Pilot Project for Direct Access to Physical Therapy

NCT ID: NCT04900480

Last Updated: 2022-03-23

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 2427 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2020-11-01
• Study Completion Date: 2022-11-01

Brief Summary

The aim of this pilot study is to evaluate the effect of publicly subsidized physiotherapy for all patients receiving general treatment in physiotherapy clinics with an official provider number. This study will evaluate effects on physical and mental health, number of consultations in physiotherapy; number of contacts with general practitioner; referrals to diagnostic imaging; number of contacts with specialists within rheumatology, neurology and orthopedics and patient satisfaction.

Detailed Description

In Denmark, patients in physiotherapy with a referral from their general practitioner (GP) get 40% of their expenses paid by public subsidy. This study aims to test the effects of direct access to physiotherapy with public subsidy without a referral from the GP.

GPs are by default the gatekeeper to all public health care services in Denmark. However, increasing demand in terms of task complexity and patient volume is putting pressure on GPs. In this study, physiotherapists may become the first point of access for patients with musculoskeletal problems.

The hypothesis is, that direct access may decrease use of health services and increase patient satisfaction by shortening the time between occurrence of symptoms and beginning treatment in physiotherapy a) by eliminating the time needed to get a referral from the GP and b) by making access to physiotherapy easier, thus encouraging patients to seek and begin treatment earlier.

The effect of direct access to physiotherapy with public subsidy will be tested in a controlled design. Four similar municipalities located in the Capital Region of Denmark were selected to participate in the study. The four municipalities have been grouped in pairs to ensure similarity on size, health utilization, urbanization and commuting patterns. Two grouped municipalities have been assigned to the intervention group by lottery; the matching pair of municipalities have been assigned to the control group.

From November 2020 to November 2021, citizens living in the two intervention municipalities can get public subsidy for general physiotherapy without a GP referral. For all citizens in the control group access to physiotherapy is provided as usual; thus, public subsidy physiotherapy is only provided for patients with a GP referral. The study includes all physiotherapy clinics in all four municipalities. All included clinics must have an official provider number, i.e. be approved to offer services with public subsidy.

All patients with residence within one of the four municipalities who seeks general treatment in included physiotherapy clinics within their own municipality will be invited to participate in the study. Both patients with and without a GP referral will be included. Participation involves giving consent to providing data for the evaluation.

Data in the study consists of health care contacts accessed through the Capital Region of Denmark's own price mechanism registers logging all transactions between relevant service providers and the Capital Region of Denmark. In addition, all patients are asked to fill in a survey before their 1st diagnostic consultation with a physiotherapist and a follow up survey at six weeks and six months. Finally, the study will collect data through interviews with general practitioners and physiotherapists as well as their respective receptionists.

Conditions

Musculoskeletal Diseases

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: NONE

Study Groups

Public subsidy to physiotherapy continue as usual

This control arm consists of all physiotherapy clinics with registered provider numbers in two municipalities, where the access and public subsidy to physiotherapy continue as usual.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Direct access to publicly subsidized physiotherapy

This intervention arm consists of all physiotherapy clinics with registered provider numbers in two municipalities, introducing temporary exemption on the legal required general practitioner referral for public subsidy for treatment in general physiotherapy.

Group Type: EXPERIMENTAL

Direct access to publicly subsidized physiotherapy

Intervention Type: OTHER

This pilot project introduces temporary exemption on the legal required GP referral for public subsidy for treatment in general physiotherapy.

Interventions

Direct access to publicly subsidized physiotherapy

This pilot project introduces temporary exemption on the legal required GP referral for public subsidy for treatment in general physiotherapy.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Begin treatment in general physiotherapy within the four municipalities included

Exclusion Criteria

• Pregnancy
• Have a GP referral to home treatment

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Region Hovedstadens Apotek

OTHER_GOV

Sponsor Role: collaborator

Ulla Toft

OTHER

Sponsor Role: lead

Responsible Party

Ulla Toft

Head of Department, Lecturer Ph.D, MSc Human Nutrition

Responsibility Role: SPONSOR_INVESTIGATOR

Principal Investigators

Ulla Toft, ph.d.

Role: STUDY_DIRECTOR

Center for Clinical Research and Prevention

Locations

Center for Clinical Research and Prevention

Copenhagen, , Denmark

Countries

Denmark

References

Dahlerup J, Toft U, Schiotz ML, Grew J, Thrysoe R, Ottosen J, Jakobsen LM. Protocol for a cluster-randomized non-inferiority trial of the effect of direct access to publicly subsidized physiotherapy for adults with musculoskeletal pain. Contemp Clin Trials. 2022 Feb;113:106648. doi: 10.1016/j.cct.2021.106648. Epub 2021 Dec 10.

Reference Type: DERIVED

PMID: 34896641 (View on PubMed)

Other Identifiers

Direct Access

Identifier Type: -

Identifier Source: org_study_id