Physiotherapy screening shoulder clinic?

Authors: McNee et al.

References: BESS, 2004

Objectives: The current study evaluates the effectiveness of a direct access physiotherapy shoulder clinic, in terms of a faster treatment, levels of patient satisfaction and consultant?s workload relief.

Material and Methods: A protocol of management of shoulder pain was created establishing the patient?s pathway from general practice to orthopaedic surgery. A clinical specialist physiotherapist was trained to lead a shoulder clinic, with shoulder treatment courses, shadowing of consultants at 3 shoulder clinics and in-service training on interpretation of x-rays with consultant radiologist. A course on injections taught by consultants was followed by a training period of 10 supervised injections. After this initial period, a letter was sent to all GPs in the catchment area informing that patients could be referred direct to the physio-shoulder clinic. In addition, patients coded for a primary consultation were also re-directed to that clinic. Only patients who did not improve after the initial treatment or who presented more complicate screening problems were redirected through a short cut to the consultant led clinic. A patient satisfaction questionnaire was used during the first 5 months.

Results: Over the first 2 years of the project, extending from November 2001 to December 2003, 203 patients were appointed to the open shoulder clinic. The first 60 patients were given the patient satisfaction questionnaire, with 47 returning it completed (78.3%). 28 of the 47 had been seen by a physio before. In a satisfaction scale of 1 to 5, 2 graded 3, 3 graded 4 and 42 graded 5 the advice received about their condition. In a similar scale 2 patients rated 3, 2 rated 4 and 43 rated 5 regarding their satisfaction with the opportunity to discuss their treatment/care options. Regarding arrangements for further care, 1 rated 1, 2 rated 3, 6 rated 4 and 36 rated 5.

For overall satisfaction 1 rated 2, 2 rated 3, 2 rated 4 and 42 rated 5. Positive aspects of patient?s feedback included ample time to ask questions, improvement obtained with early start of treatment and more accessible discussion.

Those who were not so satisfied were still worried with a long delay, difficulty in peripheral arrangements such as transport and parking and disappointment with long time for follow-up examinations such as MRI scans. 47% of the patients attending were followed up by Physiotherapy only, 18% were added directly to the surgical waiting list and 4 were referred for rheumatology. 22% were sent for further tests (MRI, USS). The waiting list for a first appointment in our upper-limb clinic was reduced from 46 weeks in 2001 to 36 weeks in 2003. Not a single patient insisted on seeing a consultant and 38% of the patients were discharged without specifically seeing one.

Conclusion: This study shows that a physio screening shoulder clinic is an effective and satisfactory way to reduce waiting times and improve patient care.


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