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Living Healthfully - December 2007

On Patient Accommodation
Patients in need of physical rehabilitation usually are being seen and examined first by physiatrists. Then they will decide whether a patient needs physical therapy management or not. They would suggest managements that we physiotherapists are to perform. However, we should not be mistaken that all we have to do is follow the list of managements written by physiatrists. We have to remember what a licensed physical therapist’s job descriptions as discussed previously. And so given the faculty to evaluate and analyze patient conditions, we by all rights may deliver additional managements that we think may benefit patients.


On the other hand, let us be reminded that physical therapy students or unlicensed graduates of physical therapy education can neither create managements nor modify the managements prescribed by licensed professionals.

What is expected of us as we receive patients in need of our care? Here are pointers that may help us in our practice (Pierson, 1999):
• Introduce oneself by name, title, and professional designation.
• Verify or confirm patient information we have received such as his/her name, diagnosis, purpose of treatment, and referral source.
• Interview the patient to obtain relevant information about him/her as part of the evaluation process.
• Perform additional evaluation activities to establish the patient’s capabilities, condition, problems, needs, and goals.
• Inform the patient of the treatment plan and techniques selected to fulfill outcome goals; include information about potential risks or adverse effects associated with the treatment.
• Encourage the patient to ask questions to obtain information to enable him/her to consent or decline treatment.

• Request that the patient sign an informed consent document or record his/her verbal consent in the medical record.

In addition to the above procedure, we may as well equip ourselves with a skill that a good physiotherapist has. It is the skill of keen observation. A good physical therapist would have already observed a patient from the moment a patient enters the clinic. By observing keenly a patient’s gesture, facial expression, manner of walking, and posture as he/she enters our premises, we would already have an idea on what a patient will be complaining of. We would also be guided in our physical examination by the things that we have observed regarding the patient.

Aside from non-verbal variables relayed to us by our patients, we have to examine other variables. Therefore, interviewing and physically evaluating a patient is necessary. These confirm our expectations or even give us an in-depth understanding of the disease process. In this way, we shall be able to come up with a sensible management suited to address our patient’s problems.

The findings we get from interviews and examinations, plus the treatments we administered should then be documented. Documentation could play a crucial role in communicating our perspectives to our colleagues. It could also be very beneficial medico-legally and even better in monitoring patient progress.
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Objectives of the Discussion

• Familiarize oneself on the physical therapy healthcare process and its documentation
• Understand a physiotherapist’s role in taking patient history and physical examination, and in managing or treating a patient’s condition
• Explain the different procedures in effectively accommodating and educating patients and their families

Institutional Types/ Practice Environments

Being part of the healthcare system, we are exposed to a variety of institutions and practice environments. We may be part of acute care services, as well as in subacute or chronic services. Our services may also be of significant factor in physicians-run primary, secondary, and tertiary healthcare systems. Clinicians working abroad may also be expected to play important roles in taking care of individuals within skilled nursing facilities, hospices, custodial care facilities, and school systems. Others become private practitioners traveling from one place to another. Below are short discussions regarding the mentioned practice settings (Arslanian and Cottrell, 2006).


Acute Care (Short-term Hospital)
• Treatment within this unit is intended for short-term illnesses and health problems.
• Average length of patient stay within this unit is less than 30 days (even less than seven days).
• Healthcare providers may be physicians, nurses, physical therapists, etc.
• The rapid discharge of patients for next level of care makes physical therapist’s role in patient and family education and in discharge planning important.

Subacute
• This type of facility is involved in taking care of patients who are too fragile to be sent home.
• Physical therapists are entailed to apply more intensive managements among patients who are candidates for rehabilitation.

Chronic Care Facility (Long Term Care Facility)
• This service is for those patients who require longer hospital accommodation (more than 60 days).
• Medical services provided in this unit are for supportive purposes and maintenance of remaining functions).

Primary Care
• This refers to the basic or “first level care”.
• This is usually provided by primary care physicians, including family practice physicians, pediatricians, internists, and obstetric/ gynecologists.
• It is provided on an outpatient basis.
• Physiotherapists support primary care teams upon request from the primary care physician.

Secondary Care (Specialized Care)
• This unit is considered as the “second level medical service”.
• The services within this system are provided by medical specialists, not having first contact with patients.
• The care within the facility requires in-patient hospitalization or ambulatory same day surgery such as hernia repair.

Tertiary Care
• Highly specialized physicians in a hospital setting provide this care.

Ambulatory Care (Outpatient Care)
• This includes outpatient preventive, diagnostic, and treatment services.
• Rehabilitation or physical therapy centers usually accommodate individuals in an outpatient basis, unless they are parts of a hospital setting. In such case, physical therapists are involved in an in-patient treatment program.


Skilled Nursing Facility
• It may be free standing or part of a hospital.
• Continuous nursing, rehabilitation, and other health services on a daily basis provide the care.

Custodial Care Facility
• It provides patient care that is not medically required but necessary for the patient who is unable to care for him/ her.
• Custodial care may involve medical or non-medical services that do not seek a cure.

Hospice Care
• This is care provided for dying patients and their family at home or in-patient setting.

School System
• The physical therapist serves as a consultant to teachers working with students with disabilities in the classroom.
• Major goal of physical therapy treatment is the child’s functioning in a school setting.



Private Practice
• Private physiotherapy practitioners may visit and treat patients within their homes.

TO BE CONTINUED...
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