Diagnosis and management of chronic hip and knee pain in a Tasmanian orthopaedic clinic: a study assessing the diagnostic and treatment planning decisions of an advanced scope physiotherapist

2019 ◽  
Vol 25 (1) ◽  
pp. 60 ◽  
Author(s):  
Dave Jovic ◽  
Jonathan Mulford ◽  
Kathryn Ogden ◽  
Nadia Zalucki
Keyword(s):  
Knee Pain ◽  
Conversion Rate ◽  
Clinical Effectiveness ◽  
Weighted Kappa ◽  
Orthopaedic Surgeon ◽  
Advanced Practice ◽  
Model Of Care ◽  
Orthopaedic Clinic ◽  
Orthopaedic Care ◽  
Planning Decisions

The aim of this study is to investigate the clinical effectiveness of an advanced practice physiotherapist triaging patients referred from primary care to the orthopaedic clinic with chronic hip and knee pain. An exploratory study design was used to assess 87 consecutive patients referred from general practice in Northern Tasmania. Patients were assessed by both an advanced practice physiotherapist and a consultant orthopaedic surgeon. Diagnostic and treatment decisions were compared, with the orthopaedic consultant decision defined as the gold standard. By using these decisions, over and under referral rates to orthopaedics could be calculated, as well as the surgical conversion rate. Conservative care of patients referred to the orthopaedic clinic with hip and knee pain was limited. The diagnostic agreement between the advanced scope physiotherapist and the orthopaedic surgeon was almost perfect (weighted kappa 0.93 (95% CI 0.87–1.00)), with treatment agreement substantial (weighted kappa 0.75 (95% CI 0.62–0.89)). Under a physiotherapist-led triage service, the surgical conversion rate doubled from 38% to 78%. An advanced physiotherapist assessing and treating patients with chronic hip and knee pain made decisions that match substantially with decisions made by an orthopaedic consultant. A model of care utilising an advanced physiotherapist in this way has the potential to support high-quality orthopaedic care in regional centres.

Understanding the value of clinical survivorship programs.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 86-86
Author(s):  
Katherine Ramsey Gilmore ◽  
Guadalupe R. Palos ◽  
Patricia Chapman ◽  
Paula A. Lewis-Patterson ◽  
Maria Alma Rodriguez
Keyword(s):  
Clinical Effectiveness ◽  
Models Of Care ◽  
Fiscal Year ◽  
Advanced Practice ◽  
Survivorship Care ◽  
Model Of Care ◽  
Billing Data ◽  
Annual Average ◽  
The Difference

86 Background: Various models of care exist for the growing number of cancer survivors; yet little is known about the value or the difference in the models’ costs. We sought to assess the professional billing and reimbursements of 2 models of survivorship care; a) oncologist-led and b) advanced practice providers (APPs). Methods: Data were collected from 6 disease specific survivorship clinics, genitourinary, gynecology, head and neck, lymphoma, melanoma, and thyroid. Billing data was obtained to determine the professional billing and reimbursement amounts for these visits over one fiscal year. Comparisons were made between the APP and oncologists average salaries to determine costs per model. Clinic FTE salaries were based on the amount of time an APP devoted to a survivorship activities with 33% fringe benefits added to salaries. Oncologists’ salaries were based on the annual average faculty salary by department including fringe. Results: Billing data of 4,255 outpatient survivorship visits across the six clinics from 09/1/2016 - 8/31/2017 were abstracted. Table 1 summarizes the percentage (%) of professional reimbursement by model of care, oncologist versus APP and survivorship clinic. Conclusions: These data indicate that the advanced practice providers' model of survivorship care was financially more efficient than the oncologist model. Further research is warranted to compare the clinical effectiveness of these models and their impact on patients' outcomes related to their quality of life and satisfaction with care.[Table: see text]

scholarly journals Initial Evaluation by a Nonoperative Provider Does Not Delay the Surgical Care of Operative Ankle Fractures in a Walk-in Orthopaedic Clinic

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0017
Author(s):  
Matthew N Fournier ◽  
Joseph T Cline ◽  
Adam Seal ◽  
Richard A Smith ◽  
Clayton C Bettin ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Ankle Fracture ◽  
Initial Evaluation ◽  
Orthopaedic Surgeon ◽  
Ankle Fractures ◽  
Definitive Treatment ◽  
Foot And Ankle ◽  
Orthopaedic Clinic ◽  
Orthopaedic Surgeons ◽  
Clinic Visits

Category: Ankle, Trauma Introduction/Purpose: Walk-in and “afterhours” clinics are a common setting in which patients may seek care for musculoskeletal complaints. These clinics may be staffed by orthopaedic surgeons, nonsurgical physicians, advanced practice nurses, or physician assistants. If orthopaedic surgeons are more efficient than nonoperative providers at facilitating the care of operative injuries in this setting is unknown. This study assesses whether evaluation by a nonoperative provider delays the care of patients with operative ankle fractures compared to those seen by an orthopaedic surgeon in an orthopaedic walk-in clinic. Methods: Following IRB approval, a cohort of patients who were seen in a walk-in setting and who subsequently underwent surgical treatment for an isolated ankle fracture were retrospectively identified. The cohort was divided based on whether the initial clinic visit had been conducted by an operative or nonoperative provider. A second cohort of patients who were evaluated and subsequently treated by a fellowship-trained foot and ankle surgeon in their private practice was used as a control group. Outcome measures included total number of clinic visits before surgery, total number of providers seen, days until evaluation by treating surgeon, and days until definitive surgical management. Results: 138 patients were seen in a walk-in setting and subsequently underwent fixation of an ankle fracture. 61 were seen by an orthopaedic surgeon, and 77 were seen by a nonoperative provider. No significant differences were found between the operative and nonoperative groups when comparing days to evaluation by treating surgeon (4.1 vs 4.5, p=.31), or days until definitive surgical treatment (8.4 vs 8.8, p=.58). 62 patients who were seen and treated solely in a single surgeon’s practice had significantly fewer clinic visits (1.11 vs 2.03 and 2.09, p<.05), as well as days between evaluation and surgery compared to the walk-in groups (5.44 vs 8.44 and 8.78, p<.05). Conclusion: Initial evaluation in a walk-in orthopaedic clinic setting is associated with a longer duration between initial evaluation and treatment compared to a conventional foot and ankle surgeon’s clinic, but this difference may not be clinically significant. Evaluation by a nonoperative provider is not associated with an increased duration to definitive treatment compared to an operative provider.

