健中实施最佳护理途径。

目的

探讨（i）管理肌肉骨骼疾病的应届毕业生和经验丰富的物理治疗师目前的转诊实践；（ii）对向预后不良风险较高的患者转介给专科物理治疗师的看法。

方法

这项定性研究包括对 23 名在初级保健中工作的应届毕业生（n=9）和经验丰富的物理治疗师（n=14）进行了 23 次半结构化访谈。寻求参与者当前转诊实践（向谁、何时以及为何转诊）和向专科物理治疗师转诊的观点。对访谈进行了录音，并在分析之前逐字记录下来。

结果

两组的转诊实践都受到特定诊断、表现的复杂性、信心、自我意识、临床环境和系统相关因素的影响。经验丰富的物理治疗师在转诊方面更加自信和具体，并且与新毕业生相比，他们已经建立了可信赖的网络。当治疗师在同一地点工作时，更有可能早期向专科物理治疗师转诊。早期转诊的障碍包括缺乏意识、卫生系统因素和对患者的影响（例如，经济、时间、护理连续性）。