Wheelchair Referral and Appointments
Original Editor - Naomi O'Reilly as part of the Wheelchair Service Provision Content Development Project
Clients who require a wheelchair and/or seating system on a long-term (more than 6 months) or permanent basis should be referred to a therapist and supplier who collaborate toward a common goal. Both the therapist and the supplier should be skilled, qualified professionals with specific training and experience in seating and mobility. The participation of both the therapist and the supplier is critical, as they possess different and complementary skill sets. In addition, the involvement of both team members removes the potential for a conflict of interest between the professionals making the recommendations and the professionals selling the wheelchair and/or seating system. The objective of good practice in referrals and appointments is to ensure that users have equitable access to wheelchair service delivery, to increase the efficiency and productivity of the service, and to minimize waiting lists.
Referral means: sending or directing a person to the right place for care or assistance.
There are different ways in which wheelchair users may be referred to a wheelchair service. Wheelchair services can help to increase the number of wheelchair users who are referred to the service by making sure that all possible referral sources know about the service.
Providing referral sources with a referral form can help to give the wheelchair service some simple initial information about the wheelchair user. each wheelchair service needs to decide whether it will find a referral form useful, what information to include and how the form will be used (for example posted to the service, or handed to the wheelchair user to bring along).
Effective referral requires good links between a wheelchair service and the community; as it is people in the community who will identify and refer wheelchair users to your service.
The way that wheelchair users are referred will vary. Users may refer themselves or be referred through networks made up of governmental or nongovernmental health and rehabilitation workers or volunteers working at community, district or regional level. Some wheelchair services may need to actively identify potential users if they are not already receiving any social or health care services or participating in school, work or community activities.
This pertains to the way in which users access the service. The way that wheelchair users are referred will vary. Users may refer themselves or be referred through networks made up of governmental or nongovernmental health and rehabilitation workers or volunteers working at community, district or regional level. Some wheelchair services may need to actively identify potential users if they are not already receiving any social or health care services or participating in school, work or community activities.
Different individuals and organizations that are likely to identify wheelchair users and refer them to your wheelchair service are:
- local hospital,
- community health centre,
- community-based rehabilitation service,
- village leaders,
- council members,
- church leaders,
- disabled people’s organizations,
- other wheelchair users.
Referral networks, consisting of health and rehabilitation personnel or volunteers working at community, district or regional level, play a crucial role in wheelchair service delivery ensuring services are accessible to users.
The importance of a strong link between specialist services and rehabilitation or health care programmes is stressed in a joint statement of the International Society for Prosthetics and Orthotics and WHO.
Wheelchair services are an example of a specialized service that cannot always be fully provided within every community. In developing countries, the majority of those people with disabilities live in rural areas and find it difficult to access rehabilitation services, which are often restricted to large cities. Health and rehabilitation workers therefore need to play a proactive role in ensuring that people living in rural areas can also access wheelchair services without difficulty.
The role of referral networks in wheelchair service delivery can include:
- identifying and referring people requiring wheelchairs;
- liaising between the users, their families and the wheelchair services to facilitate assessment, fitting and follow-up;
- reinforcing wheelchair service training such as pressure sore prevention, prevention of secondary complications, wheelchair maintenance and mobility skills;
- providing support, advice and possibly assistance in adapting the user’s home environment;
- encouraging measures to facilitate accessibility in the community;
- providing information to the wheelchair services about the acceptability and use of prescribed wheelchairs;
- assisting the user to arrange repairs, and
- promoting the benefits of wheelchairs.
When a wheelchair user is referred to a wheelchair service, they should be given an appointment for an assessment, if they cannot be attended to on the same day. The appointment may be for the user to visit the service/centre, or for wheelchair service personnel to visit the user.
An appointment system helps wheelchair service personnel organize their time efficiently, it also means that wheelchair users do not have to wait around to see the service personnel. This refers to the method of establishing appointment times with users for assessment and prescription, fitting, basic user training and follow-up. The most common method is to list appointment times in a service diary, which are then filled as users are referred. The benefits of an appointment system include reduced waiting times and increased work efficiency. The way an appointment is made depends on how easy it is to get a message to the wheelchair user. For example, messages may be sent by post, by phone or through the original referral source. Sometimes, wheelchair users will arrive without an appointment, where possible, see them on the same day, especially if they have travelled a long way.
Where there is high demand for the wheelchair service, a waiting list will need to be established. Users on the waiting list can be offered an appointment as the service works through the list. The administration of appointments will depend on the context. It is very important to review and triage the waiting list in order to prioritise those whose needs might change rapidly or develop secondary health complications:
- Children with Disabilities because of the risk of developing altered posture or secondary deformities.
- Wheelchair users at risk of developing a pressure sore, as this limits the their ability to participate in community life but also has the potential to become a life-threatening condition.
- Wheelchair users who have a progressive health condition in order to manage the changes in the conditions as they occur.
- People who are experiencing pain due to lack of a wheelchair or a poorly fitting wheelchair.
- William Armstrong, Johan Borg, Marc Krizack, Alida Lindsley, Kylie Mines, Jon Pearlman, Kim Reisinger, Sarah Sheldon. Guidelines on the Provision of Manual Wheelchairs in Less Resourced Settings. World Health Organization; Geneva: 2008.