Implementation of an advanced scope of practice physiotherapist in neurosciences clinics improves patient access to community services

Ms Jan Quiney1, Ms Lucinda  Marr1, Ms Samantha  Plumb1, Mr Scott Edwards1

1Royal Melbourne Hospital, Parkville, Australia


AIM: To investigate if the implementation of an advanced practice physiotherapist (APP) within three neurosciences outpatient specialist clinics improves patient care by addressing unmet physical need and satisfaction.

METHOD: Prospective implementation study. APP roles were implemented in three Neurosciences specialist outpatient clinics (Stroke, Neuro Oncology and Neuromuscular). An APP worked alongside the usual specialist medical staff. Quality of care data included number of patients seen; interventions performed (including referrals to community services); and patient and medical staff satisfaction.

RESULTS: Over 4 months, 126 patients were seen by the APP across the 3 clinics (equivalent to 378 per annum). Main interventions included: patient education/advice (73-100%); exercise prescription (50-92%); linking to community services (8-56%) referral to community physiotherapy (27-56%); referral to other community Allied Health discipline (8-33%). All clinic medical staff (100%) believed the APP addressed the physical needs of their patients (rated 10/10) and were supportive for an ongoing role. Patient satisfaction was high, with 100% of respondents (n=9) reporting that the APP assessment benefited them, and addressed all identified problems (44%). Over 69 hours of medical consultant time was freed up by APP over the four months.

SIGNIFICANCE OF THE FINDINGS TO ALLIED HEALTH: The APP in specialist neurosciences clinics improved the quality of care provided through timely physiotherapy interventions and increasing linkages with community based services.  The role enables optimal use of the physiotherapy workforce to free up consultant time and provides an enriching career path for hospital physiotherapists into more senior clinical roles. Further investigations are needed to determine the efficacy on patient outcomes and health economic benefits.