Advanced Physiotherapy Practitioners in the New Zealand Health Context: An Exploratory Case Study
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Background: Musculoskeletal complaints accounts for 25% of New Zealand’s total annual health spending. Internationally, Advanced Physiotherapy Practitioner (APP) roles have been adopted to reduce orthopaedic waiting lists and improve timely patient access to specialist care and services. Although APP roles were first piloted in New Zealand (NZ) in 2002 and despite recommendations from the Health Workforce New Zealand and Ministry of Health policies, it is unclear why these roles have not gained traction in NZ, where similar health care issues exist. Objective: This study investigated the drivers and barriers to APP role development in the NZ context. A secondary aim was to assess the current work practices of clinicians working in these roles. Method: An exploratory single embedded case study design was undertaken. Document analysis, qualitative survey data analysis, and semi-structured interviews were utilised as data sources. A purposive sampling strategy was used. Data were analysed using qualitative content analysis and triangulated to ensure rigour. Results: The results of this current study identified several drivers for APP role development in NZ. These included access to care, strategic, legislative, service-led, profession-led, and surgeon-led drivers. Key barriers identified relate to NZ’s dual healthcare system with different funding streams split between the Ministry of Health and Accident Compensation Corporation. Other identified barriers were a lack of recognition, lack of funding for the role, lack of training, lack of career pathway, lack of title recognition, inter-professional barriers, and intra-professional barriers. These barriers are currently greater than the drivers. This research suggests that addressing the barriers may enable the APP roles to be implemented in NZ to optimise their impact on musculoskeletal healthcare burden. The study also identifies that the APP clinical working practices in NZ are congruent with international research, but they are shaped by the health sector in which the clinician works. Conclusion: This research explored the reasons for the limited uptake of the APP roles in the NZ context despite strong drivers. These findings need to be considered by the stakeholders when considering the adoption of the APP roles. Future workforce development of the APP role in NZ needs to be tailored to meet its unique healthcare drivers.