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Direct Access to Physical Therapy in the Netherlands: Results From the First Year in Community-Based Physical Therapy

CJ Leemrijse, PT, PhD, is Researcher, Netherlands Institute for Health Services Research–Allied Health Care (NIVEL), PO Box 1568, 3500 BN, Utrecht, the Netherlands.
ICS Swinkels, MSc, is Researcher, Netherlands Institute for Health Services Research–Allied Health Care (NIVEL).
C Veenhof, PT, PhD, is Research Coordinator, Netherlands Institute for Health Services Research–Allied Health Care (NIVEL).

C.Leemrijse{at}nivel.nl

Background: In 2006, direct access to physical therapy was introduced in the Netherlands. Before this policy measure, evaluation and treatment by a physical therapist were only possible following referral by a physician.

Objective: The objectives of this study were to investigate how many patients use direct access and to establish whether these patients have a different profile than referred patients.

Methods: Electronic health care data from the National Information Service for Allied Health Care (LiPZ), a nationally representative registration network of 93 Dutch physical therapists working in 43 private practices, were used.

Results: In 2006, 28% of the patients seen by a physical therapist came by direct access. Patients with non–further-specified back problems, patients with nonspecific neck complaints, and higher-educated patients were more likely to refer themselves to a physical therapist, as were patients with health problems lasting for less than 1 month. Younger patients made more use of direct access. In addition, patients with recurring complaints more often referred themselves, as did patients who had received earlier treatment by a physical therapist. Patients with direct access received fewer treatment sessions. Compared with 2005, there was no increase in the number of patients visiting a physical therapist.

Limitations: Data came only from physical therapists working on general conditions in general practices. Severity of complaints is not reported.

Conclusions: A large, specific group of patients utilized self-referral, but the total number of patients seen by a physical therapist remained the same. In the future, it is important to evaluate the consequences of direct access, both on quality aspects and on cost-effectiveness.

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