Policy Analyses of Advanced Scope of Practice of Physiotherapy and the Newly Regulated Health Profession of Kinesiology (Mar 2012)

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Title: Policy Analyses of Advanced Scope of Practice of Physiotherapy and the Newly Regulated Health Profession of Kinesiology
Principal ApplicantTitle(s)Institutional AffiliationFunding AmountAnticipated Completion Date
Dr. Michel D. Landry Assistant Professor Dept. of Physical Therapy at University of Toronto $35,400 March 2012
Co-Applicant(s)Titles(s)Institutional Affiliation(s)
Dr. Linda Woodhouse Assistant Professor School of Rehabilitation Science at McMaster University
Dr. Raisa Deber Professor Dept. of Health Policy, Management and Evaluation at University of Toronto
Dr. Glen Randall Associate Professor DeGroote School of Business at McMaster University
Dr. Pat Miller Postdoctoral Fellow School of Social Work at McMaster University
Dr. Audrey Hicks Professor and Associate Chair Undergraduate Studies, Dept. of Kinesiology at McMaster University
Dr. Emma Stokes Senior Lecturer School of Medicine, Trinity College Dublin
Dr. François Desmeules Postdoctoral Fellow School of Rehabilitation Science at McMaster University
Dr. Scott Thomas Professor and Associate Dean Graduate Education, Faculty of Physical Education and Health, at University of Toronto

Dr. LandryBiography of Principal Investigator:

Dr. Michel D. Landry is the Chief of the Doctor of Physical Therapy Division, in the Department of Community and Family Medicine at Duke University Medical Centre in Durham North Carolina.  He is also an Adjunct Associate Professor in the Department of Physical Therapy at the University of Toronto, and an Adjunct Assistant Professor at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill.  Prior to receiving his doctoral degree, he held clinical and senior management positions within the private rehabilitation sector in Ontario, and within international humanitarian aid and development agencies in Central America and Eastern Europe.  Dr. Landry is a health policy and health services researcher, and his area of current exploration is the interface between available supply (financial and human resources) and increasing demand for health and rehabilitation services across the continuum of care.  He is a proud Canadian, a hockey fan, a Past-President of the Canadian Physiotherapy Association, and a former Career Scientist at the Ontario Ministry of Health and Long Term Care (MOHLTC).  He lectures on the changing structure of rehabilitation services across Canada and internationally, and is a provocative advocate for the moral and ethical necessity to ensure accessible rehabilitation services across the gradient of high, middle and low-income countries.

Executive Summary

Order to address the above research levels and questions, we conduced document analysis, key informant interviews (n=24) and provincial surveys of kinesiologists (n=241) and physiotherapists (n=292). This policy analysis triangulated multiple data sources in order to address the five levels of inquiry noted in section 3.0. Ethics approval for this study (with particular attention to the key informant interview and survey portions) was obtained through the University of Toronto Research Ethics Board, and the University of Ottawa Research Ethics Board.

The following are a series of six main messages that have emerged from our research.

Key Message #1 (General): There are a number of regulated and unregulated health professional groups in Ontario. Recently, Kinesiologists have been added to the list of regulated health professionals under Bill 171, and the scope of practice for physiotherapists has been expanded under Bill 179. At the time of this study, most of the regulatory changes that were included under Bill 171 and Bill 179 had not yet taken effect. The Transitional Council of the College of Kinesiologists of Ontario (TCCKO) did release its competency profile in early 2012, and had submitted all required documentation to the Ministry of Health and Long Term Care (MOHLTC). They anticipate that regulation will occur in 2013. Under Bill 179, the College of Physiotherapists of Ontario (CPO) created a process wherein all physiotherapists in the province who believe they have the required competencies, and who plan to perform any of the controlled acts, could identify themself to the CPO by adding their names to a roster of physiotherapists competent to engage in these activities. At the moment, the rostering process is only related to the following acts: treating a wound below the dermis, assessing or rehabilitate pelvic musculature, and administering a substance by inhalation. There is no process for permitting the following controlled acts that were identified under Bill 179: ordering a prescribed form of energy, ordering diagnostics (e.g., x-rays), and ordering specific laboratory tests. As of the time of writing this report, there were no specific dates when these three controlled acts would be permitted, and no description of what would constitute the required competencies.

