Factors that influence the use of direct access to allied health professionals in the Netherlands

Healthcare systems worldwide are under pressure due to increasing demand and rising costs. Simultaneously, there is a shortage of healthcare workers. This is leading to increased pressure on primary care, especially in countries where general practitioners (GPs) perform a gatekeeping function. One way to alleviate this pressure on GPs, and to reduce healthcare costs, is to introduce or expand, direct accessibility to allied health professionals. This study investigated the factors associated with this direct accessibility in the Netherlands.

We used data from electronic health records of physiotherapists, speech therapists, and dietitians, drawn from the 2022 Dutch Nivel Primary Care Database (Nivel's PCD). The data included information ranging from 15,470 to 776,690 patients, and for 62 to 593 practices, depending on the particular paramedic discipline. Multilevel logistic regressions were employed to identify patient and practice characteristics associated with direct access.

Patient characteristics significantly associated with direct access included younger age, higher socioeconomic status, and diagnosis. The patient's sex was also identified as a factor associated with the use of direct access in physiotherapy and dietetics, but not in speech therapy. Moreover, we observed significant variation between practices. We found that the dominant health insurer in an area was sometimes associated with direct access, as well as the number of therapists working in a practice.

We observed significant associations between patient and practice characteristics and the direct access to allied health professionals in primary care. These findings suggest that the use of direct access to allied health professionals could be increased in order to enhance healthcare efficiency and thereby relieve pressure on GP care.