Barriers to the use of direct access according to allied health professionals; an exploration among Dutch physiotherapists, dietitians, and health insurers.

Introduction: General practices experience high workloads and increasing volume of patients. But not all patients require GP care. We previously reported that GPs observed that allied health professionals frequently request referrals even when patients initially seek direct access to care. This study, therefore, explored the barriers to the use of direct access as identified by allied health professionals and health insurers.

Methods: Seventeen in-depth interviews were conducted comprising six dietitians, seven physiotherapists, and four health insurers. The interviews were recorded, transcribed, and analysed using the qualitative research principles of thematic analysis.

Results: The main key themes that derived from the interviews included: (1) policy, (2) motivation, and (3) public profile, which were further subdivided into sub-themes. While health insurers claimed to not impose any specific requirements for the use of direct access, allied health professionals faced several policy-related challenges with direct access. For instance, dietitians reported reduced treatment time under direct access and claimed lower reimbursement for intake appointments compared to those following referrals-an assertion denied by insurers. Other reasons for not using direct access include greater uncertainty about potentially overlooking health issues during the initial intake. Additionally, some physiotherapists and dietitians perceive direct access as less convenient than obtaining a referral, for example as it involves fewer regulations from health insurers and therefore saves time. Public profile also played a role in the use of direct access. Dietitians noted limited patient awareness of their services and the availability of direct access, unlike physiotherapists, who benefited from public campaigns and effective management strategies.

Conclusions: Despite the small sample size, this study showed a gap between the perspectives of allied health professionals and the health insurers that need to be further explored. Direct access has inadvertently increased the workload for some allied health professionals, particularly dietitians. This is an unintended outcome of a system intended, ironically, to reduce pressure on care. The use of direct access could be improved by carrying out further investigations and addressing the challenges faced by allied health professionals.