Hypnosis: A Useful Strategy for Symptom Relief

2003 ◽  
Vol 9 (5) ◽  
pp. 163-166 ◽  
Author(s):  
Sharon M. Valente
Keyword(s):  
Symptom Relief ◽  
Symptom Control ◽  
Clinical Effectiveness ◽  
Self Esteem ◽  
Psychiatric Nurses ◽  
Advanced Practice ◽  
Control Behavior ◽  
Self Confidence

Nurses are well positioned to use hypnosis to relieve symptoms, but they may lack knowledge about its clinical effectiveness. Hypnosis can help clients alleviate anxiety, reduce arousal, control behavior, and develop control when they become upset or worried. With education and supervision, psychiatric nurses in general or advanced practice can use hypnosis to help clients achieve symptom control and improve self-esteem and self-confidence.

Community Care Management: Advanced Practice Nurses as Care Managers

2000 ◽  
Vol 2 (3) ◽  
pp. 148-152 ◽  
Author(s):  
Christine M. Waszynski ◽  
Wendy Murakami ◽  
Mary Lewis
Keyword(s):  
Health Care ◽  
High Risk ◽  
Primary Care Physicians ◽  
Advanced Practice Nurses ◽  
Advanced Practice ◽  
Model Of Care ◽  
Practice Nurses ◽  
Coordination Model ◽  
Hospital Days ◽  
Care Costs

A group of advanced practice nurses partnered with a major insurer in the design and implementation of a care coordination model for high-risk older adults. This article will discuss the process of such an undertaking, highlighting the successes and barriers encountered. The key elements of this program included early identification and regular reassessment of each member’s acuity level; fostering close partnerships between individual or teams of APRNs and groups of physicians; and uninterrupted clinical management of high-risk members across the health care continuum. This model was designed to achieve the following outcomes: to support the physician management of high-risk, chronic individuals; to increase or maintain the health of members; and to reduce health care costs. Outcome studies have demonstrated a substantial net savings by decreasing acute care admissions by 54%, reducing hospital days by 42%, and trimming primary care physicians’ and specialists’ visit costs by 37%. There was a 33% reduction in the overall costs of health care for members enrolled in this program. Physicians and members both rated their satisfaction with the APRN-based model of care as very high.

scholarly journals Expanding roles in orthopaedic care: a comparison of physiotherapist and orthopaedic surgeon recommendations for triage

2009 ◽  
Vol 15 (1) ◽  
pp. 178-183 ◽  
Author(s):  
Crystal MacKay ◽  
Aileen M Davis ◽  
Nizar Mahomed ◽  
Elizabeth M Badley
Keyword(s):  
Orthopaedic Surgeon ◽  
Orthopaedic Care

scholarly journals Physiotherapy-led triage clinic for low back pain

2009 ◽  
Vol 33 (4) ◽  
pp. 663 ◽  
Author(s):  
Megan S Blackburn ◽  
Cary Nall ◽  
Belinda Cary ◽  
Sallie M Cowan
Keyword(s):  
Public Hospital ◽  
Waiting Times ◽  
Orthopaedic Surgeon ◽  
Low Back ◽  
Orthopaedic Clinic ◽  
Face To Face ◽  
Conversion Rates ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital ◽  
Outpatient Appointments

The aims of this study were to evaluate a physiotherapy-led triage clinic (PLTC) and investigate general practitioner satisfaction with the PLTC. A retrospective cohort study was undertaken from January to December 2005 at a Melbourne tertiary teaching hospital. Outcomes assessed included waiting times to first appointment, patient attendance and surgery conversion rates. Outcomes were compared with the hospital 2002 benchmark data. GP satisfaction was evaluated by a survey. One-hundred and five new patients attended the PLTC clinic during the evaluation period. Patients waited 9 weeks for a PLTC appointment compared with 26 weeks for the general orthopaedic clinic and 23 weeks for the spinal orthopaedic clinic. Sixty-seven percent of the patients triaged in the PLTC were discharged from the orthopaedic outpatient department without requiring an orthopaedic surgeon consultation. Referring GPs were at least as satisfied with the management of their patients through the PLTC as with usual management in the general orthopaedic clinic. A PLTC can significantly reduce waiting times for orthopaedic outpatient appointments in a public hospital. Many patients can be managed by these experienced physiotherapists and their GPs, without the need for face-to-face contact with an orthopaedic surgeon. Pilot results indicated that GPs whose patients are managed in this PLTC were satisfied with this model for their patients with low back conditions.

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