The effects of triaging patients with musculoskeletal disorders directly to physiotherapists in primary care.

Problem

Many patients seek primary care for medical issues which could be handled, even initially, by other professions than physicians. Patients with musculoskeletal disorders are often handled appropriately and independently by physiotherapists. However, many patients with such disorders continue to seek help of physicians first. Based on the hypothesis that nurses have the medical competence to distinguish those patients who have greater need of physiotherapists than physicians, the aims of the study are to determine whether there are any differences regarding health aspects, health care utilization and sick-leave due to musculoskeletal disorders depending on whether a patient has first contact with physiotherapist or physician after initial nurse triaging. Nurse triaging has been examined earlier within the research group, as have the effects on utilization of medical services after triaging to physiotherapists. Both have shown positive results.

Approach

A randomized controlled trial is underway in which nurses at primary care clinics randomize those patients, whom they have judged to be appropriate for initial treatment by a physiotherapist, to a first visit with either a physiotherapist or a physician. Participants fill in various questionnaires regarding health, pain and disability before the initial visit and at 4 follow-up times during the following year. They are also given a health-care utilization diary in which they record visits to health-care professionals, referrals, prescriptions and sick-leave. The intervention involves only the randomization to the first visit. The physiotherapists and physicians who treat the patients are blinded as to which patients participate in the study and are free to plan treatment together with the patient as they judge appropriate for the individual situation.

Findings

As yet, only preliminary results are available. Participants continue to be recruited to the study, while others have not yet been followed for a whole year. Already a significant difference can be measured regarding disability, with those patients who have been randomized to physiotherapists having a more favourable outcome. Further preliminary results regarding other variables will be presented at the conference.

Consequences

Earlier studies have shown advantages for the health-care organization when patients with musculoskeletal disorders were triaged directly to physiotherapists and this patient group seemed to require fewer medical services when they were handled in this way. If the present study should continue to show such advantages and, in addition, show that these patients regain function, have less pain, reduce their risk for developing persistent pain, have a better health-related quality of life and/or a stronger feeling of own responsibility for managing musculoskeletal disorders, then this method of triaging patients directly to physiotherapists should be implemented as standard practice both for the sake of the patients and the primary care organization.