Early contact with physiotherapist at primary health care centres beneficial

Patients with muscle and joint pain are often at least as well served by seeing a physiotherapist as by consulting a doctor when they seek help at a primary health care centre. Over time, the health benefits of first going to a physiotherapist appear slightly superior, new research shows.

In Sweden, primary care services sometimes have problems in offering good care within the national "health care guarantee", mainly because available visiting times to doctors are not in balance with the demand for health care services. However, many patients seek primary care for ailments which can be treated by other health professionals than doctors.

A thesis from Sahlgrenska Academy, University of Gothenburg, describes certain patients with pain and functional difficulties in muscles, joints and elsewhere in the movement system. These patients were selected for immediate treatment by a physiotherapist.

This selection, or "triaging", of patients with muscle and joint pain proved to have beneficial effects in terms of access, effectiveness and the work environment, and also reduced patients' health care utilization. There are also ample indications that these patients' health outcomes are at least as good as for those who were initially assessed by a doctor.

Better for organization and individuals

"Making more effective use of skills possessed by other professionals can help to improve the flow of patients through primary care. At the same time, it brings positive effects for the individual," says Lena Bornhöft, who has a Ph.D. from Sahlgrenska Academy and an occupational background as a physiotherapist.

One study included in Lena's thesis covered 482 patients—men and women aged 16–64 with muscle and joint pain—selected for initial assessment by a physiotherapist. The control group was comprised of 1,436 people with similar conditions who were managed in the traditional manner at their local health care centre.

In other studies, Bornhöft investigated patients' health and attitudes, and the cost-effectiveness of direct triage to physiotherapists. These studies were conducted in collaboration with Närhälsan, the public primary care provider in Region Västra Götaland.

Higher self-rated health

The patients triaged for an initial assessment by a physiotherapist were, when necessary, assessed by a doctor afterwards to fulfil any medical needs. They were shown, however, to need less medical intervention over time than the controls.

Those who were able to start with a physiotherapist had more favourable outcomes in terms of pain, disability and risk of long-term problems. Their health-related quality of life was also, according to their own self-rating, higher than that of the controls.

Today, physiotherapists are already responsible for the initial assessment of patients who seek assistance at rehabilitation clinics for muscle and joint pain. Making use of their expertise in primary care services as well may, according to the thesis, result in organizational, financial and health advantages.