Benchmarking service provision, scope of practice and skill mix for physiotherapists in adult CF care delivery

Ms Kathleen Hall1,2, Ms Robyn Cobb2, Ms Rebecca Chambers2, Mr Mark Roll2, Professor Scott Bell3, Dr Lyndal  Maxwell1, Professor Suzanne Kuys1

1Physiotherapy, School of Allied Health, Australian Catholic University , Brisbane, Australia, 2Physiotherapy, Adult Cystic Fibrosis center, The Prince Charles Hospital, Brisbane, Asustralia, 3Adult Cystic Fibrosis Centre, TPCH, Brisbane, Australia

Background/Aim: Physiotherapy management for people with cystic fibrosis (CF) is integral to their care (1). Discipline specific guidelines detailing service provision, scope of practice and skill mix recommendations have been developed (1) . Data benchmarking current delivery of services against these guidelines has not been published.

Methods: A prospective cross-sectional study in an adult CF centre documented physiotherapy services over a three-month period. All direct and non-direct clinical care and non-clinical care activities were collected using an Activity Bar Code scanning system.

Results: Staffing levels (two rotational junior and two senior physiotherapists) was <50% of recommended staffing for the centre size. More than twenty physiotherapists contributed to CF care during the three months. The majority (82%) of activity comprised clinical care (55% direct, 27% non-direct). Frequently occurring activities included respiratory (33%) and exercise treatments (11%) and outpatient reviews (7%) aligning with recommendations. Recommended activities of exercise testing (1%) and annual reviews (2%) were infrequent.   Most non-clinical care activity centered on management activities (10%).  Significant differences were found between junior and senior physiotherapists for the number of clinical (n=1278 vs 1313, p= 0.003) and non-clinical care (n=249 vs 337, p= 0.003) activities undertaken, exercise treatments (n=279 vs 59, p = 0.0001), and annual (n=15 vs 64, p = 0.0001), and patient reviews (n=15 vs 64, p = 0.0001).   Only senior staff undertook teaching/training and research activities.

Conclusions: This study is the first to describe service delivery by physiotherapists in a large tertiary adult CF centre. Staffing levels were below recommended guidelines and high numbers of different staff were involved in care. Key scope of practice activities of respiratory and exercise treatments occurred, however there was limited activity in other recommended areas.  Quantifying differences between junior and senior activities has not been previously reported. Addressing the deficits in recommended care delivery requires further research.

  1. Button, B.M., et al., Physiotherapy for cystic fibrosis in Australia and New Zealand: A clinical practice guideline. Respirology, 2016. 21(4): p. 656-667.

Biography: To be confirmed

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