Kerr, Daniel Paul

Topley, Daniel

Wilson, Iseult M

Abstract • Objectives To investigate, describe and explain the occurrence and implications of patients repeatedly referred into musculoskeletal physiotherapy departments for the same or different diagnoses. • Methods Physiotherapists have reported anecdotally a pattern of patients repeatedly re-referred into musculoskeletal outpatient physiotherapy departments, many for the same diagnoses of unspecified chronic pain. Statistical outputs, or ‘exceptional reports’, from the relevant NHS Trust patient database were generated in order to examine these claims. An exhaustive systematic literature search and review was carried out within the Cochrane library, AMED, Embase, Medline and PubMed databases to identify current knowledge of the occurrence within the published literature. These findings precede and informed the design of a further, ongoing, mixed-methods investigation. • Results Statistical outputs from the Local Community Information Database (LCID) corroborated the problematic patterns raised by Trust physiotherapists. 13,274 patients had multiple referrals over 3 years (2012-2015), far surpassing expected rates even for chronic/degenerative conditions in an ageing population (Miller et al, 2005) and responsible for one third of all referrals over the period (approximately 30,000 of 90,000 referrals). A systematic search investigated current knowledge on the issue. 56 studies were retained by title after removing duplicates. Screening the results by abstract left 32 studies. Only 4 studies however directly addressed repeated re-referral, while 28 investigated initial referrals in relation to secondary-primary care interface quality, written referral content, and predictive/influential factors to referral. No study investigated repeated re-referrals in this setting. A variety of factors affect initial referral decisions, including diagnoses/severity, GP characteristics (Jorgensen &amp; Olesen, 2008), professional interaction (Peters et al., 1994), setting (Freburger et al., 2003), and patient expectations (Ehrmann-Feldmann et al., 1996). There is no current comparison with repeat referrals, nor how patient status at time of previous discharge affects subsequent referral decisions. • Conclusions A significant gap in knowledge exists regarding populations documented as repeatedly re-referred for the same diagnoses into musculoskeletal physiotherapy, and comparison of initial to subsequent referrals. Further investigation is warranted in order to build up a comprehensive picture of the occurrence. Stakeholders, i.e. patients, physiotherapists, and referrers, ought to be included in this research, and their insights and perceptions ought to contribute to explaining the picture obtained

Wilson, Iseult

Kerr, Daniel P

Queen's University Belfast Research Portal

Questions asked of a pathway - a pattern identified of repeatedly re-referred patients to musculoskeletal outpatient physiotherapy

• Objectives To investigate, describe and explain the occurrence and implications of patients repeatedly referred into musculoskeletal physiotherapy departments for the same or different diagnoses. • Methods Physiotherapists have reported anecdotally a pattern of patients repeatedly re-referred into musculoskeletal outpatient physiotherapy departments, many for the same diagnoses of unspecified chronic pain. Statistical outputs, or ‘exceptional reports’, from the relevant NHS Trust patient database were generated in order to examine these claims. An exhaustive systematic literature search and review was carried out within the Cochrane library, AMED, Embase, Medline and PubMed databases to identify current knowledge of the occurrence within the published literature. These findings precede and informed the design of a further, ongoing, mixed-methods investigation. • Results Statistical outputs from the Local Community Information Database (LCID) corroborated the problematic patterns raised by Trust physiotherapists. 13,274 patients had multiple referrals over 3 years (2012-2015), far surpassing expected rates even for chronic/degenerative conditions in an ageing population (Miller et al, 2005) and responsible for one third of all referrals over the period (approximately 30,000 of 90,000 referrals). A systematic search investigated current knowledge on the issue. 56 studies were retained by title after removing duplicates. Screening the results by abstract left 32 studies. Only 4 studies however directly addressed repeated re-referral, while 28 investigated initial referrals in relation to secondary-primary care interface quality, written referral content, and predictive/influential factors to referral. No study investigated repeated re-referrals in this setting. A variety of factors affect initial referral decisions, including diagnoses/severity, GP characteristics (Jorgensen &amp; Olesen, 2008), professional interaction (Peters et al., 1994), setting (Freburger et al., 2003), and patient expectations (Ehrmann-Feldmann et al., 1996). There is no current comparison with repeat referrals, nor how patient status at time of previous discharge affects subsequent referral decisions. • Conclusions A significant gap in knowledge exists regarding populations documented as repeatedly re-referred for the same diagnoses into musculoskeletal physiotherapy, and comparison of initial to subsequent referrals. Further investigation is warranted in order to build up a comprehensive picture of the occurrence. Stakeholders, i.e. patients, physiotherapists, and referrers, ought to be included in this research, and their insights and perceptions ought to contribute to explaining the picture obtained

