Are patients who refer themselves to physiotherapy different from those referred by GPs? Results of a national trial

ObjectivesTo establish if there are differences in the profile of patients who refer themselves to physiotherapy compared with patients referred by or at the suggestion of their general practitioner (GP) in a range of primary care settings.Design of studyQuasi-experimental.SettingTwenty-nine general practices throughout Scotland.ParticipantsThree thousand and ten patients (>16 years of age) and 100 physiotherapists.MethodSelf-referral was introduced in each site. The demographic and clinical data relating to all referrals collated over a full year were compared by referral group (self-referrals, GP-suggested referrals and GP referrals).ResultsThere was no relationship between gender or age group and referral group, but other differences in the profile were found. The groups differed in terms of their presenting condition and its severity (P = 0.027). Greater proportions of patients who referred at the suggestion of their GP and patients who self-referred presented with low back and neck conditions (54% versus 43%, P < 0.001). Self-referrers reported having their symptoms for less than 14 days to a greater extent than the other groups (14% versus 9% and 10%, P = 0.011). Non-preferential treatment waiting time to physiotherapy also differed, with 44% of patients who self-referred being seen within 2 weeks of referral compared with 36% of patients who referred at the suggestion of their GP (P < 0.001). Self-referrers were absent from work in lower proportions (20% versus 28% and 28%, P = 0.048) and were absent for half the mean time (2.5 days versus 6 days). They also completed their treatment in greater proportions (76% versus 69% and 72%, P = 0.002). Although all groups experienced the same mean number of physiotherapy contacts (n = 4), patients who referred at the suggestion of their GP had a proportionally lower contact rate with 65% having four or less contacts compared with 55% of patients who self-referred and 51% of patients referred by their GP (P < 0.001). There was no difference in the outcome determined by physiotherapists or patients.ConclusionsPatients who refer to physiotherapy at the suggestion of their GP and patients who self-refer appear to have a different profile from patients who are referred by their GP.