title: Is physiotherapy self-referral with telephone triage viable, cost-effective and beneficial to musculoskeletal outpatients in a primary care setting?
abstract: OBJECTIVE
  The aim of the present study was to establish if physiotherapy self-referral (SR) is viable, cost effective and beneficial to musculoskeletal outpatients in a primary care setting.
  
  
  METHODS
  In an urban National Health Service (NHS) primary care physiotherapy service, waiting times, attendance rates and treatment ratios (thus, episode-of-care costs) were deemed unsustainable. The introduction of 'Any Qualified Provider' is imminent and will drive NHS physiotherapy services to compete directly with private counterparts. Current literature, healthcare policy and the Chartered Society of Physiotherapy strongly advocate SR to promote value for money and improve the patient experience.
  
  
  METHODS
  A repeated measure prospective cohort study introduced an SR pathway parallel to existing general practice (GP) referrals and compared costs, attendance and data relating to the patient experience across groups.
  
  
  RESULTS
  SR referral groups were found to have a higher proportion of female patients presenting with acute conditions. Cost minimization analysis indicated an average 32.3% reduction in episode-of-care cost with an SR-initiated intervention. An estimated cost minimization of between £84,387.80 and £124,472.06 was calculated if SR were to be expanded service-wide. SR referral reduced waiting times and improved patient satisfaction relating to waiting times and communication compared with traditional pathways.
  
  
  CONCLUSIONS
  The results of the present study showed that the introduction of the described SR pathway was feasible, cost-effective and offered comparable care. Certain aspects of the SR patient experience compared more favourably than those studied in traditional GP referral routes. They also added to an existing body of evidence supporting SR with a variety of administrative processes in various socioeconomic settings.
authors.affiliation: South West Yorkshire Foundation Trust, Musculoskeletal Screening Service, Barnsley, UK; Sheffield Hallam University, Sheffield, UK.
authors.forename: Ross
authors.initials: R
authors.lastname: Mallett
authors.forename: Edward
authors.initials: E
authors.lastname: Bakker
authors.forename: Maria
authors.initials: M
authors.lastname: Burton
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D006801:Humans; D009140:Musculoskeletal Diseases / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D026761:Physical Therapy Specialty / Q000458:organization & administration*; D011320:Primary Health Care; D012017:Referral and Consultation / Q000191:economics / Q000458:organization & administration*; D013222:State Medicine; D013689:Telephone; D014218:Triage; D006113:United Kingdom
keywords: Physiotherapy; cost minimization; self-referral; telephone triage