Transforming Musculoskeletal Physiotherapy delivery to provide a combined digitalised service

Purpose

This service evaluation sought to review whether a move from a face to face only physiotherapy pathway to one initiated by a digital first approach improved speed of access to care whilst providing wider patient choice, maintaining patient satisfaction and reducing average number of treatment sessions.

 

When the digitalised pathway was adopted 17% of patients
were successfully treated and discharged using only the remote digitalised pathway...
...with the remaining 83%
being referred into a traditional face to face pathway.
Time to first contact with a physiotherapist
reduced from 6.19 days to 3.36 days in the digitalised pathway.

Approach

The service re-design was implemented in April 2018. This evaluation looks at management information gathered between June-December 2017 versus June-December 2018 to minimise effect of seasonal trends and to allow for the new service to become established.

The data reviewed was average treatment sessions, pathway utilisation and speed of access to first contact by a physiotherapist. We used an email-based survey when capturing patient service experience.

Outcomes

Our data demonstrates that speed of first contact with a physiotherapist reduced from 6.19 working days in the original face to face only physiotherapy service to 3.36 days in the digitalised pathway.


When the digitalised pathway was adopted 17% of patients were successfully treated and discharged using only the remote digitalised pathway with the remaining 83% being referred into a traditional face to face pathway.


Those that entered the face to face only pathway in the pre April 2018 cohort had an assessment and 3.7 treatment sessions on average.

In comparison those patients that entered via the digitalised pathway post April 2018 had an assessment and 3.4 treatment sessions on average.


Patient feedback for the digitalised pathway was gathered and globally the Net Promoter Score (NPS) was +73%. The 2 components of the digitalised service were separately analysed with the face to face pathway scoring +74% NPS and the pure remote digital approach scoring +58% NPS.
 

This retrospective service evaluation highlights that providing a digital first approach enables faster initial access with a physiotherapist when compared to face to face treatment only.


It must be noted service availability in the two cohorts varied with the pre April 2018 cohort being offered an appointment within 2 working days for a face to face assessment compared with those post April 2018 who were offered a digitalised assessment within 1 working day. While this accounts for some of the 2.83 day variance in access times between the cohorts, other barriers included patient availability secondary to work and travel in the face to face only cohort which the digital pathway overcame.

It highlights a potential reduction in the average number of face to face treatment sessions following an initial digital contact while enabling a significant proportion of patients to adopt an alternative remote treatment approach.

A digital first approach can be offered and still achieve high levels of patient satisfaction as indicated by the high global NPS score and the high NPS scores for each respective pathway.

Implications

This service evaluation highlights that physiotherapy can be delivered inline with the aims of the NHS Long Term Plan providing a digital first approach. Through providing services via more cost effective remote pathways we improve the convenience of our services, while offering wider choices to patients regarding treatment pathways and maintain high patient satisfaction.

Funding acknowledgements

IPRS Health supported the time to allow for the creation of this service evaluation.

Additional notes

This work was presented at Physiotherapy UK 2019