Longitudinal continuity refers to a patient seeing the same health care provider over time and developing a therapeutic relationship built upon trust. Research has shown that longitudinal continuity with the same primary care physician is associated with high satisfaction, trust, and adherence¹. Later I will touch on similar research undertaken in outpatient physical therapy practices.

It is common for individuals who attend outpatient physical therapy to be seen by multiple physical therapists over the course of their treatment. BSR believes patients should be seen by one physical therapist over the course of their treatment. Patients at both our Barnegat and Manahawkin physical therapy clinics are managed by a single physical therapist. Our patients routinely cite this as one of the primary reasons they chose us. Unfortunately, the changing landscape of health care has forced many larger corporate owned or hospital based outpatient physical therapy clinics to adopt a different model. This conflicting model sacrifices the patient’s ability to be managed by a single therapist.

Why Sacrifice the Physical Therapist – Patient Relationship?

There are several possible reasons why an outpatient physical therapy practice would not seek to preserve longitudinal continuity. Administrative convenience, where the practice schedules patients with the earliest available physical therapist, often takes precedence over preserving the physical therapist – patient relationship. This is the result of a production model of healthcare where providers are viewed as interchangeable with emphasis placed on filling therapist’s schedules and maximizing productivity versus preserving longitudinal continuity. We view these as unacceptable reasons to schedule patients with multiple physical therapists. However, there are times when the complexity of the patient’s condition warrants additional consultation with a second physical therapist. Also, therapist vacations or illness may necessitate a small number of treatment visits with a covering physical therapist. This should be the exception not the norm at a physical therapy clinic.

The Benefits of Preserving Continuity

Now let’s turn to some of the research which supports an approach based on continuity. Beattie and colleagues² investigated the association between longitudinal continuity (seeing the same physical therapist) and patient satisfaction. These researchers looked at more than 1,500 patient satisfaction surveys from six different private outpatient physical therapy clinics. Seventy percent of those completely satisfied with their experience were seen by a single physical therapist. Only thirty percent of those completely satisfied were seen by multiple physical therapists. Put another way, those who received outpatient physical therapy care from only one therapist were 3 times more likely to report complete satisfaction than those who received care from more than one therapist. Based on this research, clinics should make every effort to preserve longitudinal continuity as a means of improving the patient experience.

Our experience, the opinions of others (EIM Blog) and published research supports the idea that patients who attend outpatient physical therapy deserve the right to be seen by the same physical therapist. This maximizes the physical therapist – patient relationship which promotes trust, adherence, satisfaction, and the best possible outcome. When inquiring about outpatient physical therapy be sure to ask the facility if you will be seen by the same physical therapist every visit.

Thank you for reading!

Ernie

References:

1. Baker R, Mainous AG III, Gary DP, et al. Exploration of the relationship between continuity, trust in regular doctors and patient satisfaction with consultations with family doctors. Scand J Prim Health Care. 2003;21:27–32.
2. Beattie P, Dowda M, Turner C. Longitudinal continuity of care is associated with high patient satisfaction with physical therapy. Phys Ther. 2005;85(10):1046-1052.