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Referrals for physical therapy for musculoskeletal conditions vary and may indicate problems with access to care

Individuals with musculoskeletal conditions ranging from acute strains and sprains to degenerative joint disease usually visit an orthopedic surgeon or a primary care physician (PCP). Patient insurance status and specific physician characteristics appear to influence whether visits to orthopedic surgeons and/or PCPs result in referral to a physical therapist (PT), even after controlling for patient diagnosis, illness severity, and supply of physical therapists, according to the findings from a recent study. The study was supported by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00032).

Variation in PT referral may indicate problems with access to care and/or inappropriate referral and may ultimately affect the quality and cost of care for patients with musculoskeletal conditions, concludes lead author Janet K. Freburger, P.T., Ph.D., of the Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC. Dr. Freburger and colleagues analyzed data from the National Ambulatory Medical Care Survey of U.S. office-based physician practices. They examined whether a PT referral was made during 4,911 visits to PCPs and 4,201 visits to orthopedic surgeons for musculoskeletal conditions.

Primary care visits covered by Medicaid or a managed care plan were less likely to result in PT referral compared with visits covered by private insurance or a nonmanaged care plan. Orthopedic surgeon visits covered by workers' compensation or managed care were more likely to result in PT referral than visits not covered by either one. Primary care visits to osteopathic physicians (who place more emphasis on the relationship of the organs and musculoskeletal system than other doctors) were more likely to result in PT referral than visits to allopathic primary care physicians (most doctors). Given identical visit characteristics, orthopedic surgeon visits were more likely than primary care visits to result in PT referral.

See "Physician referrals to physical therapy for the treatment of musculoskeletal conditions," by Dr. Freburger, George M. Holmes, Ph.D., and Timothy S. Carey, M.D., M.P.H., in the December 2003 Archives of Physical Medicine and Rehabilitation 84, pp. 1839-1849.

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