Background: Rising healthcare costs, an increasing general practitioner shortage and an aging population have
made healthcare organization transformation a priority. To meet these challenges, traditional roles of non-medical
members have been reconsidered. Within the domain of physiotherapy, there has been significant interest in
Extended Scope Physiotherapy (ESP). Although studies have focused on the perceptions of different stakeholders in
relation to ESP, there is a large variety in the interpretation of ESP. Aim: To identify a paradigm of ESP incorporating
goals, roles and tasks, to provide a consistent approach for the implementation of ESP in primary care.
Methods: An exploratory, qualitative multi-step design was used containing a scoping review, focus groups and
semi-structured interviews. The study population consisted of patients, physiotherapists, general practitioners and
indirect stakeholders such as lecturers, health insurers and policymakers related to primary care physiotherapy. The
main topics discussed in the focus groups and semi-structured interviews were the goals, skills and roles affiliated
with ESP. The ‘framework’ method, developed by Ritchie & Spencer, was used as analytical approach to refine the
framework.
Results: Two focus groups and twelve semi-structured interviews were conducted to explore stakeholder
perspectives on ESP in Dutch primary care. A total of 11 physiotherapists, six general practitioners, five patients and
four indirect stakeholders participated in the study. There was a lot of support for ‘decreasing healthcare costs’,
‘tackling increased health demand’ and ‘improving healthcare effectiveness’ as main goals of ESP. The most
agreement was reached on ‘triaging’, ‘referring to specialists’ and ‘ordering diagnostic imaging’ as tasks fitting for
ESP. Most stakeholders also supported ‘working in a multidisciplinary team’, ‘working as a consultant’ and ‘an ESP
role separated from a physiotherapist role’ as roles of ESP.
Conclusions: Based on the scoping review, focus groups and interviews with direct and indirect stakeholders, it
appears that there is sufficient support for ESP in the Netherlands. This study provides a clear presentation of how
ESP can be conceptualized in primary care. A pilot focused on determining the feasibility of ESP in Dutch primary
care will be the next step.
