Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK.
Midlands Partnership University NHS Foundation Trust, Newcastle under Lyme, Staffordshire, ST5 2BQ, UK.
BMC Health Serv Res. 2024 Sep 19;24(1):1095. doi: 10.1186/s12913-024-11585-w.
Delegation of clinical tasks from physiotherapists to physiotherapy support workers is common yet varies considerably in musculoskeletal outpatient physiotherapy services, leading to variation in patient care. This study aimed to explore patients' preferences and estimate specific trade-offs patients are willing to make in treatment choices when treated in musculoskeletal outpatient physiotherapy services.
A discrete choice experiment was conducted using an efficient design with 16 choice scenarios, divided into two blocks. Adult patients with musculoskeletal conditions recruited from a physiotherapy service completed a cross-sectional, online questionnaire. Choice data analyses were conducted using a multinomial logit model. The marginal rate of substitution for waiting time to first follow-up physiotherapy appointment and distance from the physiotherapy clinic was calculated and a probability model was built to estimate the probability of choosing between two distinct physiotherapy service options under different scenarios.
382 patient questionnaires were completed; 302 participants were treated by physiotherapists and 80 by physiotherapists and support workers. There was a significant preference to be seen by a physiotherapist, have more follow-up treatments, to wait less time for the first follow-up appointment, to be seen one-to-one, to see the same clinician, to travel a shorter distance to get to the clinic and to go to clinics with ample parking. Participants treated by support workers did not have a significant preference to be seen by a physiotherapist and it was more likely that they would choose to be seen by a support worker for clinic scenarios where the characteristics of the physiotherapy service were as good or better.
Findings highlight that patients treated by support workers are likely to choose to be treated by support workers again if the other service characteristics are as good or better compared to a service where treatment is provided only by physiotherapists. Findings have implications for the design of physiotherapy services to enhance patient experience when patients are treated by support workers. The findings will contribute to the development of "best practice" recommendations to guide physiotherapists in delegating clinical work to physiotherapy support workers for patients with musculoskeletal conditions.
在肌肉骨骼门诊物理治疗服务中，将临床任务从物理治疗师委派给物理治疗支持人员是很常见的，但变化很大，导致患者护理的变化。本研究旨在探讨患者的偏好，并估计患者在接受肌肉骨骼门诊物理治疗服务时在治疗选择方面愿意做出的具体权衡。
使用具有 16 个选择情景的高效设计进行离散选择实验，分为两个块。从物理治疗服务中招募的患有肌肉骨骼疾病的成年患者完成了一项横断面在线问卷调查。使用多项逻辑回归模型对选择数据进行分析。计算了首次随访物理治疗预约和距离物理治疗诊所的等待时间的边际替代率，并建立了一个概率模型，以估计在不同情况下选择两种不同物理治疗服务选项之间的概率。
完成了 382 份患者问卷；302 名参与者由物理治疗师治疗，80 名由物理治疗师和支持人员治疗。患者明显更喜欢由物理治疗师治疗，接受更多的后续治疗，等待第一次随访预约的时间更少，一对一就诊，由同一临床医生就诊，去诊所的路程更短，去有充足停车位的诊所。由支持人员治疗的参与者没有明显的偏好由物理治疗师治疗，如果其他服务特征与由物理治疗师提供治疗的服务一样好或更好，他们更有可能选择由支持人员治疗。
研究结果表明，如果其他服务特征与仅由物理治疗师提供治疗的服务一样好或更好，由支持人员治疗的患者可能会再次选择由支持人员治疗。这些发现对设计物理治疗服务以增强患者体验具有启示意义，当患者由支持人员治疗时。这些发现将有助于制定“最佳实践”建议，指导物理治疗师将临床工作委派给物理治疗支持人员，为患有肌肉骨骼疾病的患者提供治疗。
