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Direct access and patient self-referral to physical therapy

What is direct access and self-referral?

Direct access and self referral means that patients are able to refer themselves to a physical therapist without having to see anyone else first, or without being told to refer themselves by another health professional. This can relate to telephone and face-to-face services, as well as those delivered via new media such as over the internet.

Reference: Department of Health (2008) Self-referral pilots to musculoskeletal physiotherapy and the implications for improving access to other AHP services. Department of Health; London, UK.

 

Read more about it in WCPT's new Keynote publication, published September 2011, with an accompanying reference list.

 

Why self-referral is considered a valuable term:

  • It is thought to be clearly understood by the patient/client.
  • It clearly defines the source of referral.
  • It defines a group of patients/clients which in turn allows for analysis and comparisons across sources of referrals eg patients/clients who referred themselves versus general practitioner/family physician referral to physical therapy. With clear comparisons evidence can be produced to support self-referral as being clinically and cost effective.

Direct access is the term that is more familiar across the profession globally and among other health professionals and government officials. There is concern that not all patients/clients understand the term referral or what it implies. Direct access does not refer to access between health professionals eg a physician has direct access to physical therapists. However, it may mean that physical therapists have direct access to assess and treat patients without a medical referral, for example on an Intensive Care Unit determining which patients need physical therapy.

Both terms are still appropriate to use.

WCPT's Declaration of Principle on Autonomy has clearly stated since 1995 that "Patients/clients should have direct access to physical therapist services." However, direct access and self-referral is not a given in all of WCPT’s member organisations’ countries. Appropriate legislative and regulatory policies need to be in place to recognise and permit practice without a medical referral, as well as required levels of pre-qualifying physical therapy education. WCPT has prepared a new policy statement specifically on direct access and self-referral that was approved in June 2011 at the WCPT General Meeting. Once editing is completed it will be made available.

Direct access and self-referral to physical therapy is clinically and cost effective and results in satisfied patients/clients.

Some key facts:
 

  • Direct access and self-referral puts patients/clients in control of their care
  • Patients/clients who refer themselves to physical therapy:
    • are more proactive
    • are more autonomous in making health decisions
    • take less time off work
    • return to work sooner
    • are more likely complete a course of treatment
    • are more interested in self management
    • more satisfied with their care
  • Direct access and self-referral saves money through:
    • reducing costs of seeing other health professionals eg general practitioners/family physicians
    • less prescribing
    • less investigations
    • less secondary care
    • reducing costs to society eg through time off work
    • less administration costs
  • Direct access and self-referral does not lead to increased demands for services if they are adequately resourced
  • Direct access and self-referral is not just appropriate for musculoskeletal services but across areas of practice
  • Research to date has focused on musculoskeletal patients

Resources here can help physical therapists work strategically to develop direct access and self-referral  services and, where required, open discussions with government health departments, regulatory bodies, health professionals and others to bring about the necessary changes to support the implementation of self-referral/direct access services.

The Advanced Scope of Practice and Direct Access in Physical Therapy Policy Summit of 2009 looked in detail at the evidence for self-referral/direct access and strategies for influencing policy and implementing change from across the globe. The presentations provide summaries of the evidence and perspectives from different WCPT member organisations.

Useful Resources

Resources from WCPT member organisations

American Physical Therapy Association (APTA)

Chartered Society of Physiotherapy (CSP) UK

Evidence for the effectiveness of self-referral

These references provide evidence of the clinical and cost effectiveness of self-referral/direct access physical therapy services:

Other resources

Updated on: Fri 30 Sep 2011