An Evaluation of Physiotherapist

Independent Prescribing in Queensland

Mark Cruickshank

Physiotherapy – RBWH

2019 National Allied Health Conference

Challenges

demographic changes and the demand for health services[1]

2015 - 4.5 people aged 15-64 for every person 65 or older 2055 - 2.7 people aged 15-64 for every person 65 or older older population are higher users of the health system [2]

coordinated management of chronic conditions 75-84 age group - 72% have at least one chronic musculoskeletal condition, primarily

managed conservatively (e.g. physical therapies and medications) [3]

increasing community demands for responsiveness 1 in 5 people currently report waiting longer than acceptable to see their GP (worse in

remote areas which disproportionately disadvantages our indigenous population) [4]

Av age of GPs is 54 years and over 50% intend to retire in the next 10 years –traditional prescriber shortage [5]

Background

Challenges increasing health care expenditure

in the last 10 years total health expenditure has increased in real terms by 50%, population increase by only 17% over the same period. [6]

Solutions [7]

new models of care that enhance productivity adjustments to skill mix to allow the medical workforce to focus on tasks only

they can undertake ensuring other health professionals work to maximise their scope of practice

As an example, non-medical prescribing is a method of increasing the number of prescribers to meet community requirements for timely access to medicines while reducing the demand on the traditional prescriber workforce [8] [9]

Background

Trial Overview

As part of the overall model of care in Emergency Departments,

prescribing by primary contact physiotherapists aims to safely

improve the efficiency and effectiveness of the management of

MSK conditions, by enabling prescribing within the scope of

practice for physiotherapy

Patients have improved timely access to appropriate care and analgesia

Medical staff are released to manage more complex presentations

within the ED

Multicentre descriptive trial

2500 patients over 18 – 24

months

TPCH (2)

GCUH/Robina (1) Cairns (1)

QEII (2)

RBWH (2)

Getting Started

Health Professionals Prescribing Pathway [4]

Getting Started

Complete education

& training

Obtain recognition

from National

Board of

competence to

prescribe

Ensure

authorisation to

prescribe

Prescribe medicines

within scope of

practice

Maintain & enhance

competence to

prescribe

Prescribing

Training (QUT)• 150 hr coursework &

120 hr LIP

• Clinical

Therapeutics

• QUM & safe

prescribing

Credentialing• No Board

endorsement

• HHS credentialing

applications

• New service

application

• Individual extended

scope applications

Authorisation to

Prescribe• Approval to

prescribe under

S18 of the Health

Drugs & Poisons

Regulation as part

of research trial

Protocol, MOC &

Formulary• Protocol approved

by Ethics

• Formulary approved

by local MAC

• Existing MOC

Audit process• Local Gov. group

• NIMC audits

• Patient experience

and satisfaction

• Discharge script

audits

• Clinical incident

monitoring

Physiotherapy Defined Scope of Practice Trial – Prescribing

Governance

Local Drug Protocol Development & Endorsement through local Governance

Trial Local Governance Group Established

Site Specific Applications

Protocol Development and Ethics

Section 18 application to Medicines Regulation Quality Unit

HHS CE approval for Section 18 (HDPR) application

Prescribing Training (QUT) –coursework 150hrs & 120hrs LIP

Endorsement of Approved course of study by CHO

Trial commencement -Prescribing starts

Local Credentialing Committee approval for Extended Scope

Practice

*First participant recruited March 2017

• Prescribing Incidents

• Accuracy of PrescribingSafety

• Completeness of prescribing

• Technical efficiencyEfficiency

• Patient Experience

• Patient SatisfactionResponsiveness

Adapted from: Hale, A.R., et al., An evaluation framework for non-medical prescribing research. Aust Health Rev, 2012. 36(2): p. 224-8 & The National Health Information and Performance Principal Committee. The Australian Health Performance Framework. 2017.

Evaluation

Results to date - Safety

Safety – Adverse Events from PTHY prescribing error = 0

0

200

400

600

800

1000

1200

1400

1600

1800

CairnsHospital

Gold CoastUni Hosp

QEII RBWH TPCH Total

456

123

315

451

154

1499

468

159

387

572

170

1756

Participants & Written Orders

Participants

All Orders

Results to date

50

430

928

1208

0 200 400 600 800 1000 1200 1400

NUMBER OF PARTICIPANTS

TYPE OF PRESCRIBING

ACTIVITY

Frequency of Different Prescribing Activities

OTC Advice given

NIMC order/s

Medicines Optimised

EPP D/C Script issued

Results to date – Safety & Efficiency

Results to date – Responsiveness

Responsiveness – Patient Experience (n=871/879)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree

Confidence in physiotherapist prescribing medications safely

98%

Results to date – Responsiveness

Responsiveness – Patient Experience (n=869/879)

98%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Strongly Agree Agree Neither Agree nor Disagree Strongly Disagree

Trust physiotherapist's ability to prescribe right medications

Results to date – Responsiveness

Responsiveness – Patient Satisfaction (n=867/879)

0%

10%

20%

30%

40%

50%

60%

70%

80%

Very satisfied Satisfied Neither satisfied nordissatisfied

Dissatisfied Very dissatisfied

Satisfaction with Physiotherapist managing medication needs

92%

Summary and Future Directions

Preliminary trial data suggests autonomous prescribing by physiotherapists:

achieved safely within physiotherapy scope of practice

done with an acceptable level of accuracy, completeness and efficiency when compared to other prescribers

responsive to the needs of consumers with very high levels of confidence, trust and satisfaction

Future directions

investigate the domain of appropriateness of physiotherapy prescribing

develop new prescribers and expand to additional sites

achieve sustainable authorisation for prescribers outside of research trial framework

Contact Details

For further information, contact:

Mark.Cruickshank@health.qld.gov.au

Allied Health Professions Office of Queensland

Royal Brisbane and Women's Hospital Foundation

Acknowledgements

References

1. Commonwealth of Australia. 2015 Intergenerational Report Australia in 2055. 2015.

2. Australian Institute of Health and Welfare. Australia’s Health 2016. Australia’s health series no. 15. In. Vol Cat. no. AUS 199. Canberra: AIHW2016.

3. Australian institute of Health and Welfare. Musculoskeletal conditions and comorbidity in Australia no. 25. Cat. no, PHE 241. In. Canberra: AIHW2019.

4. Australian Bureau of Statistics. Patient Expereinces in Australia: summary of findings, 2016-17 cat. no.4839.0. In: ABS, ed. Canberra: ABS2017.

5. Commonwealth of Australia - Department of Health. National Health Workforce Data Set General practice - 2016 Factsheet. In:2017.

6. Australian Institute of Health and Welfare. Health expenditure Australia 2016–17. In. Canberra: AIHW; 2018.

7. Commonwealth of Australia. Health Workforce Australia 2014: Australia’s Future Health Workforce - Doctors. Canberra2014.

8. Morris, J.H. and K. Grimmer, Non-medical prescribing by physiotherapists: issues reported in the current evidence. Man Ther, 2014. 19(1): p. 82-6.

9. Cardiff, L., ASPRINH Project Prescribing Assessment Toolkit. 2017.

10.Health Workforce Australia, Health Professionals Prescribing Pathway (HPPP) Project -Final Report. 2013.

11.Allied Health Professions' Office of Queensland. A framework for allied health professional prescribing trials within Queensland Health. In: Department of Health. Queensland Govenment; December 2014.