title: The perceptions of Athenian physiotherapists on the referral service in Greece and its impact on professional autonomy.
abstract: OBJECTIVE
  The attainment of professional autonomy is considered a priority of any profession. The development of autonomy in physiotherapy has differed among countries, with some achieving a high degree of autonomy while others have struggled. The current literature reveals little about the autonomy of physiotherapists in Greece, although it would appear they face both external and internal threats to autonomous practice and to the development of their profession. This exploratory study investigated Athenian physiotherapists' experiences of the referral system in Greece and its impact on professional autonomy.
  
  
  METHODS
  A qualitative, phenomenological approach was chosen, using a cluster sampling method. Ten physiotherapists participated in a 30-minute, one-to-one, semi-structured interview. The interview audio tapes were transcribed and an inductive analysis was carried out. When all transcripts had been coded, categories and themes were compared to record commonalities and differences to construct a hierarchy of essential themes expressing general views.
  
  
  RESULTS
  Physiotherapists were frustrated by the physiotherapy referral system in Greece. They revealed that their practice was restricted by factors, which included a long-standing dominance by the medical profession, bureaucratic process and the public perception of the profession in addition to restrictions from within the profession itself. To overcome the perceived restrictions to practice and the development of autonomy, participants had adopted strategies in an attempt to effectively address the patients' needs.
  
  
  CONCLUSIONS
  There are clear issues related to the management and delivery of the physiotherapy referral system in Greece which impact on professional autonomy. Physiotherapists are forced to manipulate the referral system to provide a more appropriate level of care, resulting, however, in an inequitable service across the physiotherapy provision. If professional autonomy of physiotherapists in Greece is to move forward, these issues need to be acknowledged by governmental and professional bodies, as therapists can not be expected to undertake this journey alone.
authors.affiliation: Department of Physical Education and Sport Science, University of Thessaly, Trikala, Thessaly, Greece. konchanou@gmail.com
authors.forename: Konstantina
authors.initials: K
authors.lastname: Chanou
authors.forename: Julie
authors.initials: J
authors.lastname: Sellars
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D016000:Cluster Analysis; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006115:Greece; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D026761:Physical Therapy Specialty / Q000458:organization & administration / Q000706:statistics & numerical data / Q000639:trends*; D017009:Professional Autonomy; D012017:Referral and Consultation / Q000458:organization & administration*; D012494:Sampling Studies; D012649:Self Concept; D012959:Socioeconomic Factors