Physiotherapists’ perspectives on direct access in a referral-based system in Austria – A qualitative study

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Objectives To investigate physiotherapists’ perceptions of direct access to physiotherapy in Tyrol, Austria, and identify profession-specific barriers and facilitators to its implementation. Design Qualitative exploratory study. Data were collected through semi-structured interviews and analysed using structured qualitative content analysis. Reporting adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Setting Tyrol, Austria; physiotherapists working in outpatient practices. Participants Ten state-recognised physiotherapists (seven women, three men; mean age = 30.9 years, SD = 6.9) working in musculoskeletal care, recruited via purposive and snowball sampling. Professional experience ranged from 0.4 to 15 years across private practices, clinical and rehabilitation settings. Intervention(s) or exposure(s) Exposure to current physiotherapy models, including informal elements of direct access. Main outcome(s) and measure(s) Perceived readiness for direct access, including competencies, barriers, facilitators and training needs, derived from structured qualitative content analysis. Results Four main themes emerged: (1) Status quo – informal direct access already exists, with physiotherapists undertaking triage roles without a legal framework; (2) Professional competence – moderate-to-high confidence in differential diagnosis but lower confidence in red-flag screening; (3) Organisational barriers – legal uncertainty, liability concerns and hierarchical physician relationships; (4) Training needs – demand for structured education in red-flag screening, imaging interpretation and mentoring. Conclusions and relevance Participants reported perceived readiness for direct access but also identified gaps between theoretical knowledge and clinical confidence. The findings highlight targeted training, interprofessional collaboration and remuneration as important considerations for safe and equitable implementation.