Physiotherapy practice in the private sector: organizational characteristics and models

BMC Health Services Research

Diane Morin²  Stéphane Poitras³  Michel Rossignol⁵  Clermont E Dionne¹  Kadija Perreault⁴ 

[1] Axe Santé des populations et Pratiques optimales en santé, CHU de Québec Research Center, Hôpital du St-Sacrement, 1050 Chemin Sainte-Foy, Québec City G1S 4L8, Canada;Institut universitaire de formation et de recherche en soins, Université de Lausanne, Lausanne, Switzerland;School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada;Université Laval, Québec City, Canada;Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada

关键词: Survey;    Private sector;    Physiotherapy;    Organizational models;    Organizational characteristics;   

Others  :  1126627
DOI  :  10.1186/1472-6963-14-362

 received in 2013-11-01, accepted in 2014-08-20,  发布年份 2014

【 摘 要 】

Background

Even if a large proportion of physiotherapists work in the private sector worldwide, very little is known of the organizations within which they practice. Such knowledge is important to help understand contexts of practice and how they influence the quality of services and patient outcomes. The purpose of this study was to: 1) describe characteristics of organizations where physiotherapists practice in the private sector, and 2) explore the existence of a taxonomy of organizational models.

Methods

This was a cross-sectional quantitative survey of 236 randomly-selected physiotherapists. Participants completed a purpose-designed questionnaire online or by telephone, covering organizational vision, resources, structures and practices. Organizational characteristics were analyzed descriptively, while organizational models were identified by multiple correspondence analyses.

Results

Most organizations were for-profit (93.2%), located in urban areas (91.5%), and within buildings containing multiple businesses/organizations (76.7%). The majority included multiple providers (89.8%) from diverse professions, mainly physiotherapy assistants (68.7%), massage therapists (67.3%) and osteopaths (50.2%). Four organizational models were identified: 1) solo practice, 2) middle-scale multiprovider, 3) large-scale multiprovider and 4) mixed.

Conclusions

The results of this study provide a detailed description of the organizations where physiotherapists practice, and highlight the importance of human resources in differentiating organizational models. Further research examining the influences of these organizational characteristics and models on outcomes such as physiotherapists’ professional practices and patient outcomes are needed.

