Abstract
Background International policy advocates for direct access, but the extent to which it exists worldwide was unknown.
Objective The purpose of this study was to map the presence of direct access to physical therapy services in the member organizations of the World Confederation for Physical Therapy (WCPT) in the context of physical therapist practice and health systems.
Design A 2-stage, mixed-method, descriptive study was conducted.
Methods A purposive sample of member organizations of WCPT in Europe was used to refine the survey instrument, followed by an online survey sent to all WCPT member organizations. Data were analyzed using descriptive statistics, and content analysis was used to analyze open-ended responses to identify themes.
Results A response rate of 68% (72/106) was achieved. Direct access to physical therapy was reported by 58% of the respondents, with greater prevalence in private settings. Organizations reported that professional (entry-level) education equipped physical therapists for direct access in 69% of the countries. National physical therapy associations (89%) and the public (84%) were thought to be in support of direct access, with less support perceived from policy makers (35%) and physicians (16%). Physical therapists' ability to assess, diagnose, and refer patients on to specialists was more prevalent in the presence of direct access.
Limitations The findings may not be representative of the Asia Western Pacific (AWP) region, where there was a lower response rate.
Conclusions Professional legislation, the medical profession, politicians, and policy makers are perceived to act as both barriers to and facilitators of direct access. Evidence for clinical effectiveness and cost-effectiveness and examples of good practice are seen as vital resources that could be shared internationally, and professional leadership has an important role to play in facilitating change and advocacy.
Footnotes
Both authors provided concept/idea/research design and contributed to writing, data collection and analysis, and project management. Ms Bury provided study participants and institutional liaisons.
Both authors are involved with the work of WCPT. Ms Bury is an employed member of staff, and Dr Stokes is currently Vice President and sits on the Executive Committee; at the time of the study she was the European regional representative on the Committee.
The views expressed in the article are those of the authors and do not necessarily represent the views of WCPT. The authors acknowledge the support of all delegates to the European Region of WCPT Workshop on Direct Access, the external reference group for assistance in developing the survey instrument, and the respondents from WCPT's member organizations.
- Received February 14, 2012.
- Accepted November 16, 2012.
