Using digital technology and user-centred design to develop a physiotherapy self-referral service for back pain

Purpose

14 million people in England use GP online services. Harnessing digital technology in primary care to develop a physiotherapy self-referral service provides an opportunity to make physiotherapists the first point of contact for patients suffering back pain, whilst enabling service-users to make decisions about how they wish to receive care. A previous self-referral model of telephone and email access yielded low uptake and made inefficient use of administration resources. The aim of this 'proof of concept' project was to explore if a digital physiotherapy self-referral service is safe and acceptable to patients with back pain.

21/22 (95.5%)
of the patients interviewed reported having regular online access.
19/22 (86.4%)
indicated that they would use a digital physiotherapy self-referral service.
4/12 (33.3%)
of referrals were made without seeing a GP first.
4/12 (33.3%)
stratified by the STarTBack tool to a high risk of chronicity group.

Approach

Taking a user-centred design approach, attitudes to the use of digital technology and self-referral were explored with multiple stakeholders including patients attending two physiotherapy departments and service-users, GPs and administration staff at a single GP practice. Observational visits, 'waiting room' interviews and a questionnaire exploring attitudes to self-referral were undertaken. A reiterative process of designing with service-users and clinicians in a 'real-world' setting included the testing of 'red flag' screening for safety and discussion on the inclusion of the STarTBack tool. All stakeholders agreed the final iteration of the digital self-referral tool. A webpage on the GP practice site was designed to access the tool. Posters co-produced with patients incorporating a QR access code were displayed. Patients were also informed about the service via a text messaging service at the GP practice.

Outcomes

21/22 (95.5%) of the patients interviewed reported having regular online access. 19/22 (86.4%) indicated that they would use a digital physiotherapy self-referral service. 12 referrals (7 male; average age 35 years) have been made to date. 4/12 (33.3%) of referrals were made without seeing a GP first. Interviews with the reception team highlighted that uptake of self-referral was challenged by patients' beliefs that back pain management should be accessed via a GP. The average wait to be seen in the physiotherapy back clinic was 13 days. There have been no red flag presentations to date. 4/12 (33.3%) stratified by the STarTBack tool to a high risk of chronicity group. Process mapping and time and motion analysis have shown that digitising the self-referral pathway improves administrative efficiency and better utilises GP appointments. User feedback has highlighted the ease of use of the digital tool and a high level of satisfaction with the waiting times for the back pain clinic.

The use of a digital tool to enable patients to self-refer to a back pain clinic was acceptable and offers a safe and usable alternative to GP-led access to physiotherapy. Both service user and provider feedback have been critical to the understanding of the barriers to uptake.

Implications

The adoption of a digital self-referral service model has the potential for wider application which can embed intelligent logic into the digital tool and provide the ability to triage a range of musculoskeletal problems to the right place first time. A mobile-first solution supports the NHS long-term plan in empowering patients to take control of their health whilst optimising the use of the physiotherapy workforce.

Additional notes

This work was presented at Physiotherapy UK 2019