Do patients prefer outpatient physical therapy (PT) services outside hospitals?

Patient Preferences for Outpatient Physical Therapy Services Outside Hospitals

Most patients prefer outpatient physical therapy services outside hospitals due to greater convenience, reduced costs, and the ability to receive care closer to home, though clinical outcomes and efficiency may vary by setting. 1

Evidence Supporting Patient Preference for Non-Hospital Settings

Convenience and Accessibility

• Home-based rehabilitation offers the greatest convenience for patients and may prolong therapeutic benefits, as it eliminates transportation barriers and allows therapy in familiar surroundings. 1
• Patients value the ability to access care without the burden of travel to hospital facilities, particularly those with mobility limitations or living in rural areas. 1
• Community-based and home settings are explicitly noted as more convenient than hospital-based programs in multiple respiratory society guidelines. 1

Cost Considerations

• Outpatient treatment outside hospitals is consistently more cost-effective than hospital-based care, with multiple studies demonstrating significant cost savings. 1
• Hospital-based outpatient programs carry proportionally higher costs and may lack insurance coverage in some countries, making them less accessible to patients. 1
• The convenience and reduced financial burden of non-hospital settings are explicitly recognized as factors that make these options "preferred by most patients." 1

Clinical Outcomes Across Settings

Equivalence of Care Quality

• Properly conducted physical therapy rehabilitation offers clinical benefit in all settings that have been studied, with no clear superiority of hospital-based programs for most patient populations. 1
• Home-based exercise training can be as effective as hospital-based programs when appropriately resourced, with equivalent improvements in functional outcomes. 1
• The majority of studies describing pulmonary rehabilitation benefits are derived from hospital-based outpatient programs, but this reflects research patterns rather than superior outcomes. 1

Setting-Specific Advantages

• Hospital outpatient settings may provide more efficient care delivery, with one study showing 3.1 points greater functional improvement over 2.9 fewer visits compared to private practice, though this difference was below the minimum clinically important threshold. 2
• Hospital-based programs offer advantages including a safe clinical environment, availability of trained staff, and immediate access to emergency equipment. 1
• Private practice and community settings demonstrate considerable homogeneity with hospital-based practices in terms of patient populations served and treatment approaches. 3

Patient-Specific Factors Influencing Setting Selection

When Hospital-Based Care Is More Appropriate

• Patients with severe deconditioning, lack of home support, or limited transportation access are better suited to hospital-based inpatient or outpatient rehabilitation. 1
• Those requiring intensive supervision during exercise, multiple therapeutic modalities, or management of complex comorbidities benefit from hospital infrastructure. 1
• Patients in unstable pulmonary states or immediately post-exacerbation may require the monitoring capabilities of hospital settings. 1

When Non-Hospital Settings Are Preferred

• Patients with moderate disease severity, adequate home support, and stable medical conditions are ideal candidates for home-based or community rehabilitation. 1
• Those living in remote areas or with transportation barriers particularly benefit from home-based programs. 1
• Motivated patients with good social support systems achieve equivalent outcomes in non-hospital settings. 1

Common Pitfalls and Practical Considerations

Infrastructure Requirements

• Non-hospital settings must ensure adequate follow-up systems, access to trained personnel, and availability of necessary equipment to match hospital-based outcomes. 1
• Home-based programs may lack opportunities for group support and multidisciplinary team involvement, which some patients value. 1
• Telehealth options can bridge gaps in access while maintaining quality, particularly for "hands-off" rehabilitation skills. 4

Reimbursement Barriers

• Even in states permitting direct access to physical therapy, reimbursement requirements often mandate physician referrals regardless of setting, potentially limiting patient choice. 3
• Hospital outpatient settings may have different reimbursement structures that don't necessarily translate to cost-effectiveness despite greater efficiency. 2

Patient Demographics and Access

• Older patients, those with lower education levels, Hispanic and African-American patients, and those with public or no insurance are less likely to access outpatient physical therapy services regardless of setting. 5
• Urban residents have greater access to all types of outpatient physical therapy compared to rural populations. 5

Patient-Reported Priorities

The most important aspect patients identify is that "the PT is expert in their professional field," regardless of practice setting. 6 This suggests that perceived expertise and quality of care matter more to patients than the physical location of service delivery, supporting the appropriateness of non-hospital settings when properly staffed and equipped. 6