Physiotherapy and Pharmacotherapy: Future Scope of Practice

[Speaker] Alison Shield:1
[Co-author] Jessica Goyne:1, Julie Cooke:2
1:Pharmacy, University of Canberra, Australia, 2:Sport and Exercise Science, University of Canberra, Australia

The use of non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics is inherently aligned with physiotherapy practice; e.g. optimal pain management is required to facilitate rehabilitation after orthopedic surgery. In Australia, this may result in a mismatch between professional scope and patient needs as physiotherapists do not currently have medication management within their scope of practice. However, the literature suggests that individuals seek medicines advice from physiotherapists and that physiotherapists' are involved in discussing and recommending medicines. There are concerns that inappropriate recommendations may lead to medication misadventure. This project aimed to investigate the current state of physiotherapists' involvement with and knowledge of medicines and determine potential limitations of this knowledge.

Data was collected through an online survey distributed to registered Australian physiotherapists via the Australian Physiotherapist Association; a survey of physiotherapy students at the University of Canberra was conducted simultaneously. Questions asked about current understanding of safe and quality use of medicines, as well as discussion of medicines with patients. Registered physiotherapist (RP: 166) and student (ST: 29) responses were reviewed to determine physiotherapists' involvement in medicines management.

Registered physiotherapists (90%) offered medicine advice and suggested medicines to patients; this could be without a direct patient request (>80%), and included suggesting pharmacy only (e.g. up to 20% recommended oral diclofenac) or prescription medicines. These encounters more often occurred in general (35% RP) or elderly (55% ST) populations. The knowledge of medicines and medicine-related problems in RP and ST physiotherapists' was found to be inconsistent and at times incorrect throughout the population surveyed. For example less than 40% and 60% were able to recall the standard duration and frequency of administration for ibuprofen, respectively. RP and ST physiotherapists' were overwhelmingly supportive of future scope extension into non-medical prescribing, but many specified for a limited formulary.

Physiotherapists are well poised to assist with medication management however will require more medication education and training in order to deliver quality use of medicines. Areas for improvement may include identifying adverse drug reactions, and physician referral when medication use is suboptimal or causing untoward adverse effects.

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