Information on the lessons learnt by Australia and other pioneering nations, such as the

United Kingdom, where physiotherapists Nutlin-3a clinical trial became primary contact practitioners in 1978, is being keenly sought by other WCPT member nations at various stages of this journey to independence. In late 2009 there was an international summit in Washington DC where representatives from every WCPT regional group and over 18 different countries met to identify strategies to advance this agenda. Countries as diverse as Singapore, Jamaica, South Africa, Ireland, and Austria sent representatives who heard presentations on models and evidence to support direct access. There were workshops on establishing direct access services as well as the development of strategies to lobby key stakeholders such as government health departments, regulatory bodies, health professionals and others to bring about the necessary changes to support the implementation of direct access services in WCPT member countries. A key outcome of the meeting was a consensus statement, which noted that: Leaders from 18 countries attending the International Policy Summit on Direct Access

and Advanced Scope of Practice in Physical Therapy endorsed the results of research that clearly demonstrate that patient self-referral to physiotherapy is best for all health systems, whether public or private. Direct access and self-referral allows patients to access physiotherapy as their first choice for rehabilitation.

Z-VAD-FMK purchase A physician referral is not required. However, the pathway to independent practice is not so clear cut. In Australia physiotherapists were fortunate that, at the time they became primary contact professionals, there were no legislative hurdles for the profession to overcome. This is not the case in many WCPT member nations in 2010. For example, in the USA direct access has been recognised by only 45 states and the District of Columbia, which means that in the five remaining states the practice Fossariinae of physical therapy is still contingent upon the prescription or referral of a physician. The American Physical Therapy Association (APTA) is actively lobbying to amend statutes in those remaining states to permit direct access to physical therapy services, as are physiotherapy associations in countries as diverse as Turkey and Japan. However, legislation can be amended and there are many success stories from countries where sustained local advocacy has resulted in legislative changes. One example occurred in 1997 when the Health Professions Council of South Africa verified that it was legally and ethically acceptable for a patient to approach a physiotherapist for treatment without a referral from another health care practitioner.