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Physical Therapist As Patient Manager

Physical therapists must manage patients through examination, evaluation, diagnosis, prognosis, intervention, and discharge. This process involves clinical decision making, use of technology, consideration of outcomes, and legal/ethical guidelines. Physical therapy diagnosis identifies the primary dysfunction to direct treatment. Prognosis predicts the level and time of improvement. Discharge occurs when goals are met, while discontinuation happens if benefits cease. Technological advances provide new evaluation and treatment tools. Clinical decisions vary in familiarity and complexity. Legal/ethical duties include respecting patient autonomy and acting in their best interests.

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Umer Qureshi
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171 views25 pages

Physical Therapist As Patient Manager

Physical therapists must manage patients through examination, evaluation, diagnosis, prognosis, intervention, and discharge. This process involves clinical decision making, use of technology, consideration of outcomes, and legal/ethical guidelines. Physical therapy diagnosis identifies the primary dysfunction to direct treatment. Prognosis predicts the level and time of improvement. Discharge occurs when goals are met, while discontinuation happens if benefits cease. Technological advances provide new evaluation and treatment tools. Clinical decisions vary in familiarity and complexity. Legal/ethical duties include respecting patient autonomy and acting in their best interests.

Uploaded by

Umer Qureshi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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PROFESSIONAL PRACTICE IN

PHYSICAL THERAPY
LECTURE NO.4
4th year DPT
Dr.Iman Zahra
THE PHYSICAL THERAPIST AS A
PATIENT/CLIENT MANAGER
Elements of Patient/client management

1. Examination
2. Evolution
3. Diagnosis
4. Prognosis
5. intervention
Patient/client management
Patient/client management for the PT has changed over
the years in five areas:
• Knowledge and skill used in the processes of evaluation
and diagnosis, Prognosis, and discharge planning
• Referral relationships with physicians
• Technological advances in the tools available for
examination and intervention
• Interpersonal relationships with patients and clients
• Outcomes of care
EVALUATION AND DIAGNOSIS
• Evaluation is the process of making clinical
judgments, based on examination data, to
create a problem list for each patient.
• The end product of evaluation is a diagnosis,
which is the term for problems that have been
categorized into defined clusters, syndromes,
or categories
PHYSICAL THERAPY DIAGNOSIS
Sharmann defined the term diagnosis as simply the primary dysfunction
toward which the PT directs treatment, and this has helped dispel the fears
of the medical community that PTs intend to diagnose disease, infringe on
the practice of others or perform clinical services outside their scope of
expertise.

IMPORTANCE
 To distinguish PT’s findings
 To complement diagnosis made by other practitioners.
 To identify the role of PT and scope of practice.
 Bring psychological comfort to PT and the patient.
 Labelling the problem gives it a sense of reality
 To make communication easier
PHYSICAL THERAPY DIAGNOSIS
Physical therapy diagnosis achieves the following:
• It eliminates the search for a common treatment
for all patients, because diagnosis decreases the
generalization of clinical problems.
• It provides an experiential basis, rather than
hypothetical mechanisms, in which to ground
physical therapy theory.
• It ensures the homogeneity of patients in
comparison groups for research
PROGNOSIS
Prognosis is the determination of the predicted optimal level of
improvement in function, the time needed to reach that level,
and the levels of improvement that may be reached at various
intervals during the course of physical therapy.
The prognosis is documented in the physical therapy plan of
care, which includes the following:
• Specific short- and long-term goals for identified problems
• The duration and frequency of specific interventions selected
to meet goals
• The expected outcome
• The optimal level of improvement expected
DISCHARGE
Discharge is the process of ending physical
therapy services provided during a single
episode of care because the anticipated goals
and expected outcomes of treatment have
been achieved.

Discharge does not occur with a transfer; that


is, when the patient is moved from one site to
another site in the same setting or across
settings during a single episode of care.
DISCHARGE
 Discharge is based on the physical therapist’s
analysis of the achievement of anticipated goals
and expected outcomes.

 For patients/clients who require multiple


episodes of care, periodic follow-up over the life
span is needed to ensure the person’s safe and
effective adaptation to changes in physical status,
caregivers, environment, or task demands.
DISCONTINUANCE OF CARE
Discontinuation is the process of ending physical therapy services provided during a
single episode of care because of the following circumstances:

1. The patient/client, caregiver, or legal guardian declines to continue intervention.


2. The patient/client is unable to continue to progress toward anticipated goals and
expected outcomes because of medical or psychosocial complications or because
financial or insurance resources have been expended.
3. The physical therapist determines that the patient/client will no longer benefit from
physical therapy.

