Microrregulation of access to the care network in physiotherapy: strategies for improving the care flow in a secondary care service

ABSTRACT We characterized a physiotherapy service of the city. The profile of patients on the waiting list was assessed and identified to propose strategies for micro-regulation on the access to secondary-level physiotherapy to improve the resolution rate of the system. This is a cross-sectional study carried out with the physiotherapy team of the secondary care and 70 patients on the waiting list. The team was interviewed and patients were assessed and forwarded to the different care points according to their needs. The information obtained from the interviews of professionals and triage of patients was used to propose improvements and greater resolution. The secondary care physiotherapy team has a high demand. The origin of the referrals was first from Orthopedists/Traumatologists (88%), and clinical diagnosis of Osteoarthritis (36%). After the evaluation, 72% of patients did not need the complexity of a secondary physiotherapy service. The problems found were related to low resolution on primary health care, lack of coordination for physiotherapy teams, lack of dialogue with other professionals, and screening and care criteria in the secondary level of care. The lack of understanding of the network organization of services reflected in a long waiting list for secondary physiotherapy. From the identification of the main problems, strategies indicated were the screening by the primary care staff and medical professionals of the specialized care; and coordinator for improving dialogue between the care points of physiotherapy.

摘要 本研究对本市的物理治疗（physiotherapy）服务开展特征分析。研究对等待队列中的患者画像进行评估与梳理，旨在提出二级物理治疗（secondary-level physiotherapy）准入的微观调控策略，以提升该服务体系的问题解决率。本研究为横断面研究（cross-sectional study），研究对象为二级医疗照护（secondary care）物理治疗团队及70名等待队列中的患者。研究团队对该物理治疗团队开展访谈，同时对患者进行评估，并根据其需求将其转诊至不同照护点位。通过整合专业人员访谈及患者分诊（triage）所获取的信息，本研究提出优化方案以提升系统的问题解决效能。二级医疗照护物理治疗团队面临极高的服务需求。转诊（referrals）来源首位为骨科/创伤科医师（Orthopedists/Traumatologists）（占比88%），临床诊断以骨关节炎（Osteoarthritis）为主（占比36%）。经评估后，72%的患者无需二级物理治疗服务的复杂照护。研究发现的问题包括：基层医疗卫生机构问题解决率偏低、物理治疗团队间缺乏协同联动、与其他专业人员沟通不足，以及二级照护环节的分诊与照护标准不完善。对服务网络架构的认知不足，导致二级物理治疗等待队列过长。基于对核心问题的识别，本研究提出两项优化策略：一是由基层医护人员及专科医疗人员开展专科照护分诊工作；二是设立协调专员，以加强物理治疗各照护点位间的沟通联动。