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FOTO Rehab Outcomes Blog

Musculoskeletal Service Delivery in Primary Care

Typically when I voice my thoughts on working with physicians, the immediate response is negative in nature. The responder's immediate thought is physician self-referral and that conflict of interest. This sadly limits the conversation and also limits the ability to think of possibilities. The physician shortage is real and affecting patients. In my little town, patients may wait 3-6 weeks before being seen by their primary care physician for an acute condition. A patient scheduling for a preventative care physical typically waits about 6 months for that particular appointment. I have worked on educating my patients about patient self-referral (direct access). The physicians have been supportive. I continue to wonder "what if?" What if physical therapists were in primary care physician offices to be part of the team to help improve access to care so care is delivered in a more timely manner? Now that times have changed, the idea of physician self-referral is not really an issue in that setting because most physicians have sold out to hospital organizations.

The study I am sharing digs into the "what if" I've been wondering about for years.

I was immediately intrigued when I saw this study because the location was Ireland. I've been fascinated with practices of Irish physiotherapists for quite a few years. As I go back in time, I guess my fascination all began in 2011. I blogged about how I'd love to visit Ireland in 2012 (which never happened) because of a paper I saw focused on patient self-referral (direct access) to physical therapists across the globe. The physiotherapists in Ireland seemed to be the best of all that were compared. They practiced in a country where the national insurance would pay for services, yet patients chose the private physiotherapist and patients paid out of pocket for their care.

My heart swoons yet again for the physical therapists in the Republic of Ireland. The study below focuses on my exact question... what if physical therapists were in the care delivery model in the physician practices? Maybe 2018 should be the year that I visit Ireland to take in the various practice models and also the business models. 

Below you will find a quick view of the abstract.



Physiotherapy managers' views of musculoskeletal physiotherapy service provision in Ireland: a qualitative study.



Aim Integrated multidisciplinary primary healthcare is still in a relatively early stage of development in Ireland, with significant restructuring occurring in the past decade. Musculoskeletal physiotherapy services traditionally provided in acute hospital settings have been relocated into the primary care setting where the physiotherapist works as part of the multidisciplinary team. This study aimed to explore physiotherapy managers' experiences of managing musculoskeletal physiotherapy services in primary care to gain an insight into the opportunities and challenges in service delivery, changing roles and ongoing professional development needs of staff. Participants Qualitative design using semi-structured interviews with primary care physiotherapy managers in the Republic of Ireland was employed.


Five interviews took in a mix of rural and urban areas nationally. The relationship with the GP was an important one in musculoskeletal physiotherapy services in primary care. Physiotherapists were well skilled but opportunities for professional and career development were restricted. Methods of optimising resources in the face of staffing restrictions were identified. Whilst there were many examples of innovations in service delivery, various barriers negatively impacted on optimal service including resource constraints and national strategy.


A number of factors that impact on musculoskeletal service delivery in primary care from the perspective of physiotherapy managers were identified in this study. Future research should explore the views of other stakeholders to provide a more thorough understanding of the relevant issues affecting musculoskeletal physiotherapy service provision in primary care in Ireland.

 2017 Aug 14:1-11. doi: 10.1017/S1463423617000469. [Epub ahead of print]