Jenny
I am a neuro physiotherapist working in the community at the moment. My
current job allows me to treat neuro patients in the community or in an
outpatient environment as I see fit (I also have access to a hydro pool one
afternoon per week for my patients).
I think that there is a place for both of these treatment environments and
the best situation is when this option is flexible. With MS patients for
example, their condition is often variable and so if they are well, I might
see them at the hospital, but if they are having problems then I visit them
at home (I understand there is an article about to be published in Brain on
this very subject and most MS patients found domi physio preferential). It
also allows terminally ill patients with e.g.. Ca or MND to be followed by
the same physio through the course of their illness and to remain at home
with support to die if that is their choice.
Certain problems such as manual handling or a program heavily involving
carers is more suitably addressed in the home environment. Some patients
would be unable to attend physio anyway due to immobility, inability to
tolerate the journey or that their problem is directly involving the home
environment.
My "Care of the Elderly" specialist colleague certainly gets a number of
referrals for patients who have attended a full outpatient course for
"Fallers" and yet are still falling. On home assessment the problem is often
found to be something very obvious with the home environment, which had not
been discovered at the hospital.
Lastly I would like to say (as this is one of my bug bears) contrary to
popular belief community physios are not all over 50, are there because they
can't get a job anywhere else, are way out of date and generic, knit, give
out ferrules etc. I actually work in primary health care because I believe
that it is the future and specialist care can be provided for patients in
their local area.
Hope this is useful
Claire
(UK)
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