Background and Purpose Physical therapists as primary care providers is not a new . concept in patient care. Nebraska has made direct-access available since 1957 and thirty four states currently allow physical therapists to practice without a physician's referral. The state of Oregon expanded the practice of physical therapy to include evaluation and treatment without a physician's referral in 1993. Since it's implementation eight years ago Oregon's physical therapists have defined their role as primary care providers. The purpose of our study was to describe and analyze the opinions and practice of direct access by Oregon's physical therapists who are certified to practice without referral.
Method A survey was mailed to 200 individual physical therapists identified as direct access certified by the Oregon State Licensing Board. The questionnaire solicited confidential information describing the scope and limitation of direct-access in the state of Oregon. We compared opinions of experienced physical therapist with recent graduates (individuals practicing 5 years or less). Demographic information and data pertaining to practice such as the percentage of clients currently being treated under direct-access, the primary diagnoses seen, and how many patients are being referred to other care providers was analyzed. Issues such as perceived limitations of education and training, clinical experience and opinions regarding the stipulations Oregon's practice without referral law were addressed and compared.
Results and Discussion Overall Oregon direct-access certified physical therapists support practice without a physician's referral. There was no significant difference in the level of support found between the groups tested. However, the majority of all respondents feel that the stipulations imposed on direct-access practice by the Oregon State Practice Act should be changed. Differing opinions regarding entry-level education and its ability to adequately prepare graduates as well as limiting direct-access practice to those with a graduate level degree were noted between respondents who are recent graduates who have five years or less clinical experience and therapists with more than five years. Recent graduates report that their education was adequate to prepare them for direct-access practice while those with greater clinical experience disagreed. The majority of recent graduates also support limiting direct-access practice to those with a graduate degree. Significant differences were also found between direct-access certified physical therapists who entered the profession with a graduate level degree and those who entered with a bachelor's degree. Responses to questions pertaining to career satisfaction, professional development, therapist/physician communication, entry-level education and quality of care provided by Oregon's direct-access certified physical therapists suggest different perceptions and expectations between these two groups.
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