Consolidation of Publicly Funded Outpatient Musculoskeletal Physiotherapy Services in Winnipeg, Manitoba: Effects on Accessibility and Service Delivery.

Purpose: In 2017, publicly funded outpatient musculoskeletal physiotherapy services in Winnipeg, Manitoba, were consolidated by closing seven hospital-based departments and limiting access to patients who met specific diagnostic criteria. Our purpose was to compare service delivery metrics and patient demographics before and after service consolidation. Method: We used an exploratory, retrospective cohort study design. Service delivery metrics and patient demographics were obtained from the regional database and compared using inferential statistics.

Results

Initial physiotherapy assessments conducted per month decreased by 85.4% (absolute numbers decreased from 18,261 initial assessments in 23 months pre-consolidation to 6,715 in 61 months post-consolidation). Treatment duration (days from assessment to discharge) increased, whereas the number of appointments per patient and wait times decreased (all p < 0.001). The mean age of patients decreased by 5.2 years (p < 0.001). More patients with wrist/hand conditions and fewer patients with surgical knee and hip conditions were seen post-consolidation. Patients attending at both time points generally came from the same neighborhoods, and measures of deprivation and marginalization were intermediate or higher on Canadian Index of Multiple Deprivation scales.

Conclusions

Closing publicly funded outpatient physiotherapy services and changing eligibility limited access for many patients who may no longer be able to access necessary care if they cannot afford private services.