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3xwk x 4wks?
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3xwk x 4wks? - June 22, 2008 1:41:21 PM
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hmgross
Posts: 292
Joined: February 28, 2003
From: Minnesota
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Do they teach this in PA or NP schools or what? I very rarely get this from the docs anymore but almost always from an NP or PA (except ortho PAs) I can't wait for the day when this "dies out" because even though I explain to the patient why this frequency is not usually needed, I can get the sense they feel it isn't right that I am not "following the prescription"
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Holly Gross PT
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RE: 3xwk x 4wks? - June 22, 2008 3:03:42 PM
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SJBird55
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From: Michigan
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On my referral forms, I actually created a check box that states something like "physical therapist determines." Most physicians in my area write or suggest 3x/week x 4-6 weeks. I override it all the time. I view it as a recommendation. No one can make a patient attend at a high frequency. Some of my patients need it... the older folks that were recently discharged from a hospital and are dehabilitated and at risk of falling. Some patients question a lower frequency, but appreciate my perspective and appreciate how the frequency can be reduced, especially if they need to be responsible for certain aspects outside of the clinic. Most patients also appreciate that I put on my thinking cap and don't "follow" anything. ;)
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RE: 3xwk x 4wks? - June 22, 2008 3:28:29 PM
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jma
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From: NY
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Post-ops where I reside usually ask for 3x a week, especially if it was ACL reconstructions, as an example
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RE: 3xwk x 4wks? - June 22, 2008 3:29:17 PM
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jma
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From: NY
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The only exception I once had was for once a week but only because of the high co-pay. Lot of HEP each visit.
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RE: 3xwk x 4wks? - June 23, 2008 12:26:32 AM
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hmgross
Posts: 292
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From: Minnesota
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I guess what gets me it is 3 times a week no matter what the dx. I have been out on my own now for 4 years (previous hospital outpatient where 3x almost seemed the norm for all dx, and it was sort of frowned on to decrease the frequency or heaven forbid dc them "too quickly" hmmm must have been a revenue thing...) I see people 1-2x a week with very good outcomes. Sometimes I bump it up for older patients who need more assist (but then have to worry about running up the "tab" on medicare) or for "work conditioning" to get people back to work.
I think I am ranting a bit and probably in need of a vacation, but it irritates me that hospitals don't have to worry about the therapy cap, and I have people willing to pay out of pocket because they prefer the type of therapy we do, vs at the hospital. Actually, people don't seem to mind coming in only once or twice a week these days, now that gas is at $4/gallon.
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Holly Gross PT
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RE: 3xwk x 4wks? - June 23, 2008 6:29:04 AM
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Sebastian Asselbergs
Posts: 1203
Joined: September 29, 1999
From: Barrie, Canada
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Holly, that IS frustrating! Only the assembly line clinics here have people come 3xpw - but only AFTER they have checked the full coverage.....
Once or twice is much more the norm in the other clinics (PT-owned and operated). Good thing here is that we do not have docs telling us much of anything, other than: "please assess and treat" . Bad thing is, we have a hard time getting the assembly-clinics to change, since they too are autonomous, and we are risking them messing it up for our profession.
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Mundi vult decipi
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RE: 3xwk x 4wks? - June 24, 2008 1:16:16 PM
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buckeye
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Agree with sjbird - Discuss with the patient and make a professional clinical decision based on your examination. Then inform the physician of your plan.
I usually have the most trouble with workers compensation cases - not following the authorization paper may pose some medicolegal risk.
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RE: 3xwk x 4wks? - June 26, 2008 2:07:06 PM
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VagusX
Posts: 215
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From: Savannah, GA, USA
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The question is if we can actually expect for our patients to do what they are told. What is the statistic? 15% of our patients do their HEP. Under those circumstaces I don't have an issue with seeing somebody on 3X/wk or more basis. Of course there are people that only need the education and see ya later. I see 95% medicare in an outpatient ortho setting and 2-3X/wk is the way I see most my patients.
< Message edited by VagusX -- June 26, 2008 2:12:20 PM >
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RE: 3xwk x 4wks? - June 26, 2008 6:11:59 PM
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Sebastian Asselbergs
Posts: 1203
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From: Barrie, Canada
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Vagus, you make a good point - the patient demographic is a VERY important point in this issue.
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RE: 3xwk x 4wks? - June 26, 2008 6:34:46 PM
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Kaden
Posts: 334
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I think you always have to take patient population into account especially with a population like Vagus has coming to the clinic.
However, I disagree that someone not doing there exercises at home is a reason to see them three times a week. There is a difference between not able to do them at home and choosing not to do so. The 15 percent statistic may speak to our ability as PT's to emphasize the importance of a HEP, provide clear well thought out programs, or be a problem with patient motivation. All of which are not reasons to jump of visits to three times a week.
If in your profressional judgement the patient could be seen once and week and continue with a HEP on non therapy days then this is what should happen. If a patient is not doing his or her program then the PT must emphasize the importance of the patient doing so and ultimately the patient taking responsibility in care will lead to better outcomes. If one simply increases visit frequency then it decreases the patients active indpendent roll in there own care.
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RE: 3xwk x 4wks? - June 27, 2008 7:50:32 PM
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jma
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From: NY
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This is true.
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RE: 3xwk x 4wks? - June 27, 2008 8:03:39 PM
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rwillcott
Posts: 435
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From: Canada
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Great points Kaden regarding home exercise program. Here in Canada the average patient has about $500 under the insurance for physiotherapy. I tend to have an acute patient attend 3x's per week the first week and then decrease to 1-2 sessions in order to spread out their coverage. I tend to see post surgical 1-2 sessions per week since it doesn't take long for their insurance to run out. I really emphasize the importance of performing their home exercises on their own due to their limited time with me.
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RE: 3xwk x 4wks? - June 27, 2008 8:11:50 PM
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hmgross
Posts: 292
Joined: February 28, 2003
From: Minnesota
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I actually find that my medicare patients are way more compliant than my younger patients. If we used non-compliance as a reason to see patients more often, then I should call my dentist and get cleanings once a week rather that every six months. Of course we don't do that because we would be paying out of pocket and would probably listen to a stern lecture by the Hygienist (I admit to not flossing every day and it is most positively my fault and I know better!!). I spend a large portion of every treatment session on education. Help the patient realize how they came to be a "patient" and how it is in their best interest to learn self management. Of course it is differerent if you are seeing someone with a recent surgery, stroke, TBI, etc, but you get the idea.
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Holly Gross PT
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RE: 3xwk x 4wks? - July 7, 2008 9:49:10 AM
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orthotherapist
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IMO there are very few "non-compliant" patients. Instead they are likely "non-committed". If the patient does not know why they need to do this or that (educated appropriately) they will not do it. If they have been educated as to the reasons they are being given exercises, the expected outcomes, etc they will usually find the time to do them.
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