Identifying goals, roles and tasks of Advanced Practice Physiotherapy in Dutch primary care

Abstract

Aim To identify a framework of Advanced Practice Physiotherapy(APP) incorporating goals, roles and tasks, to provide a consistent approach for the implementation of APP in Dutch primary care. Methods A qualitative multi-step design was used containing focus groups and semi-structured interviews. The study population consisted of patients, physiotherapists, general practitioners and indirect stakeholders like lecturers, health insurers and policy makers related to primary care physiotherapy. The main topics discussed in the focus groups and semi-structured interviews were the goals, skills and roles affiliated with APP. The 'framework' method, developed by Ritchie & Spencer, was used as analytical approach to refine the framework. Results Two focus groups and twelve semi-structured interviews were conducted to explore stakeholders perspectives on APP in Dutch primary care. A total of eleven physiotherapists, six general practitioners, five patients and four indirect stakeholders participated in the study. There was a lot of support for ‘decreasing healthcare costs’, ‘tackling increased health demand’ and ‘improving healthcare effectiveness’ as main goals of APP. The most consensus was reached on 'triaging', 'referring to specialists' and 'ordering diagnostic imaging' as tasks fitting for APP. Most stakeholders also supported 'working in a multidisciplinary team', 'working as a consultant' and 'an APP role separated from a physiotherapist role' as roles of APP. Conclusion Based on focus groups and interviews with various direct and indirect stakeholders, it appears that there is sufficient support for APP in the Netherlands. A trial focused on determining the (cost)effectiveness of APP in Dutch primary care will be the next step. Clinical Relevance Rising healthcare costs, an increasing shortage of physicians and an aging population have made healthcare organization transformation a priority. To meet these challenges, traditional roles of non-medical members have been reconsidered. Within the domain of physiotherapy, there has been significant interest in APP. Although studies have focused on the perceptions of different stakeholders in relation to APP, there is a large variety in the fulfillment of APP. This study provided a clear representation of how APP ought to be conceptualized in Dutch primary care.