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Physical Therapists' Opinions and Practices Regarding Direct Access

KL Crout, PT, is Coordinator of Clinical Care, HealthAlliance-Fairlawn Nursing Center, 370 West St, Leominster, MA 01453 (USA) (crout79@aol.com).
J Hodgkins Tweedie, PT, is Physical Therapist, Rehabilitation Services Department, St Mary's Regional Medical Center, Lewiston, Me.
DJ Miller, PhD, PT, is Associate Professor, Department of Physical Therapy, Springfield College, Springfield, Mass.

Background and Purpose. This study examined whether differences exist about physical therapists' opinions and practices regarding the use of direct access between therapists practicing in Massachusetts, a direct-access state, and therapists practicing in Connecticut, a state that allows only evaluation without referral. A second purpose was to examine direct-access practices of therapists in Massachusetts. Subjects. A sample of 329 therapists in Massachusetts and 179 therapists in Connecticut were surveyed. Methods. A cover letter, questionnaire, and return-reply envelope were mailed to each therapist. Independent group t tests and chi-square analyses were used to determine whether therapists' opinions about direct access differed between states. Frequencies were calculated to examine direct-access practices of therapists in Massachusetts. Results. Adjusted response rates were 65.5% in Massachusetts and 57.9% in Connecticut. Therapists in both states were equally supportive of direct access (74.9%). Therapists in Connecticut were more supportive of three stipulations regulating direct access than therapists in Massachusetts were. In Massachusetts, 34.0% of the respondents stated that they practiced using direct access, and 8.8% of the patients seen by the therapists sampled were treated without physicians' referrals. The therapists indicated that the most common reasons for limited use of direct access were employer policies and lack of insurance reimbursement. Conclusion and Discussion. Therapists in Connecticut favored more stipulations regulating direct access than therapists in Massachusetts did. Although therapists in both states appear to be supportive of direct access, the number of patients in Massachusetts seen through this mode of care appears to be limited because of practice and financial restraints.

Key Words: Direct access • Opinion • Practice • Referral • Stipulations

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