[Direct access to physiotherapy: the case of France]

The first direct access initiatives were conducted in 1976 and many English-speaking countries have followed this movement, which is designed to obviate a visit to the doctor for certain procedures, apart from diagnosis. Cooperative actions in this field are exceptional in France. Direct access must be distinguished from advanced practices in hospital in the fields of orthopaedics, musculoskeletal disorders, preoperative assessment and total hip and knee replacement. In hospital, men between the ages of 40 and 59 years have access to this type of consultation, with an excellent correlation between 86% and 100% compared to the physician's practice, opening the way to direct access. The apparently successful trajectory in Quebec and the opinion of the Swiss subjects interviewed reveal a very different trajectory. France occupies a special place in this field, as, although cooperative actions with physicians are encouraged, they are exceptional, despite a favourable territorial coverage. Strong points and weak points are considered, but it appears that this process is hampered by numerous obstacles and challenges. Chronic diseases are perfectly suitable for these exchanges of practices, as many other professionals are already active in this field. Delegations of responsibility and transfers of practices indicate a growing professional autonomy in the form of partial direct access.