P0177 - Delay in Time to Physical Therapy after Orthopaedic Surgery

Introduction: Physical therapy is an essential component of treatment for a variety of conditions. Previous studies have examined the discrepancies in the access to care between insurance types; however, no studies have prospectively examined how insurance type influences delays and clinical outcomes following referral to physical therapy. The purpose of this study is to identify factors associated with delays in physical therapy (PT).

Methods: Patients referred to PT were prospectively recruited from a major metropolitan institution. The subject was administered a demographic questionnaire and a Pediatric Outcomes Data Collection Instrument (PODCI) or Adolescent Outcomes Questionnaire (AOQ) (self or parent reported) at their 6-week follow-up orthopaedic appointments or their 6-month follow-up appointment. Date of referral, authorization (if required) and first appointment with therapy were collected. A delay was defined as a wait of 2 weeks or more between the referral and first physical therapy appointment.

Results: 100 patients with an orthopaedic etiology were enrolled. 60% (60/100) of patients had government insurance and 40% (40/100) had private insurance. There was a significant difference between insurance type and the time to first PT appointment after the referral (p=0.01), between ethnicity and the time to first appointment (p=0.04), and between underlying etiology and time to first appointment (p=0.03). After adjusting for underlying etiology and ethnicity, patients with government insurance were 2.85 times more likely than patients with private insurance to experience a delay to physical therapy (95% CI: 0.12, 0.67). 57% (34/60) of patients with government insurance experienced a delay to physical therapy, as opposed to 27% (11/40) of patients with private insurance. Of the patients with public insurance who experienced a delay, 10% (6/60) were never able to see a physical therapist. 60% (60/100) of patients completed a PODCI; however, there was no correlation between PODCI score and delay in therapy (p=0.40).

Conclusion: Patients with government insurance were almost three times more likely to experience a delay to attend a physical therapy appointment than patients with private insurance. 10% of patients with public insurance were never able to see a physical therapist. These findings demonstrate a marked inequality in access to care based on insurance type.
Significance: There is a delay in access to PT based on insurance type.