Physical therapy care can be accessed in two primary ways: direct access occurs when a patient visits a physical therapist on their own without being sent from another health-care provider, while in a referral, the patient is referred by a physician. The Netherlands introduced a new health care system in 2006 that allowed patients to directly access physical therapy. All 50 U.S. states have passed legislation that now permits some degree of direct access to physical therapy, but many restrictions still apply and some remain unaware of this option. Since the Netherlands uses a similar system, their use of direct access may be helpful in understanding and predicting trends. Therefore, a study investigated direct access to physical therapy for low back pain (LBP) in the Netherlands.
Data was taken from a network of 100 physical therapists and consisted of all episodes of care for patients with LBP who saw a physical therapist between 2006-09. This included 10,887 patients who visited a physical therapist for 12,931 episodes of care. Data was collected on all patients regarding demographics, education level, urbanization and recurrence, duration and severity of LBP before and after treatment.
Results showed that over three years, 7,077 (59%) of episodes of care were from referral, while 4,941 (41%) were from direct access. More importantly, the percentage of patients who used direct access increased substantially over this time, from 973 episodes (28.9%) in 2006 to 1,544 episodes (52.1%) in 2009. Further interpretation showed most patients who directly accessed physical therapy had used physical therapy before and had LBP that recurred and lasted for a while. These results indicate that within the first three years of a new health care system, more Dutch people began taking advantage of direct access. For states in the U.S. where direct access is fairly new, the findings suggest that direct access utilization has the potential to increase with time. With this, Americans should be aware that accessing physical therapy directly could save them significant time and money, and may provide greater improvements on pain and movement disorders without dealing with a middleman.
-As reported in the March '14 edition of Physical Therapy