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Abstract

Introduction: Decisions about physiotherapy service provision occur within the context of organisations, locations, and settings. The uniqueness of rural communities means it is important to consider contextual factors when making decisions about rural health services. As literature describing decision making about rural physiotherapy services is limited, this study sought perspectives on service level decision making (SLDM) from a range of stakeholders. The research approach needed to support consideration of both location and the broader health system. Method: A sequential mixed methods approach within a systems theory-case study heuristic provided the framework to explore rural physiotherapy SLDM. The investigation site, a large area of one Australian state, contained a mix of regional, rural, and remote communities. Perspectives on SLDM were obtained through surveys of physiotherapists, colleagues, and managers, with follow up interviews of a purposeful sample of participants. Results: Responses from physiotherapists, colleagues, manager surveys (n=34), and in-depth interviews (n=19) revealed commonalities and differences between sites and sectors. Available skill and expertise were common considerations across sites. Decisions about prioritisation of services occurred in both public and private settings; however, organisational priorities were a greater influence in the public sector and financial viability in the private sector. Service size influenced the perceived degree of autonomy of physiotherapists in SLDM, with physiotherapists in smaller sites having more independence. Directions from health facility management and the increasing need to prioritise services were reflected in physiotherapy responses from larger facilities. National health reforms and state level priorities were noted as influencing factors, as were connection to community, rurality, and the distance from decision makers. Conclusion: This study provides insight into decisions informing rural physiotherapy service provision. Understanding context and diversity is important to understanding local health service decisions. System level influences from macro and meso level decision makers provide the framework within which micro level physiotherapy SLDM occurs. Service sector, size and rurality then further qualify local service options and influence SLDM. Decisions about service provision need to take into consideration the current availability of services, the context of each location and skill mix required.

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