title: Physiotherapy in Primary Care Triage - the effects on utilization of medical services at primary health care clinics by patients and sub-groups of patients with musculoskeletal disorders: a case-control study.
abstract: BACKGROUND
  Primary Care Triage is a patient sorting system used in some primary health care clinics (PHCCs) in Sweden where patients with musculoskeletal disorders (MSD) are triaged directly to physiotherapists. The purpose of this study was to investigate whether sorting/triaging patients seeking a PHCC for MSD directly to physiotherapists affects their utilization of medical services at the clinic for the MSD and to determine whether the effects of the triaging system vary for different sub-groups of patients.
  
  
  METHODS
  A retrospective case-control study design was used at two PHCCs. At the intervention clinic, 656 patients with MSD were initially triaged to physiotherapists. At the control clinic, 1673 patients were initially assessed by general practitioners (GPs). The main outcome measures were the number of patients continuing to visit GPs after the initial assessment, the number of patients receiving referrals to specialists/external examinations, doctors' notes for sick-leave or prescriptions for analgesics during one year, all for the original MSD.
  
  
  RESULTS
  Significantly fewer patients triaged to physiotherapists required multiple GP visits for the MSD or received MSD-related referrals to specialists/external examinations, sick-leave recommendations or prescriptions during the following year compared to the GP-assessed group. This applies to all sub-groups except for the group with lower extremity disorders, which did not reach significance for either multiple GP visits or sick-leave recommendations.
  
  
  CONCLUSIONS
  The reduced utilization of medical services by patients with MSD who were triaged to physiotherapists at a PHCC is likely due to altered management of MSD with initial assessment by physiotherapists.
authors.affiliation: Department of Clinical Neuroscience and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden .
authors.forename: Lena
authors.initials: L
authors.lastname: Bornhöft
authors.forename: Maria E H
authors.initials: ME
authors.lastname: Larsson
authors.forename: Jörgen
authors.initials: J
authors.lastname: Thorn
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000458:organization & administration; D016022:Case-Control Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis* / Q000534:rehabilitation*; D016017:Odds Ratio; D009936:Organizational Innovation; D063868:Patient Outcome Assessment; D026741:Physical Therapy Modalities / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D024382:Professional Role; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013548:Sweden; D014218:Triage; D055815:Young Adult
keywords: Musculoskeletal disorders; physical therapists; primary health care; triage