Hospital-Based Outpatient Direct Access to Physical Therapist Services: Current Status in Wisconsin.
BACKGROUND
Direct access to physical therapist services is available in all 50 states, with reported benefits including reduced health care costs, enhanced patient satisfaction, and no apparent compromised patient safety. Despite the benefits and legality of direct access, few data exist regarding the degree of model adoption, implementation, and utilization.


OBJECTIVE
The purposes of the study were: (1) to investigate the extent of implementation and utilization of direct access to outpatient physical therapist services in Wisconsin hospitals and medical centers, (2) to identify barriers to and facilitators for the provisioning of such services, and (3) to identify potential differences between facilities that do and do not provide direct access services.


METHODS
A descriptive survey was conducted.


METHODS
Eighty-nine survey questionnaires were distributed via email to the directors of rehabilitation services at Wisconsin hospitals and medical centers. The survey investigated facility adoption of the direct access model, challenges to and resources utilized during model implementation, and current barriers affecting model utilization.


RESULTS
Forty-seven (52.8%) of the 89 survey questionnaires were completed and returned. Forty-two percent of the survey respondents (20 of 47) reported that their facility offered direct access to physical therapist services, but fewer than 10% of patients were seen via direct access at 95% of the facilities offering such services. The most frequently reported obstacles to model implementation and utilization were lack of health care provider, administrator, and patient knowledge of direct access; its legality in Wisconsin; and physical therapists' differential diagnosis and medical screening abilities.


CONCLUSIONS
Potential respondent bias and limited generalizability of the results are limitations of the study. These findings apply to hospitals and medical centers located in Wisconsin, not to facilities located in other geographic regions.


CONCLUSIONS
Respondents representing direct access organizations reported more timely access to physical therapist services, enhanced patient satisfaction, decreased organizational health care costs, and improved efficiency of resource utilization as benefits of model implementation. For organizations without direct access, not being an organizational priority, concerns from referral sources, and concerns that the physician-patient relationship would be negatively affected were noted as obstacles to model adoption.
W.G. Boissonnault, PT, DPT, DHSc, FAPTA, Professional Affairs Unit, American Physical Therapy Association, 1111 N Fairfax St, Alexandria, VA 22314-1488 (USA). At the time of the study, Dr Boissonnault was affiliated with the Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin. billboissonnault@apta.org.
William G
WG
Boissonnault
K. Lovely, PT, DPT, Presbyterian Healthcare Services, Albuquerque, New Mexico. At the time of the study, Dr Lovely was affiliated with the Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison.
Karen
K
Lovely
D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D017146:Models, Organizational; D010044:Outpatient Clinics, Hospital; D017060:Patient Satisfaction; D059825:Physical Therapists; D010814:Physical Therapy Department, Hospital / Q000458:organization & administration*; D026761:Physical Therapy Specialty / Q000458:organization & administration; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D014922:Wisconsin