A Comparison of Physician Referral and Direct Access Practice Models: An analysis of physical therapy practice patterns when accessed through direct access versus a physicianÍs referral

Abstract

Study Design: Individual semistructured qualitative interviews Objective: To evaluate physical therapy practice patterns with patients accessing care through direct access (DA) compared to physician referral (PR), focusing on critical thinking, clinical reasoning, differential diagnosis, medical screening, complementary care, and perceived barriers to DA. Background: The literature currently shows the efficacy and cost-effectiveness of DA by a decrease in time during episode of care, financial burden, utilization of services, and appropriate referral to physicians and other specialists as necessary. Methods: Physical therapists, current and former physical therapist students, and patients of H&D Physical Therapy, Manhattan, NY were recruited. Individual interviews were conducted to assess if and how physical therapy practice patterns change from a DA versus a PR episode of care. Responses were analyzed for areas of contradiction or consensus. Results: Respondents all implemented skills in clinical reasoning, critical thinking, differential diagnosis, medical screening, and complementary care at equal levels with both modes of care. They maintained an equal level of confidence in patient care and appropriate referral of patients as needed in both situations. Conclusion: æDA facilitated both timeliness and a high standard of care. Therapists and students utilize the same level of skill in multiple, varied domains. A greater awareness of the availability of DA among consumers and other medical professionals would result in more widespread implementation.