【 授权许可】

   
2014 Perreault et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 2.

【 参考文献 】

• [1]Canadian Institute for Health Information: Physiotherapists in Canada, 2011-Data tables. Ottawa; 2012.
• [2]Canada’s Health Care System (Medicare) http://www.hc-sc.gc.ca/hcs-sss/medi-assur/index-eng.php webcite
• [3]Landry MD, Deber RB, Jaglal S, Laporte A, Holyoke P, Devitt R, Cott C: Assessing the consequences of delisting publicly funded community-based physical therapy on self-reported health in Ontario, Canada: a prospective cohort study. Int J Rehabil Res 2006, 29(4):303-307.
• [4]Bury TJ, Stokes EK: A global view of direct access and patient self-referral to physical therapy: implications for the profession. Phys Ther 2013, 93(4):449-459.
• [5]Poitras S, Blais R, Swaine B, Rossignol M: Practice patterns of physiotherapists in the treatment of work-related back pain. J Eval Clin Pract 2007, 13(3):412-421.
• [6]Paul J, Park L, Ryter E, Miller W, Ahmed S, Cott CA, Landry MD: Delisting publicly funded community-based physical therapy services in Ontario, Canada: a 12-month follow-up study of the perceptions of clients and providers. Physiother Theory Pract 2008, 24(5):329-343.
• [7]Canadian Physiotherapy Association: Position Statement: Funding for Physiotherapy. Ottawa: Canadian Physiotherapy Association; 2010.
• [8]Poitras S, Blais R, Swaine B, Rossignol M: Management of work-related low back pain: a population-based survey of physical therapists. Phys Ther 2005, 85(11):1168-1181.
• [9]Derghazarian T, Simmonds MJ: Management of low back pain by physical therapists in Quebec: how are we doing? Physiother Can 2011, 63(4):464-473.
• [10]Gross DP, Lowe A: Evaluation of a knowledge translation initiative for physical therapists treating patients with work disability. Disabil Rehabil 2008, 31(11):871-879.
• [11]Casserley-Feeney SN, Bury G, Daly L, Hurley DA: Physiotherapy for low back pain: differences between public and private healthcare sectors in Ireland-a retrospective survey. Man Ther 2008, 13(5):441-449.
• [12]Landry MD: Physical Therapy Services in Ontario: Assessing a Changing Public/Private mix. Toronto: University of Toronto; 2005. [Doctoral Thesis]
• [13]Mathieu E, Allemand H, Teitelbaum J, Lévy D: Les masseurs-kinésithérapeutes du secteur libéral: profils, projets, aspirations. Cah Sociol Demogr Med 2005, 45(4):415-472.
• [14]Lamarche PA, Beaulieu M-D, Pineault R, Contandriopoulos A-P, Denis J-L, Haggerty J: Sur la voie du changement: pistes à suivre pour restructurer les services de santé de première ligne au Canada. Ottawa: Fondation canadienne de la recherche sur les services de santé; 2003.
• [15]Meyer AD, Tsui AS, Hinings CR: Configurational approaches to organizational analysis. Acad Manage J 1993, 36(6):1175-1195.
• [16]Touati N, Pineault R, Champagne F, Denis J-L, Brousselle A, Contandriopoulos A-P, Geneau R: Evaluating service organization models. Evaluation 2009, 15(4):375-401.
• [17]Prud’homme A, Pineault R, Couture A, Borgès Da Silva R, Levesque JF, Tousignant P: Rapport méthodologique de l’enquête organisationnelle à Montréal et en Montérégie. Montréal: Gouvernement du Québec; 2012.
• [18]Yarbrough Landry A, Hernandez SR, Shewchuck RM, Garman AN: A configurational view of executive selection behaviours: a taxonomy of USA acute care hospitals. Health Serv Manage Res 2010, 23:128-138.
• [19]Dubbs NL, Bazzoli GJ, Shortell SM, Kralovec PD: Reexamining organizational configurations: an update, validation, and expansion of the taxonomy of health networks and systems. Health Serv Res 2004, 39(1):207-220.
• [20]Dubois CA, D’Amour D, Tchouaket E, Rivard M, Clarke S, Blais R: A taxonomy of nursing care organization models in hospitals. BMC Health Serv Res 2012, 12:286. BioMed Central Full Text
• [21]Roberge D, Pineault R, Hamel M, Borgès Da Silva R, Cazale L, Levesque J-F, Ouellet D: L’accessibilité et la continuité des services de santé : Une étude sur la première ligne au Québec. Rapport méthodologique de l’analyse des contextes. Montréal: Centre de recherche de l’Hôpital Charles LeMoyne, Agence de la santé et des services sociaux de Montréal – Direction de santé publique, Institut national de santé publique du Québec; 2007.
• [22]Creswell JW: Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. 3rd edition. Los Angeles: Sage Publications; 2009.
• [23]Survey Monkey http://www.surveymonkey.com/Default.aspx webcite
• [24]Campanelli P: Chapter 10: Testing Survey Questions. In International Handbook of Survey Methodology. 1st edition. Edited by de Leeuw ED, Hox JJ, Dillman DA. New York: Lawrence Erlbaum Associates; 2008:176-200.
