Disparities in Service and Clinical Outcomes in State-Wide Advanced Practice Physiotherapist-Led Services

This study explored variations in the primary service and clinical outcomes of a state-wide advanced practice physiotherapist-led service embedded in public medical specialist orthopaedic and neurosurgical outpatient services across Queensland, Australia. An audit of the service database over a six-year period was taken from 18 service facilities. The primary service and clinical outcomes were described. Variations in these outcomes between facilities were explored with a regression analysis adjusting for known patient- and service-related characteristics. The findings showed substantial positive impacts of the advanced practice model across all facilities, with 69.4% of patients discharged without a need for medical specialist review (primary service outcome), consistent with 68.9% of patients reporting clinically important improvements in their condition (primary clinical outcome). However, 15 facilities significantly varied from the state average for the primary service outcome (despite only three facilities varying in the primary clinical outcome). While this disparity in the primary service outcomes appears to be influenced by potentially modifiable differences in the service-related processes between facilities, these process differences only explained part of the variation. This study described the subsequent development of a new, more comprehensive set of service evaluation metrics to better inform future service planning.

Provision of foot and ankle care services for people with rheumatic and musculoskeletal disease across Europe

BACKGROUND

The aim of the present study was to explore the variation in the provision of care for people with rheumatic and musculoskeletal diseases (RMDs), and foot and ankle problems between European healthcare systems.

METHODS

An electronic questionnaire was developed and piloted in seven countries prior to being distributed to the presidents of all 22 national health professionals in rheumatology associations within the European League Against Rheumatism (EULAR). Summary data were obtained using SPSS V22. Ethical approval was sought from the Medical Research Ethics Committee of University of Malaga (CEUMA-91-2015-H).

RESULTS

Sixteen questionnaires (73% response rate) were completed (Austria, Belgium, Czech Republic, Denmark, France, Hungary, Ireland, Italy, Malta, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and the UK). All 16 respondents indicated that foot and ankle healthcare services were provided in their country, but only three countries had services specializing in RMD-related foot and ankle problems (the Netherlands, the UK and Malta). The professions providing care varied, depending on the pathology and the country. Foot and ankle pain was mostly treated by rheumatologists and physiotherapists; foot and ankle deformities by orthopaedic surgeons and orthotist/prosthetists; and foot and ankle ulcers by nurses. Services were predominantly delivered through the public sector, and in secondary care (hospital) settings.

CONCLUSIONS

Only three countries reported having specialist foot and ankle services addressing the needs of people with RMDs. Variation was seen in the professions which provided care between countries, and also between the foot and ankle pathologies cared for. There is a lack of clinical pathways and guidelines for the management of patients with RMD-related foot and ankle problems.