An initiative to improve equity, timeliness and access to District Health Board-funded physiotherapy in Canterbury, Christchurch, New Zealand

Abstract

Background and context: General practice teams frequently request orthopaedic and musculoskeletal physiotherapy. In the Canterbury District Health Board (DHB) region, before November 2018, the criteria for DHB-funded physiotherapy were unclear. Wait times were many months. Care was provided on hospital sites. Limited data were available about the service. Assessment of problem: A clinical project group including private and DHB hospital physiotherapists and general practitioners was established. Patients requiring orthopaedic and musculoskeletal physiotherapy who had certain criteria were seen by physiotherapists in contracted private clinics in the community instead of by physiotherapists in hospital departments. Patients received up to NZ$300 (excluding GST) of care. A claiming process was established that required the physiotherapy clinics to provide data on patient outcomes. Results: In the first 12 months of the programme, 1229 requests were accepted. Patients waited an average of 11.1 days for their first appointment. There was an average Patient Specific Functional Scale increase of 3.7 after treatment. Strategies for improvement: A change environment was critical for this community-based, geographically distributed model to succeed. It was supported by key clinicians and funders with sufficient authority to make changes as required. It required ongoing clinical oversight and operational support. Lessons: DHB orthopaedic and musculoskeletal physiotherapy can be moved from hospital sites to a community-based, distributed service in a timely, effective and equitable fashion. There was a prompt time to treatment. Data collection was improved by tracking 'before' and 'after' measures.