• [25]Fowler FJ, Cosenza C: Chapter 8: Writing effective questions. In International Handbook of Survey Methodology. 1st edition. Edited by de Leeuw ED, Hox JJ, Dillman DA. New York: Lawrence Erlbaum Associates; 2008:136-160.
• [26]Perreault K, Dionne CE: Patient-physiotherapist agreement in low back pain. J Pain 2005, 6(12):817-828.
• [27]Mikhail C, Korner-Bitensky N, Rossignol M, Dumas JP: Physical therapists’ use of interventions with high evidence of effectiveness in the management of a hypothetical typical patient with acute low back pain. Phys Ther 2005, 85(11):1151-1167.
• [28]Sondage National des Médecins http://nationalphysiciansurvey.ca/ webcite
• [29]Larivère C, Savoie A: Bilan de l’implantation et du fonctionnement des équipes multidisciplinaires de travail dans le réseau de la santé et des services sociaux au Québec. Montréal: Centre de recherche et de formation du CLSC Côte-des-Neiges; 2002.
• [30]Pineault R, Hamel M, Levesque JF, Roberge D, Lamarche P, Haggerty J: Questionnaire organisationnel-Clinique médicale de première ligne. Montréal: Direction de santé publique, Agence de la santé et des services sociaux de Montréal; 2006:15.
• [31]Unité d’évaluation des technologies et des modes d’intervention en santé ChudS: Évaluation des Cliniques Interdisciplinaires Musculosquelettiques en Orthopédie: le modèle du Centre Hospitalier Régional de Trois-Rivières. Sherbrooke: Unité d’évaluation des technologies et des modes d’intervention en santé, Centre hospitalier universitaire de Sherbrooke; 2011:144.
• [32]Sicotte C, D’Amour D, Moreault MP: Interdisciplinary collaboration within Quebec Community Health Care Centres. Soc Sci Med 2002, 55(6):991-1003.
• [33]Cleary KK: Collaborative practices of physical therapists: relationships with clinical practice and interprofessional education experiences. Pocatello: Idaho State University; 2004.
• [34]Meulman JJ, Heiser WJ: Chapter 5: Correspondence Analysis. In PASW Categories 18. Edited by Meulman JJ, Heiser WJ. Chicago: SPSS Inc; 2009:46-66.
• [35]Rencher AC: Chapter 15. Graphical Procedures. In Methods of Multivariate Analysis. 2nd edition. Edited by Rencher AC. New York: John Wiley & Sons; 2002:504-548.
• [36]Lebart L, Piron M, Morineau A: Chapitre 4. Analyse des correspondances. In Statistique exploratoire multidimensionnelle: Visualisation et inférence en fouille de données. 4th edition. Edited by Lebart L, Piron M, Morineau A. Paris: Dunod; 2006:131-186.
• [37]Guinot C, Latreille J, Malvy D, Preziosi P, Galan P, Hercberg S, Tenenhaus M: Use of multiple correspondence analysis and cluster analysis to study dietary behaviour: food consumption questionnaire in the SU.VI.MAX. cohort. Eur J Epidemiol 2001, 17(6):505-516.
• [38]Poitras S, Blais R, Swaine B, Rossignol M, Perron M: Continuing education of physiotherapists involved in treating persons with work-related back pain. Physiother Can 2005, 57(3):225-233.
• [39]Pineault R, Lévesque J-F, Roberge D, Hamel M, Lamarche P, Haggerty J: L’accessibilité et la continuité des services de santé: une étude sur la première ligne au Québec. Rapport de recherche. Montréal: Gouvernement du Québec; 2008.
• [40]Everitt BS, Landau S, Leese M, Stahl D: Cluster analysis. 5th edition. West Sussex: John Wiley & Sons; 2011.
• [41]Lebart L, Piron M, Morineau A: Chapitre 1. Analyses en axes principaux: principes de base. In Statistique exploratoire multidimensionnelle: Visualisation et inférence en fouille de données. 4th edition. Edited by Lebart L, Piron M, Morineau A. Paris: Dunod; 2006:11-36.
• [42]SPSS Inc: PASW Statistics. 18th edition. Chicago: SPSS Inc; 2009.
• [43]Volet du Santéscope: “Santé des populations rurales et urbaines du Québec” http://www.inspq.qc.ca/Santescope/documents/RuralUrbain_GuideMethoInterpr_fev2008.pdf webcite
• [44]D’Amour D: Dix-septième chapitre: La collaboration professionnelle: un choix obligé. In Les soins infirmiers: vers de nouvelles perspectives. 1st edition. Edited by Goulet O, Dallaire C. Boucherville: Gaëtan Morin Éditeur; 2002:339-363.
• [45]Guzman J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C: Multidisciplinary bio-psycho-social rehabilitation for chronic low back pain. Cochrane Database Syst Rev 2002, 1:CD000963.
• [46]Karjalainen K, Malmivaara A, van Tulder M, Roine R, Jauhiainen M, Hurri H, Koes B: Multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working age adults. Cochrane Database Syst Rev 2003., 2CD002193
• [47]Hoppe E, Rowat B, Verrier M: A black box: the rehabilitation clinic. Physiother Can 1996, 48(1):16-26.
• [48]Fédération de la physiothérapie en pratique privée du Québec http://www.physioquebec.com/ webcite
• [49]Ketchen DJ, Shook CL: The application of cluster analysis in strategic management research: an analysis and critique. Strateg Manage J 1996, 17(6):441-456.