Given that patients in the direct access group received fewer medications and less imaging while achieving similar or superior discharge outcomes, the results from this review suggest a relative decreased risk of harm in the direct access group, potentially due to fewer side effects of medication or less exposure to imaging radiation. . Epub 2005 Jun 1. A point was awarded only when the intervention was clear and specific. Data from the included studies supported a grade D (inconsistent) recommendation that patients in the direct access group saw their general practitioner (GP) or other consultants less than in the physician referral group, suggesting that patients maintain contact with other medical providers despite seeking direct access to physical therapy. Mitchell and de Lissovoy9 found that paid claims per episode of care were $1,232 less in the direct access group for all services and drugs per episode of physical therapy care (P<.001). The precise method of randomization need not be specified. The consistent results identified across the several moderate-quality studies included in this systematic review may form a solid basis for policy and payment decisions that would facilitate delivery of physical therapist services through direct access.8,9,1115,28 Some form of direct access to physical therapist services is currently available by statute in 47 out of 50 states (United States),29 as well as internationally.8,15 However, self-referral accounts have been estimated to account for as little as 6% to 10% of referral volume30 in some direct access states. I=intervention group, C=comparison group, D&B=Downs and Black checlist (see Appendix 1 for criteria), NH =National Health Service, BCBS=Blue Cross Blue Shield, pts=patients, CEBM=Centre for Evidence- Based Medicine, dx=diagnosis, DC=discharge, PT=physical therapist, msk=musculoskeletal, peds=pediatrics, 95% CI=95% confidence interval, GP-general practitioner, NR=not reported, NS=not significant. McCallum , Heisey DM. Finally, although Holdsworth et al13 did not run statistical analyses, patients in the direct access group had approximately 22 ($34) less cost (not including cost to patients), which we extrapolated would amount to an average cost benefit to the National Health Service of Scotland of approximately 2 million per year ($3,107,400). Direct Access - ORS - ORSMI.COM We can refer to specialists, insurance is the only problem but if they came to you and required a referral for specialists they would need a PCP appt to see you. Due to limitations inherent in study design, differences in number of participants between groups, and other potentially confounding variables, we believe our most relevant findings are that patient and health care costs were not greater in the direct access group compared with the physician referral group. Despite . SJ ERIC - EJ1324801 - Speech and Language Therapy Service Provision in Federal government websites often end in .gov or .mil. Have all of the important adverse events that may be a consequence of the intervention been reported? Yelin Nordeman Were those individuals who were prepared to participate representative of the entire population from which they were recruited? Disclaimer. Aggregate physical therapy claims for each member by defining the start of the episode as the date of the physical therapy initial evaluation code (ie, CPT 97001). 2020 Sep;68(5):306-313. doi: 10.1016/j.respe.2020.08.001. What is direct access to physical therapy? Your policy may require a referral to physical therapy by your primary care physician. 2005;5(8):1-91. of articles located in database, Two rural practices, ~42% spinal injuries, the rest extremity injuries(> 95% msk), 2.3% had GP consultations, 2.5% referred to specialists, 1.5% had GP consultations, 8.2% referred to specialists. Did the study have sufficient power to detect a clinically important effect where the probability value for a difference being due to chance is less than .05? There were statistically significant and clinically meaningful findings across studies that satisfaction and outcomes were superior, and numbers of physical therapy visits, imaging ordered, medications prescribed, and additional nonphysical therapy appointments were less in cohorts receiving physical therapy by direct access compared with referred episodes of care. The validity of studies using a between-group comparison was evaluated by 2 authors not blinded to authors or journals. and T.E.D.). In contrast, in our review, we investigated a group of physical therapists, the majority of whom were not practicing in advanced practice roles (7 out of 8 studies exclusively focused on physical therapists without any special training reported who largely held master's or bachelor's degrees), and still found advantages in terms of treatment effectiveness, use of resources, economic costs, and patient satisfaction over initial physician care. Little previous work has been conducted to critically evaluate and synthesize the literature related to physical therapy clinical management obtained through direct access. Were study