Needs Assessment to Inform Service Delivery Redesign in a Local Tertiary Teaching Clinic

Abstract

Aims: To examine the extent to which physical therapy at a local tertiary teaching clinic enables best practice and to identify priority areas for service redesign. Methods: A retrospective file review of clinical records of patients receiving physical therapy (n = 237) from 2011 to 2015 in Manila, Philippines. Data on clinical diagnosis, interventions, parameters of episode of care, goals and outcome measures were extracted and coded by trained researchers using a standardised form. Results: Most patients (n = 229, 97%) had developmental conditions. Active interventions were employed (n = 236, 99%) and self-management plans appeared in 161 (68%) records. The duration of the episode of care was variable (median = 16 months, range = 1–139). Almost all patients (n = 230, 97%) commenced with weekly sessions, with the total number of sessions ranging from 1 to 150 (median = 15). Therapy goals were reported routinely (n = 236, 99%). Objective measures were recorded in 209 (88%) records at baseline and in 136 (57%) records at follow-up. The time point for outcome assessment was inconsistent (range = <1–36 months). Conclusions: Service delivery at the clinic requires more robust longitudinal management procedures, streamlined mechanisms for monitoring and better involvement of the family in decision-making. Some elements of existing practice (active, self-management approaches) suggest the adoption of best practice principles. Results contribute to ‘idea generation’ for service redesign.