A study protocol for the policy intervention design and development of the implementation strategies for direct access to physiotherapists in primary care: a sequential mixed-method study using implementation mapping and a Delphi survey.

Background: In many Asian jurisdictions, patients are required to obtain referrals from registered doctors before consulting physiotherapists. In contrast, countries such as the United States, the United Kingdom, and Australia have a direct access model for physiotherapists designed across different healthcare settings and under prescribed conditions. While research has demonstrated the benefits of direct access, issues remain on the appropriate policy design for direct access in the context of patient safety and organizational challenges in the implementation. Recently the policy to allow direct access in primary care context is being considered in Hong Kong. This study aims to examine the intervention design options for the policy of direct access to physiotherapists and identify corresponding implementation strategies, to inform the appropriate intervention design for direct access to physiotherapists and the implementation strategies.

Methods: We adopt a systematic process for developing the design of the policy and the implementation strategies using an Implementation Mapping approach informed by Consolidated Framework for Implementation Research (CFIR). We will conduct literature reviews to understand the different aspects of policy intervention design and employ qualitative in-depth interviews and focus group discussions to understand key stakeholders' perspectives related to the direct access model. The identified barriers and facilitators associated with policy implementation of an acceptable intervention design will inform the development of an effective implementation strategy tailored to the implementation context. Our approach will involve mapping the research evidence and the subsequent findings from the stakeholders' deliberations into the CFIR domains and referencing the Expert Recommendations for Implementing Change (ERIC) to develop the acceptable intervention characteristics and the corresponding implementation strategies. These insights will be further validated in a Delphi Expert Survey, for a consensus-based approach.

Discussion: This study employs a sequential mixed-method approach to explore the intervention characteristics for an acceptable intervention design in the policy formulation and the corresponding implementation strategy for direct access to physiotherapists. Integrating research insights into actionable policy recommendations and refining these recommendations in a Delphi Survey will inform the appropriate policy intervention design and implementation strategy for direct access to physiotherapy services.