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

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36 Physiotherapy & Physical and Rehabilitation Medicine KCE reports 87 3.3.3 Inpatient or outpatient treatment during the care episodes, per age group The portion of episodes involving inpatient care sequences increases with age. For persons over 80, more than half of the care episodes included at least one care sequence during hospitalisation. The portion of episodes not involving outpatient sequence also increases with age. For patients older than 80 years, at least 30% of the care episodes did not involve any outpatient treatment. See details in Appendix 13. 3.3.4 Kind of treatment observed during the episodes, per age group The portion of the episodes involving Physical and Rehabilitation Medicine treatment or rehabilitation convention with physiotherapy also increases with patient age, while the frequency of physiotherapy treatment diminishes. For patients over 70 years of age, 20% and more of the care episodes involved Physical and Rehabilitation Medicine treatment. In particular, the proportion of multi-disciplinary Physical and Rehabilitation Medicine and of serious diseases treated by physiotherapy (E, Fb and Fa-lists) also increased with age. See details in Appendix 13. 3.3.5 Kind of rehabilitation observed during the episodes, by district The importance of Physical and Rehabilitation Medicine treatment in rehabilitation episodes varies according to the district. h On average, Physical and Rehabilitation Medicine in outpatient is found in 7.39% of care episodes while inpatient PRM is found in 8.93% of the episodes. In four districts, the prevalence of Physical and Rehabilitation Medicine for outpatients exceeds 12% of care episodes. It may be noted that, where episodes have a low proportion of physiotherapy, Physical and Rehabilitation Medicine is often in high proportion and inversely. This observation indicates a relative substitution effect but this phenomenon is not systematic. Moreover, in districts where Physical and Rehabilitation Medicine is more frequent, there is no increase in the proportion of care episodes involving both kinds of rehabilitation (details in Appendix 13). There is no link between a higher frequency of Physical and Rehabilitation Medicine and a higher number of specialists in Physical and Rehabilitation Medicine: the districts with a high proportion of care episodes with Physical and Rehabilitation Medicine are not exclusively situated in the provinces with a high density of PRM specialists. Two explanations can be given for this surprising finding: • PRM is mainly delivered in hospitals, during a hospitalisation. In 2005, for example, of 6 782 patients treated with PRM 49% were treated during hospitalisation. The distance between home and the setting where the care is delivered does seem to be a constraint in such circumstances. Hospitals do attract patients living in another province. • The data are provided for provinces and did not well capture the nonhomogeneous spreading of local settings. Further refinement on geographical spreading of the PRM supply (per district at least) is needed to confirm a lack of association between consumption and supply. 3.3.6 Kind of treatment observed during the episodes, by gender Women consumed 61.73% of the episodes of care. There is a difference in the kind of treatment between men and women except for Physical and Rehabilitation Medicine: Physical and Rehabilitation Medicine is found just as frequently in care episodes for men as for women. See details in Appendix 13. h District = “arrondissement” in French or Dutch.
KCE Reports 87 Physiotherapy & Physical and Rehabilitation Medicine 37 3.3.7 Kind of treatment observed during the episodes, by social status The differences of kind of treatment between BIM and non-BIM were statistically significant, except for some marginal interventions (mono-disciplinary sessions and rehabilitation after multi-disciplinary sessions). BIM patients received more rehabilitation during hospitalisation: 40% of care episodes involved inpatient rehabilitation as against 21% for non-BIM patients. See details in Appendix 13. Key points Analysis of care episodes Two thirds of the patients had one single care episode during the 3-year period. Most (87.31%) of the episodes only involved one single rehabilitation treatment (physiotherapy, Physical and Rehabilitation Medicine or rehabilitation convention with physiotherapy). Almost 5% of care episodes were related to childbirth, 8.70% to chronic conditions (identified as E and Fb-listed conditions) and up to 10% to acute Fa-listed conditions. Although not all the potential factors influencing rehabilitation could be explored, we observed differences between gender, age, social status and geographical area. The proportion of episodes with Physical and Rehabilitation Medicine or with physiotherapy differs between districts. Some districts have a much higher percentage of PRM and a lower percentage of physiotherapy than the national average. 3.4 REHABILITATION PATHWAYS IN IMA SAMPLE The conditions of reimbursement of Physical and Rehabilitation Medicine were adjusted on 01/08/2004. The distribution of care episodes is consequently presented for two distinct periods: the period from 01/01/2003 to 31/07/2004 and the period from 01/08/2004 to 31/12/2005. The classification of the care episodes depends on the beginning of the care episode. The first period begins after the 31/01/2003. The second one begins later than 31/08/2004. As stated in the methodology (see Appendix 13), patients whose care episodes commenced prior to 01/02/2003 and patients whose care episodes were not completed by 30/11/2005 were excluded from the analysis. The following paragraphs analyse the care episodes consisting of several sequences of treatments. The definitions of care episode, care sequence and care circuit were listed on page 34. 3.4.1 Number of sequences in a care episode Two types of sequences have been defined: • By type of rehabilitation (PRM versus PT) and by inpatient/outpatient setting; • By type of treatment (even within the same type of rehabilitation) and by inpatient/outpatient setting. These sequences are shorter. 3.4.1.1 Sequences defined by type of rehabilitation and inpatient/outpatient setting. Most episodes (88.54%) involved only one type of rehabilitation (either physiotherapy or Physical and Rehabilitation Medicine or rehabilitation convention) in the same setting (inpatient or outpatient). One tenth (11.31%) of the episodes consisted of 2 or 3 sequences (different kinds of rehabilitation or a mix inpatient/outpatient). Less than 1% of the episodes involved more than 4 kinds of rehabilitation.
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