Nigerian physiotherapists’ perception of direct access and patients’ self-referral
Abstract
Background: The global advocacy for Direct Access (DA) and Patients’ Self-Referral (PSR) to physiotherapy is consistent with the quest for promoting professional autonomy and recognition. It was hypothesized in this study that the attainment of this clarion call in Nigeria may be hamstrung by challenges similar or different from those reported in other climes.Objective: This study assessed the perception of DA and PSR among Physiotherapists (PTs) in South-West, Nigeria.
Methods: One hundred PTs from ten purposely selected public-funded out-patient facilities from South-West, Nigeria responded in this cross-sectional study, yielding a response rate of 75% (100/150). A previously validated questionnaire for World Confederation of Physical Therapists (WCPT) on the global view of DA and PSR for physical therapy was used in this study. Data was analyzed using descriptive statistics.
Results: There was a high awareness on legislation regulating practice (91%) and scope (84%) of the profession. Respondents assert that the extant legislation allows for DA (49%) and PSR (97%). However, 40% of the respondents opined that the baccalaureate qualification of PTs was inadequate for competence in DA and PSR; and a post-professional residency programme was mostly recommended (52%). Public support for DA and PSR to physiotherapy was rated more than the advocacy role of the Nigeria Society of Physiotherapy (60% vs. 40%). Physicians’ (71%) and politicians’ (65%) views were rated the major barrier to achieving DA and PSR status in physiotherapy. Similarly, physicians’ (90%) and politicians’ (88%) support was perceived as the major facilitator.
Conclusion: Physiotherapy practice in Nigeria has the semblance of autonomy in DA and PSR but is devoid of legislative support. Most Nigerian physiotherapists assume professional autonomy but were not aware of the lack of legal support for DA and PSR. The current entry-level academic curricula were considered to be deficient and inadequate for autonomous practice in Nigeria. Physicians and politicians were the most important barrier or facilitator to achieving legal support for DA and PSR in physiotherapy in Nigeria.
References
Bury TJ, Stokes EK. (2013). A global view of direct access and patient self-referral to physical therapy: Implications for the profession. Physical Therapy. 93 (4):449-459.
Boissonnault W. (2006a). Direct Access: Legitimate Beef or Acts of Desperation? The Challenge from Orthopaedic Surgeons. AAOMPT official newsletter: Articulations. http://www.apta.org/StateIssues/DirectAccess/ChallengeFromOrthoSurgeons. Accessed 02/03/2014
Boissonnault W (2006b). Direct Access: Where's the Beef? The Challenge from Chiropractors. AAOMPT official newsletter: Articulations. http://www.apta.org/StateIssues/DirectAccess/ChallengeFromChiropractors. Accessed 02/03/2014
Cooke RL, Lipowski E, Magness JW. Achieving recognition as patient-centered care providers: We are our own best advocates. J Am Pharm Assoc (2003) 2013;53:234-238.
Crout K, Tweedie J, Miller D. Physical therapists' opinions and practices regarding direct access. Physical Therapy 1998; 78:52-61.
Galley.P (1977): Physiotherapists as first contact practitioners-New challenges and responsibilities in Australia. Physiotherapy:63(8):246-248
Ganiyu LO (2008): Physiotherapy in the primary care: are we ready? JNSP vol 16 No. 1
Holdsworth LK, Webster VS. 2004. Direct access to physiotherapy in primary care: now and into the future? Physiotherapy 90:64_72.
Holdsworth LK, Webster, VS and McFadyen, AK. Are patients who refer themselves to physiotherapy different from those referred by GPs? Results of a national trial. Physiotherapy 2006;92(1):26-33.
Holdsworth LK, Webster, VS and McFadyen, AK. What are the costs to NHS Scotland of self-referral to physiotherapy? Results of a national trial. Physiotherapy 2007; 93(1):3-11.
Holdsworth LK, Webster, VS and McFady en, AK. Physiotherapists' and general practitioners' views of self-referral and physiotherapy scope of practice: results from a national trial. Physiotherapy 2008; 94(3):236-243.
Leemrijse CJ, Swinkels, ICS and Veenhof, C. Direct Access to Physical Therapy in the Netherlands: Results From the First Year in Community-Based Physical Therapy. Physical Therapy 2008; 88 (8):936-946.
Massey Jr BF. What's All the fuss about direct access?(2008) Physical Therapy; 82(11):1120-1123.
Medicare Payment Advisory Commission. 2004. Glenn M. Hackbarth, Chairman. Letter to the Honorable Richard Cheney on Direct Access to Outpatient Physical Therapy Services, Washington, DC: MedPAC. http://www.medpac.gov/publications/congressional_reports/Dec04_PTaccess.pdf. [accessed 03/04/2014]
Ojha HA, Snyder RS, Davenport TE (2014). Direct access compared with referred physical therapy episodes of care: a systematic review. Physical Therapy. 94(1):14-30.
Pendergast J, Kliethermes SA, Freburger JK, Duffy PA (2012). A comparison of health care use for physician-referred and self-referred episodes of outpatient physical therapy. Health Service Research. 47:633–654.
Rose SJ (1989). Physical therapy diagnosis: role and function. Physical Therapy. 69:535-535.
Shoemaker MJ (2012). Direct consumer access to physical therapy in Michigan: challenges to policy adoption [erratum in: Physical Therapy. 92:236–250.
Taylor T and Domholdt E. (1991). Legislative change to permit direct access to physical therapy services: a study of process and content issues. Physical Therapy. 71:382-389.
The Nigeria Medical Rehabilitation Therapists Bulletin (NMTB) Bulletin (2004). 13(18): page 14-16.
World Confederation for Physical Therapy. Policy statement: Direct access and patient/client self-referral to physical therapy. London, UK: WCPT; 2011. http://wcpt.org/node/34062. [Accessed 12/02/2014).