When physical therapy services must be terminated before anticipated goals and
expected outcomes have been achieved, the status of the patient/client and the
rationale for discontinuation are documented.
Discharge Planning
• Discharge plans are completed at each transfer point in an episode of care
• Hospitals must have in effect a discharge planning process that applies to all
patients
• The discharge planning evaluation must include an evaluation of the
likelihood of a patient needing post hospital services and of the availability
of the services.
• The hospital must include the discharge planning evaluation in the patient’s
medical record for use in establishing an appropriate discharge plan
• The hospital must discuss the results of the evaluation with the patient or
individual acting on his or her behalf. In addition, the patient and family
members must be counseled to prepare them for post-hospital care. (CFR
code of federal regulation box 4-2)
• Transfer and referral
OUTCOMES
The PT informally reflects on, or formally analyzes the overall
impact of the interventions at the end of an episode of care, on
the patient’s disorders, impairments, functional limitations,
disabilities, health status, and satisfaction with care, as well as
risk prevention, in terms of each likely outcome
• The more PTs assume responsibility for practicing without
referrals, the more accountable they will become for the
outcomes of the care they provide.
• PTs who provide care as members of interdisciplinary teams face
the challenge of determining the contribution of the physical
therapy component to the outcome of the team effort.
CLINICAL DECISION MAKING
May’s model is useful for considering decisions in
every component of patient/client management
because, in the course of a day, all four types of
decisions could be made in patient care
1) Standard familiar decisions
2) Standard unfamiliar decisions
3) Open familiar decisions
4) Open unfamiliar decisions
EXAMPLE
A pediatric PT may make the following kinds of decisions:

1. Standard familiar decisions:


The PT’s knowledge and experience make these decisions
almost automatic.
For example, 85% of a PT’s caseload may be made up of
children with developmental delays. Patient/client
management decisions for these patients are standard and
familiar and become more so as the PT’s knowledge of
developmental delays and experience in working with these
children increase.
CLINICAL DECISION MAKING
2. Standard unfamiliar decisions:
The diagnosis and treatments for a condition are
well known or at least supported by research but are
not commonly encountered.
For example, the same PT as above may be assigned
a patient with torticollis; the PT is able to make
decisions about the child’s therapy but may feel less
comfortable with or confident in patient/client
management decisions for this new patient.
CLINICAL DECISION MAKING
3. Open familiar decisions:
These are familiar decisions that involve some
idiosyncratic element, such that further
investigation or new strategies are required.
For example, the pediatric PT may be assigned a new
patient with developmental delays who also has
visual and hearing impairments; the PT must
therefore modify all the components of
patient/client management to work effectively with
the patient.
CLINICAL DECISION MAKING
4. Open unfamiliar decisions:
These decisions involve confusing or conflicting information
that requires longer and more careful consideration.
For example, the parents of a child with developmental delays
may request that the PT incorporate aromatherapy into the
treatment sessions; otherwise they will take the child to
another PT. Later the same day, the father of another patient
tells the PT that he has lost his job and no longer has insurance
to pay for the physical therapy services his child has been
receiving regularly for over a year. In each case the PT must
decide what action would be in the best interest of the patient
TECHNOLOGICAL ADVANCES
The most visible change in patient/client
management has occurred in the tools
available to PTs in tests, measurements, and
interventions.
COMPARISON OF PT EQUIPMENTS
1932 1999
• WOODEN PLINTHS • MAT TABLES
• HI-LOW TABLES
• SMALL WOODEN BLOCKS
• FREE WEIGHT EQUIPMENT
• ELECTRIC LIGHT CABINET • TREADMILL/EXERCISE BIKE
• AIR COOLED UV • MOIST HEAT/ COLD PACK UNIT
• GALVANIC SINUSOIDAL • ELECTRICAL STIMULATOR
• ULTRASOUND MACHINE
MACHINE
• TRACTION UNIT
• PORTABLE HIGH • PERSONAL COMPUETR AND PRINTER
FREQUENCY MACHINE FOR • IONTOPHORESIS UNIT
DIATHERMY • PARALLEL BARS/STAIRS/RAMP
ETHICAL AND LEGAL ISSUES
• Legal issues in patient/client management are
addressed in practice acts, that regulate the
physical therapy profession.
• PTs must be knowledgeable about the practice
act in each state in which they intend to work,
because the components of patient/client
management and the factors that affect it may
differ from one jurisdiction to another.
ETHICAL AND LEGAL ISSUES
According to the APTA’s Guide for Professional Conduct (GPC)
• Confidentiality
• Trustworthiness, or fidelity,
• Respect for the individual’s rights and dignity
• The autonomy of the patient

A physical therapist shall place the patient’s/client’s interests above those of


the physical therapist. Working in the patient’s/client’s best interest requires
knowledge of the patient’s/client’s needs from the patient’s/client’s
perspective. Patients/clients often come to the physical therapist in a
vulnerable state and normally will rely on the physical therapist’s advice, which
they perceive to be based on superior knowledge, skill, and experience. The
trustworthy physical therapist acts to ameliorate the patient’s/client’s
vulnerability, not to exploit it.
AUTONOMY
Autonomy refers to self-determination
• An important ethical principle in patient/client management.
• The principle of patient autonomy asserts that patients ought
to have the right to make decisions about their health care.
For example,
• GPC states, “A PT shall respect the patient’s/client’s right to
make decisions regarding the recommended plan of care,
including consent, modification, or refusal”
• The principles of confidentiality and informed consent are
extensions of the basic principle of patient autonomy
INFORMED CONSENT
PTs have an ethical obligation to honor the right of patients to make
decisions about their health care
• True informed consent depends on a good relationship between
the PT and the patient, characterized by continual communication.
Five Elements
• Competence
• Disclosure
• Understanding
• Voluntariness
• Consent.
BE PROFESSIONAL!

THANKS

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