11 Oct 2021

Physios question why retail can open in step 2, but they still can't work

7:25 am on 11 October 2021

Patients are unnecessarily suffering because some health professionals are unable to deliver face-to-face care, under level 3 restrictions, Allied Health practitioners say.

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Photo: 123RF

They are calling for the restrictions to change so more patients can access the ongoing care they need.

This comes as the three-step roadmap out of restrictions for Auckland, introduced by the government, sees retail stores and the zoo open before physios.

Physiotherapist Katherine Forch said it was not about the money, but about her patients.

Level 3 appointments for Allied Health services, such as physios, osteopaths and podiatrists, are mostly held online or on the phone.

Some face-to-face appointments may be provided but for urgent care only, and as long as the clinicians can take appropriate measure to manage public health.

Forch said she was concerned for her patients who are suffering daily.

"You get these emails from people, you get phone calls. They want help and if they don't get it from their regular healthcare practitioner then they start looking for other alternatives and it may be that they go to some other alternative that's not evidence-based, that's doesn't necessarily have that understanding of risk mitigation and so you worry for people and I know I speak for my physio colleagues, it's not about the money at this point."

While telehealth can be useful in some settings, online sessions pose an accessibility and privacy issue for many patients, she said.

"One chap, a couple of weeks ago, he did an initial consult with me sitting in his car in the car park at McDonald's because he didn't have reliable access to internet at home. I've had a number of people for example, who don't have the bandwidth to be able to operate a video consult."

Forch believed physiotherapists could operate safely under strict Covid-19 protocols, which include vaccinations, use of PPE, regular testing and contact tracing.

"We're regulated healthcare practitioners. We have extensive understanding of infection control and risk mitigation.

"I personally don't think it should be business as usual, I don't think we should have waiting rooms crammed full of people. But equally I think the current limitations or guidelines around who we can and can't see face-to-face is a little bit restrictive."

And the issue is beginning to gain some traction with many Allied Health practitioners coming forward to support the cause.

An online petition addressed to the government was created last week and already has over 8000 signatures.

Pukehohe-based osteopath Cushla Geck said only 2 percent of her patients have chosen to do online sessions.

"Hardly anyone wants to engage with you via telehealth, they want hands on treatment. They know that hands on care is going to give them improved function and decrease the symptoms that they're experiencing, that's what they're seeking."

She said she was receiving calls almost daily from patients in desperate need of help.

"We get a lot of patients who have been able to get elective surgeries during this time and they've not been able to get their post-operative care. We've had people that have sustained injuries during this time, whether it be a fall off a ladder, or waking up with a wry neck and they're not able to seek any care for acute health. We also have people that have injuries that worsen if they don't get regular care and they've not been able to seek any care during this time."

Geck wants to see a review of the current guidelines to allow Allied Health practitioners to see their patients and treat them in person.

"GPs are already under huge workloads, with or without Covid. They have a huge amount of demand on their system and for us being able to return to the workforce will allow them to get back to doing the more urgent care and allow us to take care of the musculoskeletal complaints that are walking through their door ... why should someone have to attend A&E for acute lower back pain when there are other options?"

Angela Spain fractured her shoulder at the end of July, and was in full physio rehab before lockdown and on track to regain her mobility.

Since Auckland has been in lockdown, Spain has been having weekly Zoom appointments with her physio, but said it didn't make up for face-to-face appointments.

"I've been with physios for different ailments over the years and they course correct, they rehabilitate, they really push you to make progress. They're also good for your mental health when you're dealing with an injury because they give you positive reinforcement and encouragement.

"It affects your mental health because you feel like you're missing out or going backwards and not making the progress that you want to."

She was frustrated with the new 'roadmap' which sees retail shops and the zoo open before she can see her physio in person again.

"I can't see my physio until I can also get my haircut, but I can go and click and collect and go shopping and go to the zoo or even go to a CrossFit class with 10 friends. But I can't go to a physio, I just find it really counter-intuitive to actual health needs of people."

In a written statement, Ministry of Health Chief Allied Health Professions Officer Dr Martin Chadwick said that maintaining a balance between protecting patients during Covid-19 and maintaining people's general wellness had been a priority for the ministry since Covid-19 first emerged in 2020.

"It's been important to the ministry to work with the diverse Allied Health sector to take on board suggestions and feedback. Most recently, we have worked with a sector-led working group to adjust the settings around alert level 3 to look at settings to improve access while keeping checks and balances in place for public protection.

"For physiotherapists, the threshold for treatment to be carried out has been reviewed recently and the threshold has been modified to include the extra flexibility to support treatment provision if the treatment cannot be delayed or carried out remotely."

Chadwick met with the sector working group on Friday and will continue to work with them this week to continue to refine guidance for the sector operating under alert level 3.

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