This thesis includes four manuscripts with overarching objectives to identify if Canadians experience unmet need for physiotherapy. McIntyre et al.’s framework was utilized across the manuscripts to explore reasons why unmet need may exist.
The first manuscript presents a scoping review investigating unmet need for physiotherapy across Canada. The objective was to describe current evidence for unmet need for community-based physiotherapy services (CBPTS). Adults with chronic conditions versus those without, or who lived in rural versus urban communities were more likely to report unmet need for CBPTS. Availability and affordability were identified as reasons for unmet need.
The second manuscript presents a secondary data analysis of three Canadian Community Health Survey (CCHS) cycles (2001, 2003, 2005) for three provinces: Ontario (ON), Alberta (AB), British Columbia (BC). This study investigated factors that explain variations in self-reported unmet needs of individuals with specific chronic conditions. Unmet need for treatment of a physical health problem (PHP) was the most common type of need in all three cycles. Affordability was the only domain with significant differences between cycles in two provinces. Women were less likely than men, and older persons less likely than persons 40 – 45 years, to report unmet need for treatment of a PHP.
The third manuscript analyzed CCHS data for ON, AB and BC to investigate which socio-demographic variables were associated with reporting a visit to a physiotherapist in three cycles. People with lower income were less likely to report a physiotherapy visit compared to people with higher income. Women, and individuals with an injury or physical activity limitation were more likely to report a physiotherapy visit.
The fourth manuscript presents themes from key informant interviews that explored the partial removal of physiotherapy from the Ontario Health Insurance Plan (“delisting”). Partial delisting contributed to increased unmet need immediately following, and more than ten years post implementation. Longstanding unmet need due to affordability and availability was identified. / Thesis / Doctor of Philosophy (PhD) / Physiotherapy is a health profession that works with people to help them stay healthy and maintain physical function. There are many people with chronic conditions who would benefit from receiving physiotherapy treatment, but are not able to do so. Three reasons that may explain why people do not receive physiotherapy are they: cannot afford to pay; cannot find a physiotherapist close to where they live or work; or they do not believe a physiotherapist will improve their health. This thesis includes four papers aimed at better understanding the reasons why people in three Canadian provinces, Ontario, Alberta and British Columbia, do not see a physiotherapist when their health would benefit from doing so. The results suggest that cost and the location where physiotherapy services are provided are reasons why some people do not receive physiotherapy care - even if they believe physiotherapy is needed. The findings from this thesis may help to inform the future organization and delivery of physiotherapy services.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/22840 |
| Date | January 2018 |
| Creators | Wojkowski, Sarah |
| Contributors | Richardson, Julie, Rehabilitation Science |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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