O'Cathain A, Froggett M, Taylor M P
Department of Physiotherapy, Doncaster Royal Infirmary.
Br J Gen Pract. 1995 Jul;45(396):352-4.
In November 1992, a pilot scheme was established in Doncaster to provide an on-site physiotherapy service in six non-fundholding general practices covering a population of approximately 44,000 people.
The aim of the pilot scheme was to transfer a hospital-based physiotherapy service, to which general practitioners had direct access, to a primary care setting and to reduce referrals to an orthopaedics outpatient department.
Use of physiotherapy services and referrals to orthopaedics and rheumatology before and during the first year of the scheme were monitored. Comparisons were made with data over the same time periods for general practices that were not in the scheme. The location of management of patients referred to physiotherapy was monitored for an eight-month period during the scheme.
In the first year the scheme had a utilization rate of 31 per 1000 patients in the participating practices, representing a 164% increase over the hospital-based physiotherapy utilization rate for the year prior to the scheme. Eight per cent of physiotherapy patients received hospital-based treatment during the scheme. Changes in hospital outpatient referral rates attributable to the scheme were reductions of 8% to the orthopaedics department and 17% to the rheumatology department.
The increase in the use of the physiotherapy service was possibly caused, in part, by general practitioners sending patients to on-site physiotherapy who previously would have been referred to orthopaedics and, largely, by an increase in the treatment of patients who previously would not have been referred to hospital. Physiotherapy based in general practice can be a substitute for hospital-based physiotherapy and can contribute to a reduction in referrals to orthopaedics and rheumatology outpatient departments. However, it can result in an increase in use of physiotherapy services.
1992年11月，唐卡斯特启动了一项试点计划，在六个非基金持有型全科诊所提供现场物理治疗服务，覆盖人口约44000人。
该试点计划的目的是将全科医生可直接使用的医院物理治疗服务转移到基层医疗环境，并减少骨科门诊转诊。
监测了该计划第一年前后物理治疗服务的使用情况以及骨科和风湿病科的转诊情况。与未参与该计划的全科诊所在同一时间段的数据进行了比较。在该计划实施期间，对转介接受物理治疗的患者的管理地点进行了为期八个月的监测。
在第一年，参与计划的诊所中该计划的利用率为每1000名患者31人次，比该计划实施前一年的医院物理治疗利用率增长了164%。在该计划实施期间，8%的物理治疗患者接受了医院治疗。该计划导致的医院门诊转诊率变化为骨科减少了8%，风湿病科减少了17%。
物理治疗服务使用量的增加，部分原因可能是全科医生将以前会转诊到骨科的患者送去接受现场物理治疗，很大程度上是因为以前不会转诊到医院的患者的治疗量增加了。基层医疗中的物理治疗可以替代医院物理治疗，并有助于减少骨科和风湿病科门诊的转诊。然而，这可能会导致物理治疗服务使用量的增加。
