Direct access to physiotherapy (DAP) in the treatment of patients with musculoskeletal symptoms A literature review of the division of labour between physiotherapists and GPs, and experiences of DAP in Finland

Background Direct access to physiotherapy (DAP) has increased greatly both in Finland and worldwide, and therefore practical issues related to the division of labour between physiotherapists and general practitioners (GPs) are of great interest.

Methods We performed a literature review of the division of labour between physiotherapists and GPs in DAP. We also carried out a Digium -survey on the national practices of DAP in Finland.

Results The literature review found 24 articles, and 59 health care professionals responded to the survey. Based on the review, patients were satisfied and had quicker access to care. DAP did not seem to increase the use of physiotherapy services or decrease patient safety or continuity of care. In Finland, the criteria for DAP and GP referral vary greatly by region. The respondents considered that patients’ self-management ability and health care units’ operational effectiveness had improved considerably as a result of DAP. Medical support for physiotherapists was usually available but not always made use of.

Conclusions On the basis of both the literature review and national experiences DAP is regarded as an effective activity, but further research is needed.