GP referral for physiotherapy to musculoskeletal conditions - a qualitative study

Background. Little is known about the dynamics of GP referral for physiotherapy. Better understanding of this process is important because of the growing number of physiotherapy referrals by GPs. Objectives. Our aim was to achieve insight into the experiences and views of patients, GPs and physiotherapists in relation to physiotherapy referral for musculoskeletal conditions. Method. The study involved qualitative methodology using 22 semi-structured in-depth interviews. The interviews were recorded and transcribed verbatim. The transcripts were coded and analysed using the methods developed in grounded theory. Interviews were undertaken with GPs in primary care, Health Authority and hospital locations. Interviews with physiotherapists and patients were undertaken within community and district hospital locations. Results. Three classifications of referral type were developed by the authors from the data, 'appropriate referral', 'load-sharing referral' and 'dumping referral'. There are descriptions of influences on GP referral behaviour, physiotherapists' response to appropriateness and expectations from the perspective of GPs and physiotherapists. Communication was shown as important in determining appropriate referral, but the quality of communication was variable. GPs' past experience of physiotherapy significantly affected referral. Patients' expectations about physiotherapy were described as variable and sometimes unrealistic. Conclusions. The selection of appropriate referrals by GPs could be helped by improved communication and better definitions of appropriateness. Closer working between the two professions would result in the better management of problematic patients and prevent wasted resources through avoiding inappropriate referral. Written guidelines appeared to be of less use than direct contact. The concept of expectations appeared relevant to multiple aspects of physiotherapy referral.