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Musculoskeletal patients’ preferences for care from physiotherapists or support workers: a discrete choice experiment

Sarigiovannis, Panos; Loría-Rebolledo, Luis Enrique; Foster, Nadine E.; Jowett, Sue; Saunders, Benjamin

Authors

Panos Sarigiovannis

Luis Enrique Loría-Rebolledo

Nadine E. Foster

Sue Jowett



Abstract

Background: Delegation of clinical tasks from physiotherapists to physiotherapy support workers is common yet varies considerably in musculoskeletal outpatient physiotherapy services, leading to variation in patient care. This study aimed to explore patients’ preferences and estimate specific trade-offs patients are willing to make in treatment choices when treated in musculoskeletal outpatient physiotherapy services. Methods: A discrete choice experiment was conducted using an efficient design with 16 choice scenarios, divided into two blocks. Adult patients with musculoskeletal conditions recruited from a physiotherapy service completed a cross-sectional, online questionnaire. Choice data analyses were conducted using a multinomial logit model. The marginal rate of substitution for waiting time to first follow-up physiotherapy appointment and distance from the physiotherapy clinic was calculated and a probability model was built to estimate the probability of choosing between two distinct physiotherapy service options under different scenarios. Results: 382 patient questionnaires were completed; 302 participants were treated by physiotherapists and 80 by physiotherapists and support workers. There was a significant preference to be seen by a physiotherapist, have more follow-up treatments, to wait less time for the first follow-up appointment, to be seen one-to-one, to see the same clinician, to travel a shorter distance to get to the clinic and to go to clinics with ample parking. Participants treated by support workers did not have a significant preference to be seen by a physiotherapist and it was more likely that they would choose to be seen by a support worker for clinic scenarios where the characteristics of the physiotherapy service were as good or better. Conclusions: Findings highlight that patients treated by support workers are likely to choose to be treated by support workers again if the other service characteristics are as good or better compared to a service where treatment is provided only by physiotherapists. Findings have implications for the design of physiotherapy services to enhance patient experience when patients are treated by support workers. The findings will contribute to the development of “best practice” recommendations to guide physiotherapists in delegating clinical work to physiotherapy support workers for patients with musculoskeletal conditions.

Citation

Sarigiovannis, P., Loría-Rebolledo, L. E., Foster, N. E., Jowett, S., & Saunders, B. (in press). Musculoskeletal patients’ preferences for care from physiotherapists or support workers: a discrete choice experiment. BMC Health Services Research, 24(1), Article 1095. https://doi.org/10.1186/s12913-024-11585-w

Journal Article Type Article
Acceptance Date Sep 12, 2024
Online Publication Date Sep 19, 2024
Deposit Date Sep 23, 2024
Publicly Available Date Sep 23, 2024
Journal BMC Health Services Research
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 24
Issue 1
Article Number 1095
DOI https://doi.org/10.1186/s12913-024-11585-w
Keywords Travel distance, Musculoskeletal physiotherapy, Patient preferences, Parking, Discrete choice experiment, Continuity of care, Support workers, Skill mix, Delegation
Public URL https://keele-repository.worktribe.com/output/923694
Publisher URL https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-024-11585-w

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Licence
https://creativecommons.org/licenses/by/4.0/

Publisher Licence URL
https://creativecommons.org/licenses/by/4.0/

Copyright Statement
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.





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