The Value of Integrating Physical Therapists into Primary Care, Including Patient Outcomes and Health Care Costs: A Scoping Review

OBJECTIVE: Physical therapists have served in primary care roles in the United States military, but the model has yet to be widely adopted in US private, non-governmental health care settings. This review aims to map existing literature regarding the implementation and variations of primary care physical therapy (PCPT) models, assessing health care utilization and patient outcomes. DATA SOURCES, STUDY SELECTION, DATA EXTRACTION AND SYNTHESIS: We searched 3 electronic databases (PubMed, CINAHL, and Scopus) for studies published from 2014 to 2023 in English language. Studies that evaluated health care utilization/costs or patient outcomes while comparing PCPT with the traditional medical primary care model were included. MAIN OUTCOMES AND MEASURES: Main outcomes included study characteristics (population, setting, and model of PCPT), and reported outcomes relevant to health care utilization/costs and patient outcomes. RESULTS: Of the 3565 publications identified, 39 were included in the scoping review. Seventeen studies contained sufficient detail to describe the integration of physical therapists into primary care, and included approaches such as team-based care, co-location of physical therapists in a primary care clinic, and the use of a formalized triage system at the primary care clinic that directed patients to schedule with a physical therapist first. PCPT models have been described in multiple countries internationally. In the United States, PCPT is largely described in unique payor systems including the military, Veterans Affairs, and employee health settings. PCPT may be associated with lower health care costs and utilization compared to traditional medical primary care, particularly in terms of reduced imaging (17 out of 19 studies) and medication use (11 out of 17 studies), including opioid use (5 out of 5 studies). Patient outcomes appeared similar between PCPT and medical primary care pathway, but less robust evidence is available on the topic. CONCLUSIONS AND RELEVANCE: This scoping review found a variety of PCPT models used in governmental, including military, and civilian settings in the United States and internationally, with evidence suggesting that integrating physical therapists in primary care may result in reduced health care utilization with non-inferior patient outcomes.