Brian Pearce: Optimizing Impact in Primary Care

Brian Pearce is a Registered Physiotherapist at Parkdale Queen West Community Health Centre in downtown Toronto. With 11 years of experience as a physiotherapist, Brian has worked in private outpatient orthopedics and hospital settings, with the most recent seven years spent working in primary care.

Team-Based Care and Scope Optimization 

Brian’s move into primary care was motivated by a desire to practice within a more integrated model of care. In private practice settings, he notes, physiotherapists often work with limited clinical information about the patient. Working within a primary care team enables shared access to medical records, including medical histories, medication lists, diagnostic imaging and laboratory reports, and hospital and specialist consult notes.  All of these medical reports help to inform assessment, diagnosis and management.

“You’re not privy to a lot of information when you see a patient in private practice,” Brian explains. “It’s really interesting to have the opportunity to work within a primary care team where you have all this information at your disposal.”

This access promotes real collaboration within the team and enables a broader role for physiotherapists who contribute to comprehensive care planning and management of patients.

Brian says that working in the same location as other primary care providers has allowed him to develop a strong sense of trust with his team members. “A lot of times it’s just having those informal water cooler conversations about a patient that we’re co-managing. Often it’s through those informal discussions that other providers really understand your thought processes and competencies as a clinician.

Those conversations have led to the creation of a medical directive for Brian to order x-rays and ultrasounds which has been in place for three years. Brian’s physician colleagues would like to see an even broader scope of practice for physiotherapy, including joint injections. Brian notes that having medical directives in place promotes all around efficiency – for both the patient and providers.

Musculoskeletal Care and First Contact 

Brian indicates that most of the care he provides is orthopedics, however, he identifies the common overlap with chronic disease management. He identifies, for example, the connection between metabolic diseases including obesity, dyslipidemia, hypertension, type 2 diabetes, and osteoarthritis and tendinopathy. In his role he works to support the client holistically. 

When a client accesses physiotherapy directly (ie. a first contact role), Brian observes that patients don’t see their family physician or nurse practitioner as often for that condition.  He notes about his physician colleagues: “A lot of times in one visit they’re dealing with five or more different problems that their patients are coming in for. They have a chronic COPD exacerbation and then they’re talking about their diabetes and then somewhere during their visit they bring up their back pain and knee pain or maybe they’ve got polyarthritis in their hands. So, if I’m able to take on a more central role in managing our client’s MSK concerns, I’m pleased to help take that burden off the shoulders of our GP and NP colleagues.”

Brian has expanded his role in primary care even further by completing his training with the Advanced Clinical Practitioner in Arthritis Care (ACPAC) program. The ACPAC program provides post-licensure training for health care professionals to independently assess, diagnose, triage, and manage rheumatic and musculoskeletal diseases. Brian tells the story of a patient who he suspected had rheumatoid arthritis. “Through the training I received with the ACPAC program we were able to order the appropriate blood work and diagnostic imaging studies which indicated that inflammatory arthritis was high on the list of differential diagnoses. As a result, this client was seen by the Rheumatology team at St. Michael’s Hospital within 3 weeks where he was formally diagnosed with rheumatoid arthritis.  

Care Across the Lifespan 

Primary care is fundamentally oriented toward continuity says Brian “I think of what primary care is, and its longitudinal care over the lifespan,” he says. Patients may be followed for extended periods, particularly those managing chronic pain, functional decline, or complex health conditions which provides a unique opportunity for patient support.

This long-term focus helps redefine expectations around physiotherapy outcomes. “Any real physical change someone would demonstrate through exercise or other interventions…you’re going to appreciate that more over a longer time frame,” Brian notes. He explains that for chronic disease management, a consultative model, with check ins every 2 to 3 months, can be helpful for longer term support.

Physiotherapy Service Model 

Brian reports that he typically sees 7 to 10 patients in a day, depending on the number of assessments and follow ups in a day. Although there is no set number of sessions per patient, Brian must balance the demand for service. He accomplishes this by focusing on active rehabilitation strategies, with a strong focus on patient education and self-management. This model allows for the right amount of care to be provided according to the presenting problem. Some patients require more, some less, but on average patients are seen for 4 to 5 physiotherapy sessions in Toronto area Community Health Centres. For Brian, impact is measured by whether physiotherapy supports his patients in managing their health more effectively over time.

The Time is Now  

The Ontario government is currently making significant investments in expanding team-based primary care through the Primary Care Action Team. Brian’s work illustrates how physiotherapists are essential to promote access to effective and efficient primary care for the management of musculoskeletal conditions. Full implementation of physiotherapy scope will only contribute to improved patient access, faster diagnosis and improved health outcomes.

For more information about physiotherapy in primary care, please see: 

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