Introduction: Following a review of the process in which patients receive orthotics through the Wicklow Primary Care aids and appliance budget, long waiting times, up to 52 weeks, an increase in the price of orthotic... [ view full abstract ]
Introduction:
Following a review of the process in which patients receive orthotics through the Wicklow Primary Care aids and appliance budget, long waiting times, up to 52 weeks, an increase in the price of orthotic quotations and budget restraints were some of the challenges observed. A Physiotherapy led Foot Clinic service was developed in Wicklow Primary Care in 2015 as a quality initiative.
Objective:
The objective was to reduce waiting times for an orthotic assessment and receipt of the orthotic, ensure patient satisfaction with the orthotic and quality of the service they received. To achieve significant cost savings while continuing to have positive health outcomes for the patients attending the service.
Methods:
A 6 month review of patients assessed in the Foot Clinic was undertaken from Nov 2016 – May 2017. Inclusion and Exclusion criteria were established and screening of the aid and appliance waiting list took place. All orthopaedic and musculoskeletal referrals were included, the majority of diabetic and rheumatology referrals were excluded as established specialist services are available. A database was created to capture all relevant data. Ethical approval sought from the Health Service Executive (HSE) Research Ethics Committee.
20 Adult Patients (12 female and 8 male) were individually assessed by the same Senior Physiotherapist at their local Primary Care Health Centre. A musculoskeletal and biomechanical assessment was completed, the needs of the patient regarding orthotic prescription were established and orthotics ordered as appropriate. Pre and post outcome measures were recorded. The Foot Function Index (FFI) was used to measure the impact of foot pathology on function in terms of pain, disability and activity restriction (1). The Orthotics Prosthetics User Survey (OPUS) was used to assess patient satisfaction with the orthotics and the service received and the Global Rating of Change Scale (GROC) was used to quantify the extent to which the patient had perceived improvement or deterioration (2). Cost savings were measured against the original quotations and staff time input. Data was analyzed using qualitative and quantitative methods.
Results:
Total cost saving of 72% was achieved. The time waiting for an appointment was reduced to under 12 weeks for 81% of patients. 91% of patients received their orthotic within 16 weeks. FFI outcome resulted in a reduction in foot pain and disability from 42% to 19% post orthotic intervention. OPUS survey resulted in 95 % satisfaction with the service and 81 % satisfaction with the orthotic device. GROC scale rated an average outcome of 5 “Quite a bit better”
Conclusion:
Reduction in waiting times, positive patient outcomes and cost savings can be achieved by providing a local foot clinic service. This initiative is within a primary care physiotherapy service, inclusion criteria was restrictive and staffing hours to the service limited. Future considerations should include long term outcomes in foot function and quality of life and governance support for development of community based integrated foot clinic services.
References:
- Budiman-Mak E, Conrad KJ, Mazza J, Stuck RM. (2013) A review of the foot function index and the foot function index – revised. Journal of Foot and Ankle Research, 6(1):5
- Jarl GM, Heinemann AW, Hermansson LMN. (2012) Validity evidence for a modified version of the Orthotics and Prosthetics Users’ Survey. Disability and Rehabilitation: Assistive Technology, 7.6: 469-478
