Advanced practice women’s health and continence

Ms Robyn Brennen1

1Monash Health, Cheltenham, Australia

Aim:

In 2014 and 2015, Monash Health and Barwon Health implemented the first public advanced practice physiotherapy services in continence and women’s health in Australia, aiming to increase:

  • Timely access to evidence-based best-practice care
  • Workforce integration and collaboration
  • Satisfaction of patients with the management of their pelvic floor dysfunction

Method:

Patients referred to the Urogynaecology Clinic with incontinence or mild-moderate pelvic organ prolapse, were offered an appointment in the advanced practice physiotherapy clinic. After initial assessment, the physiotherapist made referrals for medical review and/or ongoing physiotherapy or could discharge the patient according to set criteria.

Data was collected on waitlists and waiting times, patient and staff satisfaction, clinical presentations and management, and cost-effectiveness, from December 2014-December 2015, with analysis conducted by PriceWaterhouse Coopers in January 2016.

Results:

External evaluation found:

  • 40%-50% reduction in time and cost per occasion of service,
  • 58% improvement in meeting best-practice guidelines, with patients receiving timely non-surgical intervention instead of, or prior to, invasive procedures,
  • 100% patient agreement with clinical care and decision-making
  • No adverse events

Six advanced practice physiotherapy in continence and women’s health competency and credentialing packages were developed, due to be published on the Victorian DHHS website in December 2016.

Significance of the findings to allied health:

Advanced practice continence and women’s health physiotherapy roles contribute to a streamlined, cost-efficient service, consistent with best-practice guidelines.

Through competency-based assessment, allied health professionals can demonstrate their clinical excellence and ability to meet patient needs in the face of medical workforce shortages.

Allied Health interdisciplinary professional practitioner (AHIPP)

Nick Ternes1, Scott Edwards2, Lucinda Marr3, Samantha Plumb4

1 Royal Melbourne Hospital, Grattan Street Parkville, Victoria, 3052, Nick.Ternes@mh.org.au

2 Royal Melbourne Hospital, Grattan Street Parkville, Victoria, 3052, Scott.Edwards@mh.org.au

3 Royal Melbourne Hospital, Grattan Street Parkville, Victoria, 3052, Lucinda.Marr@mh.org.au

4 Royal Melbourne Hospital, Grattan Street Parkville, Victoria, 3052, Samantha.Plumb@mh.org.au

Aim

The aims of the AHIPP -General Medicine role were to improve access to allied health intervention to improve patient outcomes and flow; provide clinical leadership and improve capacity of the allied health team; and provide an alternative career pathway for experienced allied health staff that encompasses a broad range of high level skills and capabilities, whilst maintaining hands on clinical responsibility.

Methods

The AHIPP was implemented as a feasibility pilot study with initial funding support from the Department of Health and Human Services. Two general medical units received AHIPP intervention and two control group general medical units received standard care. The AHIPP interventions included screening and early assessment of patients to establish allied health needs and ensure appropriate referrals were in place for timely intervention from each discipline. The AHIPP reviewed patients with a length of stay greater than 7 days to support allied health decision making and discharge planning.

Results

The AHIPP was implemented and initially evaluated over a four month period from July to November 2015 with positive trends seen. The role continued throughout 2016 with further extensive analysis completed.  Key findings included a 1 day decrease in median length of stay in AHIPP intervention units compared to control units (7 days (IQR 4-12) versus 8 days (IQR 5-13), p=0.016), 4.3% increase in proportion of patients discharged directly to their previous place of residence compared to control units and a 10% increase in allied health referrals being made within 48 hours of admission.

Significance of the Results to Allied Health

The AHIPP – General Medicine is an innovative model of care enabling a more responsive allied health service to better meet the challenges of a complex patient caseload.

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Credentialling, competency and capability framework (Revised edition)

Ms Catherine Radkowski1, Ms Sally Martin1, Ms Kathy MacDonald1

1Western Health, Sunshine, Australia

Aim: To determine whether the Allied Health: Credentialling, Competency and Capability Framework may be applied to the science disciplines of allied health.

Method: The framework was introduced to various allied health: science disciplines via 3.5 hour introductory workshops conducted in metropolitan, rural and regional areas. Utilising a science discipline example the workshop highlighted how the framework may be applied to facilitate the introduction of a new service. Afterwards, participants were asked to fill out a questionnaire to determine if the framework, as currently written, can be applied to their discipline.

Results: A total of 90 questionnaires were completed from 9 introductory workshops with 98% of participants indicating that they found the framework was useful to very useful for their discipline. It was determined that 54% of participants indicated that minimal changes were required to contextualise the framework for allied health: science disciplines.

Significance of the findings to allied health: Allied health: science disciplines are very new to the terms credentialling, competency and capability. The Introductory Workshops provided a platform to define the three ‘C’s and how the framework can be utilised in practice. Feedback from the workshops was very positive and provided science disciplines the opportunity to collaborate and share ideas with other science disciplines that they may not usually interact with. Adopting a standardised and consistent approach across allied health disciplines in Victoria will allow new and effective workforce developments to be readily transferred between health services, reducing the need for organisations to ‘reinvent the wheel’ and supporting the development of clear career pathways in allied health.