Primary contact physiotherapy versus standard emergency physician care in the emergency department: a Time-Driven...

Compare the average cost of an emergency department (ED) visit between three ED care models, namely emergency physician-led management (usual care), management by a primary contact physiotherapist and an emergency physician (intervention), and physiotherapist-led management (sensitivity analysis).

Cost study (Canadian Public Payer perspective) based on data collected during a pragmatic randomized clinical trial (2018-2019) conducted in an urban Canadian academic ED (CHUL, Quebec City, Canada; n = 78, 18-80 years old). Costs incurred for the management of persons presenting to the ED for a minor musculoskeletal disorder were calculated using Time-Driven Activity-Based Costing, in which time invested with a patient determines care costs. The main outcome measure was the average cost of an ED visit. Generalized linear models with Gamma distributions and log links were used to assess whether there were significant differences in average costs between the care models.

Mean ED visit cost was $267.08 (2019 $CAD, 95% CI 212.75 to 346.40) for physiotherapist and emergency physician management, compared with $245.14 for emergency physician-led management (169.46 to 336.72), resulting in a non-significant absolute difference of 21.94 CAD/patient (- 87.33 to 132.63) between models. Sensitivity analyses showed that the average cost of physiotherapist-led ED management could be $194.38 (161.50 to 234.34), representing an average saving of 50.76 CAD/patient that was not statistically significant (- 156.91 to 37.54) compared to emergency physician-led management.

This study is a first step towards a better understanding of the costs incurred by the Canadian Public Payer for the management of persons presenting with musculoskeletal disorders in the ED using different care models. In EDs, physiotherapists may have the potential to help manage persons presenting with a musculoskeletal disorder without significantly increasing healthcare costs.