Contextual factors influencing physiotherapists’ clinical reasoning related to older adult clients’ finance and economics
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Date
2024-02-26
Authors
Adedotun, Kafayat
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Abstract
Introduction: Older adults experience age-related changes, including increased incidence of chronic health conditions, that can influence their participation in activities of daily living. Physiotherapists can address many of these changes associated with aging. However, older adults’ finances can limit their participation in physiotherapy services. Yet, little is known about if physiotherapists consider older adult clients’ finances in clinical reasoning.
Purpose: To examine if physiotherapists consider older adult clients’ finances in their clinical reasoning, factors influencing inclusion of finance in clinical reasoning, and how dementia might influence their clinical reasoning related to client finance.
Methods: I completed a descriptive qualitative study involving nine Manitoban physiotherapists. Participants completed one-on-one, in-depth, semi-structured interviews. Interviews were audio recorded and analyzed using reflexive thematic analysis. Seven out of nine participants were women, and seven participants had practiced for over ten years. Multiple strategies were used to strengthen trustworthiness, including triangulation of perspectives in data analysis.
Results: I generated two themes by analyzing the interviews: (1) considering older adult clients’ finances in clinical reasoning depends on contextual factors internal and external to the physiotherapists, and (2) diagnosis of dementia adds another layer to contextual factors. Examples of internal factors included past client and personal experiences, perceptions of the finances of older adults as a sub-population, and perception of regulatory and ethical obligations. Examples of external factors included the clients not discussing their finances with the physiotherapists or the clients’ preference about including finance in clinical reasoning. Physiotherapists used a variety of approaches to address the needs of clients with less finances available for physiotherapy services, including modifying their care plan, emphasizing self-management strategies, and changing billing methods.
Conclusion: Including clients’ finances in clinical reasoning is a complex process. There were conflicts within each participant and across participants on if and how to consider clients’ finances in their clinical reasoning. More educational or professional development related to this clinical reasoning area could help clarify some of the confusion or concerns physiotherapists have about incorporating client’s finance in clinical reasoning. Doing so could help improve client access to needed physiotherapy services to optimize older adults’ health and well-being.
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Keywords
clinical reasoning, access to care, aging, finance, care plan