Consolidation of Publicly Funded Outpatient Musculoskeletal Physiotherapy Services in Winnipeg, Manitoba: Effects on Accessibility and Service Delivery

Purpose: In 2017, publicly funded outpatient musculoskeletal physiotherapy services in Winnipeg, Manitoba were consolidated by closing seven hospital-based departments and limiting access to patients who met specific diagnostic criteria. Our purpose was to compare service delivery metrics and patient demographics before and after service consolidation. Methods: We used an exploratory, retrospective cohort study design. Service delivery metrics and patient demographics were obtained from the regional database and compared using inferential statistics. Results: Initial physiotherapy assessments conducted per month decreased by 85.4% (absolute numbers decreased from 18,261 initial assessments in 23 months pre-consolidation to 6,715 in 61 months post-consolidation). Treatment duration (days from assessment to discharge) increased, whereas the number of appointments per patient and wait times decreased (all p < 0.001). The mean age of patients decreased by 5.2 years ( p < 0.001). More patients with wrist/hand conditions and fewer patients with surgical knee and hip conditions were seen post-consolidation. Patients attending at both time points generally came from the same neighborhoods, and measures of deprivation and marginalization were intermediate or higher on Canadian Index of Multiple Deprivation scales. Conclusions: Closing publicly funded outpatient physiotherapy services and changing eligibility limited access for many patients who may no longer be able to access necessary care if they cannot afford private services.