General practitioner referral to physiotherapy
Many interventions are amenable to physiotherapy interventions. The Physiotherapy Evidence Database (PEDro.org.au) now indexes over 40,000 randomised trials, systematic reviews and evidence-based clinical practice guidelines. This evidence spans a broad range of conditions from musculoskeletal, cardiorespiratory and neurological to women's health, paediatrics and geriatrics.
In Australia, people can attend a physiotherapist without a referral from a GP. Despite this, Australians who attend a physiotherapist are becoming less likely to self refer and more likely to attend a physiotherapist after referral by a medical general practitioner (GP). It is therefore timely to consider whether GPs are referring on those patients with conditions that are amenable to physiotherapy.
A new study has analysed from the Bettering the Evaluation and Care of Health (BEACH) study, which is a national observational study of Australian GP clinical activity. The authors analysed over 750,000 GP-patient appointments and subsequent referrals, from which there were about 7000 referrals to a physiotherapist.
The health problems that were most commonly referred were back complaints, sprains and osteoarthritis. This is mainly due to the prevalence of these conditions, not because these conditions are particularly likely to be referred when they do present. Among these conditions and most others, the proportion of people who were referred when they presented with any condition amenable to physiotherapy was below 20% - often far below.
2 minor exceptions were some relatively infrequent health problems that were more likely to be referred on the few occasions when they did present: limited function/ disability during pregnancy had a 40% likelihood of referral and post-partum symptoms/ complaints had a 20% likelihood of referral.
Overall, most referrals made to physiotherapists were for musculoskeletal problems. However, even among the most commonly referred problems (such as back complaints and osteoarthritis), the likelihood of referral was low, especially when they presented as a new problem.
There is an opportunity to increase referrals from general practice to physiotherapy for many common conditions with effective physiotherapy interventions.
Want to read deeper into this topic? Have a look at the free full text version of this article published in Journal of Physiotherapy!
> From: Dennis et al., J Physiother 64 (2018) 178-182. All rights reserved to the Australian Physiotherapy Association. Click here for the online summary.