ASSESSMENT OF PERCEIVED QUALITY OF PHYSIOTHERAPY SERVICES IN NIGERIA (A CASE STUDY OF UNIVERSITY OF NIGERIA TEACHING HOSPITAL)

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CHAPTER ONE

INTRODUCTION

BACKGROUND OF THE STUDY

The idea of teaching hospitals in Nigeria is a very importantsegment of the country’s healthcare system, renderinga wide range of modern and highly experienced and developed specialist services like acute, emergency, newborn, geriatric, diagnostic, rehabilitation, palliative and outpatient care. As segment of broad system that renders health services, teaching hospitals chip in to the nation’s health results in collaboration with other national health major components, together with higher education and training schemesmeant for diverse disciplines including medicine, dentistry, nursing, pharmacy, medical technologist, paramedic and specialist training schemes. Over and beyond that, teaching hospitals also played significant roles in making sure diseases prevention strategies, health-promotion strategies, chronic disease management, other primary care services and accessible aged care are brought into existence and implemented. The teaching hospitals are designed to render and satisfy the diverse health needs of communities in Nigeria and beyond.

Viewing it from the perspective of physiotherapy services, the patients desire to be referred by physicians or specialists through a referral letter in order to receive the needed physiotherapy services at rehabilitation medicine department whichincludes the first ‘Entrance’ between patients and physiotherapists.

Concurrent with the growing of our population is a meaningful rise in the frequentness of chronic diseases. This in turn has maximized the cravings for physical therapists and physical therapy services by all health agencies. The unaccustomed, unfamiliar need for services may outsmart and exceed the capabilities of the already existing medical facilities. There is also a fast growing need and urge for out-ofhospital treatment programs with a concurrent shortage of competent and well to do physical therapists to staff them. Irrespective of the expertise in therapeutic exercises and the available record of effectiveness and productiveness, many people continue to live with physical disabilities all around the world, specifically in Africa, Nigeria. Access to rehabilitation for people with disability is deficient and wanting, not to talk of the rural communities, with the attendant economic and social outcomes if the status quo is maintained. Notwithstanding, physiotherapy being perceived from the positive sided positively by all referral groups of patients, there is still a differentdeficient of knowledge about the profession by the general public, which influences self-referral. Diverse referral practices exist among doctors based on the different views held by these doctors as to the conditions seen as amenable to physiotherapy or their therapeutic intentions when suggesting physiotherapy with or without other medications as noted by Akpala et al.

Hurley 2002 opined that other factors that might affect referral systems could be the age, sex of individual doctors, medical school attended, and previous experience of hospital or other rehabilitation services, and specifically of physical therapy. There is also a challenge in the employment of evidence-based practice by many physical therapists. Jetteetal.also pointed out that physical therapists had a desire to maximize the use of evidence in their everyday practice.

The reduced idea of public-health-oriented physical therapy can be seen in the midstdiverse physical therapists. According to the chartered society of physiotherapy in the year 2010, physiotherapy workforce has a major significant role to play in the public health agenda through its contribution to the prevention of disease, promotion of good health, specifically through physical activity and development in the all-round quality of life. Numerous studies have indicated the urge to resolve these issues and put an end to the constraints in physiotherapy specifically in the Nigerian environment. Irrespective of being a large research work supporting the importance of physiotherapy for most effective and satisfactory public health of every nation’s citizenry, there still remains a need for a more public health-oriented well researched and reasoned physical therapy practice. On this premise, this study will assessthe perceived qualities of physiotherapy services in University of Nigerian Hospital.

  1. STATEMENT OF THE GENERAL PROBLEM

Based on the aging of our population is a significant rise in the prevalence of chronic diseases recorded in Nigerian hospitals. This in turn has increased the need for physical therapists and physical therapy services by all health agencies. The unprecedented need for services may outstrip the capabilities of the existing medical facilities. There is also an increasing need for out-of-hospital treatment programs with a concurrent shortage of competent physical therapists to staff them.

Despite the expertise in therapeutic exercises and the available evidence of effectiveness, many people continue to live with physical disabilities across the globe, especially in Nigeria. Access to rehabilitation for people with disability is inadequate especially in the hospitals, more so in rural communities, with the attendant economic and social implications if the status quo is maintained. Webster et al. in 2008 stated that despite physiotherapy being regarded positively by all referral groups of patients, there is still a distinct lack of knowledge about the profession by the general public, which affects self-referral and service delivery coupled with the lack of facilities in our hospitals and health care centers for effective service delivery. Different referral practices exist among doctors based on the different views held by these doctors as to the conditions considered amenable to physiotherapy or their therapeutic intentions when prescribing physiotherapy with or without other medications. They stated that other factors that might influence referral and service delivery patterns could be the age, sex of individual doctors, medical school attended, and previous experience of hospital or other rehabilitation services, and particularly of physical therapy. There is also a problem in the employment of evidence-based practice by many physical therapists. Jette et al.(2010) noted that physical therapists had a need to increase the use of evidence in their daily service delivery but this has regrettably not been the case as the level of physiotherapy service delivery is poor.

AIMS AND OBJECTIVES OF THE STUDY

The major aim of the study is to assess the perceived quality of physiotherapy services in the University of Nigeria teaching hospitals. Other specific objectives of the study include;

  1. To examine the need for effective physiotherapy service delivery in Nigerian hospitals.
  2. To examine the need for physiotherapy services in Nigeria.
  3. To determine the role of government in ensuring a quality physiotherapy service in Nigerian health care centres.
  4. To recommend ways of improving the quality of physiotherapy services in Nigerian hospitals.

RESEARCH QUESTIONS

  1. What is the perceived quality of physiotherapy services in the university of Nigeria teaching hospital?
  2. What is the need for effective physiotherapy service delivery in Nigerian hospitals?
  3. What is the need for physiotherapy services in Nigeria?
  4. What is the role of government in ensuring a quality physiotherapy service in Nigerian health care centers?
  5. What are the ways of improving the quality of physiotherapy services in Nigerian hospitals?

RESEARCH HYPOTHESES

H0: The quality of physiotherapy services in university of Nigeria teaching hospital is low.

H1: The quality of physiotherapy services in university of Nigeria teaching hospital is high.

H0: There are no challenges to the quality physiotherapy services in Nigerian Hospitals.

H1: There are no challenges to the quality physiotherapy services in Nigerian Hospitals.

SIGNIFICANCE OF THE STUDY

The study would be of immense importance to the development of physiotherapy in Nigeria and its delivery to patients as it would assess the quality physiotherapy services in Nigerian health care centres with the sole aim of recommending ways of improving or consolidating the level of physiotherapy services in Nigerian hospitals. The study would also benefit students, researchers and scholars who are interested in developing a further study on the subject matter.

  1. SCOPE AND LIMITATION OF THE STUDY

The study is restricted to the assessment of perceived quality of physiotherapy services in the university of Nigeria teaching hospital Enugu state.

LIMITATION OF THE STUDY

Financial constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview)

Time constraint: The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.

ASSESSMENT OF PERCEIVED QUALITY OF PHYSIOTHERAPY SERVICES IN NIGERIA (A CASE STUDY OF UNIVERSITY OF NIGERIA TEACHING HOSPITAL)