ArticleFamily medicine and community health2024
Reducing strain on primary healthcare systems through innovative models of care: the impact of direct access physiotherapy for musculoskeletal conditions-an interrupted time series analysis.
Article in Family medicine and community health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- How direct access to physiotherapy reshapes GP gatekeeping for musculoskeletal care in primary care: an exploratory organisational typology across health systems.Family medicine and community health · 2026Article
- Learnings from a rural primary care physiotherapy program and its practice registry: A synthesis of clinical patterns, Primary Health Care Team Competencies, and Care Access in Southern Rajasthan, India.Journal of family medicine and primary care · 2026Article
- Effectiveness of Balint group interventions for physician burnout: a systematic review and meta-analysis protocol.BMJ open · 2026Article
- Economic evaluation of national immunization program vaccines in China: a systematic review.Health economics review · 2026Review
- The Role of Physiotherapists in Multi-professional Primary Care: Lessons for Japan.Physical therapy research · 2026Review
- Adapting the German demand planning guideline for physiotherapy: a cross-sectional analysis from Lower Saxony.Research in health services & regions · 2025Article
- Advancing first-contact, primary care physiotherapist practice: the value of integrating point-of-care diagnostic tools.Frontiers in rehabilitation sciences · 2025Article
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Authors and funding
8 authors.
Funding
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Abstract
objectivesTo evaluate the longitudinal impact of introducing a national, direct access physiotherapy model of care on the rates of primary and secondary care consultations for musculoskeletal (MSK) conditions.
designInterrupted time series analysis using segmented linear regression.
settingNorway primary care
participantsA cohort of 82 072 participants was derived from 3 population-based health surveys conducted across separate geographical regions in Norway. All participants surveyed were eligible for inclusion as a national representative sample of the Norwegian population. Registered MSK consultations were linked to the Norwegian Control and Payment of Health Reimbursement database and the Norwegian Patient Register using the International Classification of Primary Care diagnostic medical codes L-chapter for MSK conditions and spine related International Classification of Diseases, 10th Revision, codes.
interventionDirect access to physiotherapy model of care introduced nationally in Norway in 2018. This model allowed Norwegians to consult directly with qualified physiotherapists for MSK conditions (eg, back pain, knee osteoarthritis) without the need for a medical referral in order to claim a social security reimbursement. MAIN OUTCOMES MEASURED: Rates of primary care consultations per 10 000 population (general practitioner (GP) and physiotherapist consultations) and secondary care (specialist consultations and surgical procedures) measured from 2014 to 2021.
resultsThe introduction of the direct access physiotherapy model was associated with an immediate stepped reduction of 391 general practice consultations per 10 000 population, (95% CI: -564 to -216), without an associated change in physiotherapy consultations. Subgroup analyses suggested there was an associated reduction in physiotherapy consultations for those in the lowest education group of 150 consultations per quarter (95% CI:-203 to -97), 70 consultations per quarter in the intermediate education group (95% CI:-115 to -27) and a stepped reduction of 2 spinal surgical procedures per 10 000 population, for those aged between 40 and 60 years (95% CI: -3 to -1) following the introduction of the direct access physiotherapy model.
conclusionThe national introduction of a direct access to physiotherapy model of care was associated with a reduction in the workload of GPs for the management of MSK conditions. The use of physiotherapists in direct contact roles is a potential strategic model to reduce the burden on the GP workforce in primary care worldwide.
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