The Problem: Medication-only treatment
There are thousands of Albertans without access to a local physiotherapist or who cannot afford community physiotherapy – leaving many family physicians with no choice but to rely on prescription pain medications as their primary treatment option (“medication-only treatment”).
Unfortunately, a medication-only treatment plan for musculoskeletal conditions is often cited as how progressive dependency on pain medications begins.
Albertans who receive delayed, inadequate or inappropriate treatment for a musculoskeletal injury or condition are considered to be at a higher risk:
- To develop chronic neuromuscular pain,
- To become dependent on prescription pain medications,
- To develop permanent disability that prevents them from working or performing normal activities of daily living,
- To place a greater burden on families and other caregivers for support over their lifetime.
- To see their family physician more frequently and to demand prescription pain medication, inappropriate studies and consults.
- To become increasingly dependent on the healthcare system over their lifetime and drive public health care costs up.
The Solution: Primary Care Physiotherapy.
Physiotherapists are regulated primary contact healthcare professionals, competent in a differential diagnosis model of assessments and triaging, evidence based treatment methods and designing safe, appropriate and progressive rehab exercise programs based on a patient’s medical profile, current condition and state of healing. After post-graduate education, Alberta physiotherapists are permitted to order diagnostic imaging independently of physicians.
In addition, research conducted at the University of British Columbia Department of Orthopaedic Surgery, into a physiotherapy triage model for orthopaedic surgery, found that experienced physiotherapists were four times better at identifying patients requiring surgery than emergency room physicians and family physicians (90% vs 22%).
It was estimated that a physiotherapy-based surgical triage system could reduce over three-quarters of premature or inappropriate surgical referrals and shorten wait lists.
In 2014, the Calgary West Central Primary Care Network (CWC PCN) initiated a Primary Care Physiotherapy program that embedded six physiotherapists in approximately 30 different primary care clinics. Every physiotherapist spent one day a week seeing patients inside each of their five clinics. The program was not established to duplicate community based physiotherapy services, but rather to provide physicians with an opportunity to refer their patients internally for a triage assessment and collaborative treatment plan There was no charge to the patient and the number of appointments was capped.
The emphasis of primary care physiotherapy is not on passive treatments that can create dependence but rather on (1) multi-disciplinary diagnostics and triaging, (2) unhurried patient education and empowering patients on self-management strategies and (3) engaging patients to become active ASAP in safe and appropriate exercise to improve their functional capacity and independence.
In my clinical experience with CWC PCN, primary care physiotherapists;
- Improved front-line triaging of patients onto the most appropricate clinical pathway.
- Educated and empowered patients early in self-management strategies and resuming physical activity as soon as possible.
- Reduced the need for second and third refills of prescription pain medications.
- Reduced unnecessary imaging studies.
- Reduced premature and / or inappropriate consults to specialists and surgeons.
- Helped in the early identification and secondary prevention of conditions in a number of vulnerable patient populations.
With budgetary changes to provincial PCNs, the CWC PCN decided to discontinue the physiotherapy program in 2016. The response amongst many CWC PCN physicians was one of disappointment, with many of them voicing their concern for a return to a medication-only model.
After leaving the CWC PCN in 2016, I’ve had the good fortune to continue working with a number of outstanding Calgary family physicians to offer primary care physio in a funding model that helps them to continue offering the CWC PCN model.
If you’re a primary care physician and interested in learning more about incorporating a physiotherapist in your clinic, I invite you to contact me at email@example.com
Terry Kane, Registered Physiotherapist