Ulster University's Research Portal

Questions asked of a pathway – a pattern identified of repeatedly re-referred patients to musculoskeletal outpatient physiotherapyAuthors Mr. Daniel Topley (Ulster University) Dr. Daniel Kerr (Ulster University) Dr. Iseult Wilson (Ulster University) Abstract• Objectives To investigate, describe and explain the occurrence and implications of patients repeatedly referred into musculoskeletal physiotherapy departments for the same or different diagnoses. • Methods Physiotherapists have reported anecdotally a pattern of patients repeatedly re-referred into musculoskeletal outpatient physiotherapy departments, many for the same diagnoses of unspecified chronic pain. Statistical outputs, or ‘exceptional reports’, from the relevant NHS Trust patient database were generated in order to examine these claims. An exhaustive systematic literature search and review was carried out within the Cochrane library, AMED, Embase, Medline and PubMed databases to identify current knowledge of the occurrence within the published literature. These findings precede and informed the design of a further, ongoing, mixed-methods investigation. • Results Statistical outputs from the Local Community Information Database (LCID) corroborated the problematic patterns raised by Trust physiotherapists. 13,274 patients had multiple referrals over 3 years (2012-2015), far surpassing expected rates even for chronic/degenerative conditions in an ageing population (Miller et al, 2005) and responsible for one third of all referrals over the period (approximately 30,000 of 90,000 referrals). A systematic search investigated current knowledge on the issue. 56 studies were retained by title after removing duplicates. Screening the results by abstract left 32 studies. Only 4 studies however directly addressed repeated re-referral, while 28 investigated initial referrals in relation to secondary-primary care interface quality, written referral content, and predictive/influential factors to referral. No study investigated repeated re-referrals in this setting. A variety of factors affect initial referral decisions, including diagnoses/severity, GP characteristics (Jorgensen & Olesen, 2008), professional interaction (Peters et al., 1994), setting (Freburger et al., 2003), and patient expectations (Ehrmann-Feldmann et al., 1996). There is no current comparison with repeat referrals, nor how patient status at time of previous discharge affects subsequent referral decisions. • Conclusions A significant gap in knowledge exists regarding populations documented as repeatedly re-referred for the same diagnoses into musculoskeletal physiotherapy, and comparison of initial to subsequent referrals. Further investigation is warranted in order to build up a comprehensive picture of the occurrence. Stakeholders, i.e. patients, physiotherapists, and referrers, ought to be included in this research, and their insights and perceptions ought to contribute to explaining the picture obtained. • References Ehrmann - Feldmann et al., (1996) Physician Referral to Physical Therapy in a Cohort of Workers Compensated for Low Back Pain; Physical Therapy, 76(2); pp150-156 Freburger et al., (2003), Physician referrals to Physical Therapy for the Treatment of Musculoskeletal Conditions; Arch Phys Med Rehabil Vol 84, pp1839-1849 Jorgenson & Olesen (2008), Predictors for referral to physiotherapy from general practice; Scand J Prim Health Care Vol 19; pp48-53 Miller et al., (2005), Geriatric Referral Patterns for Physical Therapy: A Descriptive Analysis; J Geriatr Phys Ther, 28(1); pp20-27 Peters et al., (1994), Musculoskeletal clinic in general practice: study of one year’s referrals; Brit Journ Gen Prac Vol 44; pp25-29 Reviewer #1Interesting and topical. The authors do not explain if the methodological quality of included studies was determined and if so, what tool was used?Reviewer #2N/A

Questions asked of a pathway – a pattern identified of repeatedly re-referred patients to musculoskeletal outpatient physiotherapy

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