Het gebruik van kinesitherapie en van fysische geneeskunde ... - KCE

KCE Reports 87 Physiotherapy & Physical and Rehabilitation Medicine 15
Key points
General organisation of PRM
In every country, inpatient and outpatient multi-disciplinary PRM treatment
is offered in general hospitals or specialized rehabilitation centres. In the UK
and Canada, there are also community-based multi-disciplinary
rehabilitation teams.
° In the Netherlands, UK and Canada, access to multi-disciplinary PRM care
is restricted by a gate-keeping system and patients face waiting lists. But,
services are 100% free of charge and there is no limit on the number of
sessions covered.
° French and Belgian patients have free access to PRM services and do not
have to wait long. Reimbursement, however, is limited; co-payments are
charged in both countries, and, in Belgium, the number of reimbursed
PRM sessions is limited.
Patients in need of musculoskeletal rehabilitation are often treated with
mono-disciplinary PRM care.
° In the Netherlands, UK and Canada, these patients are often referred to
the private practice of a physio-, occupational or speech therapist
because of the waiting times in the multi-disciplinary facilities. These
private rehabilitation services are typically not covered by the public
system and patients pay for them with out-of-pocket payments or
through private health insurance. The number of sessions covered varies
according to the insurance plan. Access to such a private practice is
easier though than to multi-disciplinary PRM because it is not restricted
by any gate-keeping system.
° In France and Belgium, PRM specialists tend to treat patients in need of
musculoskeletal rehabilitation in their own private practice or clinic in
stead of referring them to a physiotherapist. This leads to an overlap
between PRM specialists and physiotherapists both offering outpatient
physiotherapy.
2.3.5 Quality initiatives in PRM
2.3.5.1 Quality measures for PRM specialists
In every country, PRM specialists must participate in programs of continuous medical
education (CME). CME is a condition for accreditation (Belgium, France) or for
renewal of the PRM specialist’s license to practice (Netherlands, UK and Canada). In
Canada, the public can even consult a public register that includes information on every
specialist’s status of CME.
In addition, European PRM specialists are encouraged to become a European Board
Certified PRM specialist which is granted by the European Board of Physical and
Rehabilitation Medicine. Board certification is optional and does not give an academic
qualification but it means that the candidate has reached the European standards of
competence in PRM. It can be obtained by examination (for young specialists) or by
equivalence.
The Netherlands, France and the UK developed clinical guidelines that recommend a
certain treatment to the PRM specialist.
FInally, the Dutch Association of PRM physicians (‘Nederlandse Vereniging van
Revalidatieartsen’, VRA) organises practice visits (‘visitaties’) in all PRM practices and
has set up a system for registering complications (‘complicatieregistratie’).