Key Message #2 (Education Level): Based on our findings, the necessary education to support either the regulation of kinesiology or expanded scope of practice for physiotherapy remained vague. In kinesiology, there is a wide range of educational program across the 13 institutions that graduate kinesiologists in Ontario. These graduates earn a range of degree types in kinesiology, including Bachelor of Arts (BA) and Bachelor of Sciences (BSc) degrees. Moreover, it was not clear that any further education, beyond a jurisprudence course, was planned for current kinesiologists in order to qualify for self-regulation. It was clear, however, that there was somewhat of a gap between what kinesiologists believe should be included in the educational curriculum, and what the academic institutions are currently providing. In physiotherapy, it was clear that the expanded scope of practice under Bill 179 were not entry-level to practice skills, and as such, the university programs are not planning any significant alteration in curriculum. Some institutions are, however, planning to provide continuing educational courses that would be related to the new controlled acts. Many of the criteria that would describe competency either for newly regulated kinesiologists or the expanded scope of physiotherapy practice has not yet been clearly identified by the regulatory authorities. It is important to note that it is early in the genesis of the practical application of Bill 171 and Bill 179, so our data represent preliminary and foundational information.

Key Message #3 (Regulatory Level): It is clear that the Transitional Council of the College of Kinesiologists of Ontario (TCCKO) and the College of Physiotherapists of Ontario (CPO) have made significant advances with respect to the implementation of Bill 171 and Bill 179. The TCCKO is a new organization and appears to have submitted all documentation that will lead to kinesiologists 'actually' practicing as regulated providers (expected in 2013). The CPO was identified as the primary source of information for physiotherapists regarding regulatory changes. In general and overall, our data seem to indicate that the respective professions are satisfactorily meeting proposed objectives related to new regulation. However, most respondents expressed concern with the length of time from proclamation to making changes in practice.

Key Message #4 (System of Professionals): Very few of the regulatory colleges outside of kinesiology had opinions regarding the upcoming regulation of kinesiologists. Many informants did express that they were "not really" aware of what TCCKO was planning, and in any case most were indifferent toward this legislation. On the other hand, given that the expanded scope of practice has the potential for overlap with other disciplines, many other colleges did have opinions and perspective on the advancement of physiotherapy practice. None of the feedback for either kinesiology or physiotherapy was in any way negative, and most regulatory colleges seem to be adopting a 'wait and see' approach to the outcomes of Bill 171 and Bill 179. Some stakeholders were encouraged by the fact that the Ministry of Health and Long-Term Care (MOHLTC) introduced new legislation to regulate kinesiologists and expand the scope of practice for physiotherapists, and are now considering processes that might lead to an expanded scope of practice within these disciplines. It would therefore seem that the introduction of Bill 171 and Bill 179 has sent a message, real or imagined, and that there is opportunity for health professional groups in Ontario to alter their regulation status or scope of practice. To some extent, reviewing the RHPA for the first time since the early 1990s (and introducing Bill 171 and Bill 179) may have set a precedent in terms of future expectations for legislating expanded scopes of practice. Whether this results in a positive or negative impact on healthcare delivery remains unclear.

Key Message #5 (Practitioner Level): The response rate to the provincial surveys was very low and therefore the generalizability of our data are limited. Responses among those who did respond to the survey were generally very positive towards the proposed changes. However, those who responded may be more interested in the topic and thus represent a biased sample, and may also have offered a more favourable viewpoint with respect to the proposed changes in scopes of practice. The responding kinesiologists believed that regulation was a positive step, that it will improve their interactions with others, and will provide them with an improved mechanism to treat patients. Although very positive at the conceptual level, many expressed some degree of confusion or uncertainty in what regulation will mean, and what the requirements will be expected. As is often noted, the 'devil is in the details' and at the moment there are few details. The physiotherapists who responded were also very positive, and many planned to use the controlled acts within the expanded scope legislation. However, ironically, the controlled acts that physiotherapists are most interested in incorporating into their daily practice are also those very acts that are not yet permissible (e.g., ordering imaging), and there are no specific timelines when these will be allowed under Bill 179.

Key Message #6 (Health System Level): Both disciplines have argued that Bill 171 and Bill 179 would yield positive outcomes such as improved access to care. However, the extent to which Bill 171 and Bill 179 will have an impact at the patient or health system level is not clear. Much of the information that was collected through key informant interviews indicated that there will likely be a positive impact on clinical outcomes, but much of these claims remain unsubstantiated. Further investigation is required in order to measure the outcomes of these legislative changes.

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