Unequal Access to Physical Therapy

Sprains, strains, and fractures are the most common musculoskeletal injuries. They make up one of the biggest reasons patients go to the doctor. Degenerative joint disease that comes with aging is also a common condition. Most patients with these problems see their primary care doctor or an orthopedic doctor.

Sometimes patients with musculoskeletal problems are sent to a physical therapist (PT). In many states the patient can go the therapist without seeing a doctor first. This is called direct access. In every state, a doctor can refer patients to PT.

In this study, therapists try to find out which doctors send patients to PT. They looked for ways to tell which doctors are more likely to make a PT referral. The goal is to understand the doctor's role in the use of physical therapy for musculoskeletal conditions. Do orthopedic doctors refer more often than primary care doctors? Why or why not?

The authors of this study found out:

  • Osteopathic doctors send patients to PT more often than other primary care doctors.
  • PT referral from an orthopedic doctor is more likely if the patient is covered by worker's compensation or managed care insurance.
  • Primary care doctors are less likely to send a patient to PT if the patient is covered by Medicaid or managed care.
  • Patients with more than one problem or who need an X-ray are more likely to be referred to PT.
  • The more time the doctor spends with the patient, the greater the chances the patient will go to PT.

    The researchers say several things may explain these results. A patient's diagnosis and the severity of the problem are important factors. For example, a fracture may need a cast or surgery. No PT is needed. Orthopedic doctors and osteopaths are more familiar with physical therapy. They may be more likely to refer patients to PT. Medicaid patients are 35 percent less likely to get a PT referral.

    This study shows that the type of physician and the insurance status are the two major deciding factors in whether or not a patient sees a physical therapist. Musculoskeletal patients don't have equal access to physical therapy. This may affect the cost and quality of care for patients with musculoskeletal conditions. The authors suggest this information may affect health care policy in the future.



    References: Janet K. Freburger, PT, PhD, et al. Physician Referrals to Physical Therapy for the Treatment of Musculoskeletal Conditions. In Archives of Physical Medicine and Rehabilitation. December 2003. Vol. 84. No. 12. Pp. 1839-1849.

    eOrthopod.com

    All content provided by eOrthopod® is a registered trademark of Mosaic Medical Group, L.L.C.. Content is the sole property of Mosaic Medical Group, LLC and used herein by permission. Alteration of these documents in any way is a violation of the copyright.