Self-referral

Published Date: 19th July 2016

Publication Authors: Clayton AM, Griffiths AE, Clewes A, Lynch M, Abernethy R, Dawson J

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Background: 

Nurse Advice Lines have been a long accepted practice in Rheumatology. At St. Helens Hospital we expanded this to a Therapy Advice Line, and noticed an increasing tendency for self referral by our patients. From working parties on management of Early RA and Stable RA we emphasized our self referral facility to patients.NICE Guidelines (section 1:3) recommends ongoing access to SPECIALIST Physiotherapy and Occupational Therapy. ARMA (Arthritis and Musculoskeletal Alliance) Standard 2 encourages self management, and Standard 6 recommends access to safe evidence based care and management. Our concern was whether the self referrals were appropriate and relevant so this was the basis of our investigation. The recent National Rheumatoid Arthritis Society (NRAS) survey reported in October 2011 in a national newspaper, as well as in professional publications, raised concerns around access to SPECIALIST Rheumatology physiotherapy.

Methods: 

We audited physiotherapy self referrals between September 2010 and August 2011. We randomly selected 3 of these from each month. They were then scored on relevance on a scale of: 0 (inappropriate) to 5 (wholly appropriate), from information provided in discharge letters. The conditions covered and attendance rates were noted.

Results: 

Self referrals per month varied between 7 and 22 out of total monthly referrals between 39 and 89, which worked out as between

16% and 26% of the total referrals. 67% of referrals selected for investigation (36) were wholly appropriate, each scoring 5. Only 2 scored 0; one patient cancelled and one did not attend. Conditions reported as requiring treatment included neck and back, shoulders, elbows, wrists, hips, knees, ankles and feet. Attendance rates were excellent at 94%. It was encouraging to discover that the details were available in all discharge letters, and that the Physiotherapy correspondence reviewed was of a high quality.

Conclusions:

Patients have become more aware of our self referral facility. A variety of problems presented, which were felt to be largely appropriate, with excellent outcomes and attendance. This suggests that if patients know how physiotherapy can help them and are well informed in this respect they can utilize this service to help manage their long term condition. As outcomes were decided from information in discharge letters, it highlighted the importance of recording appropriate and relevant details in these communications. In a speciality where we strongly encourage appropriate self management, self referral is a vital component of this approach. This method of accessing Physiotherapy is consistent with NICE guidelines, ARMA standars and NRAS recommendations.

Clayton, AM; Lynch, M; Clewes, A; Dawson, J; Abernethy, V; Griffiths, AE. (2012).  Self-referral to rheumatology physiotherapy: A vital component of self-management . Rheumatology. 51 (Supplement 3), iii59-iii60.

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