participants in different intervention groups (trials and cohort studies), or were the cases and controls (case-control studies) recruited over the same period of time? It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. In summary, findings from this systematic review support the safety, efficacy, and cost-effectiveness of physical therapist services by way of direct access compared with physician-referred episodes of care. APTA continues to expand an important member benefit. , Roy JS, Macdermid JC, et al. What are the benefits of direct access physical therapy? Verify that all physical therapy visits occurred in a physical therapy office or in a hospital-based outpatient facility setting. We hypothesized that policies permitting patients to seek physical therapy directly would result in decreased health care costs and similar patient outcomes. Aggressive Vertebral Hemangioma and Spinal Cord Compression: A Particular Direct Access Case of Low Back Pain to Be Managed-A Case Report. The study did not receive a point unless the participants were randomly allocated and the methods for ensuring random allocation were specified. Are the distributions of principal confounders for each group of participants to be compared clearly described? SH As different jurisdictions passed laws and regulations that granted varying degrees of access, the terms "unrestricted access," "patient access with provisions," and "limited patient access," became three main categories used to identify a state's level of direct access to PT services. How Direct Access to Physical Therapy Works - Verywell Health Before HB29: Physical Therapy Direct Access Is Coming To Texas. government site. Please check for further notifications by email. A point was awarded if any adverse events, unwanted side effects, or lack thereof were explicitly indicated from either referral or direct access interventions. The data of the included studies indicated a grade B recommendation that patients reported a higher level of satisfaction when they received physical therapy through direct access versus physician referral. Your comment will be reviewed and published at the journal's discretion. The 13 states that have introduced or are considering introduction of compact legislation are Alaska, Connecticut, Hawaii, Illinois, Maine, Massachusetts, Michigan, Minnesota, Nevada, New Mexico, New York, Rhode Island, and Vermont. A point was awarded as long as the number of dropouts lost to follow-up accounted for less than 10% of the initial number of total participants or a maximum of 5% from each group. No points were awarded if the study did not report any confounders. No point was awarded for studies that reported qualitative or quantitative data without any form of statistical comparisons or if the statistical tests reported were not appropriate. , Bird C, McAuley JH, et al. DA showed less number of physiotherapy treatments, visits to physician, imaging performed and required fewer non-steroidal anti-inflammatory drugs and secondary care. Data Synthesis. "Side effects" of physical therapy include improved mobility, increased independence, decreased pain, and prevention of other health problems through movement and exercise. and R.S.S.) AM Florida Direct Access to PT - Florida Physical Therapy Association Da Ros A, Paci M, Buonandi E, Rosiello L, Moretti S, Barchielli C. Bull World Health Organ. Included studies compared data from physical therapy by direct access with physical therapy by physician referral, studying cost, outcomes, or harm. Direct access means the removal of the physician referral mandated by state law to access physical therapists' services for evaluation and treatment. GP-suggested referral group results excluded. L A physical therapist who has completed a doctor of physical therapy program approved by the Commission on Accreditation of Physical Therapy Education or who has obtained a certificate of authorization to 54.1-3482.1 2 ( according to 18VAC112-20-81, Requirements for Direct Access Certification. Physical therapy visits per episode of care (mean across all patients). Background: . While it has been achieved in some form across the country, APTA continues to advocate for unrestricted direct access everywhere. Please check with your insurance company to determine if you can use your benefits to cover direct access for physical therapy care. Pennsylvania is one of 26 states that allow direct patient access to PT with some provisions. , Kliethermes SA, Freburger JK, Duffy PA. Holdsworth The purpose of this study was to establish the effects of direct access and physician-referred episodes of care in individuals receiving physical therapy based on a systematic review of peer-reviewed literature. , Webster V. Holdsworth Currently 30 states (see Table 1) permit both physical therapy evaluation and treatment through direct access (APTA, Govt Affairs Dept, 1992). Twelve states and the . Limitations Primary limitations were lack of group randomization, potential for selection bias, and limited generalizability. 2010 Dec;8(4):256-8. doi: 10.1111/j.1744-1609.2010.00177.x.