PodCast: A rural and regional service model for podiatrist-led advanced off-loading

Mr Marcus Gardner1, Mr  Adam McLean1, Dr Byron Perrin2

1Bendigo Health, Bendigo, Australia, 2La Trobe Rural Health School, Bendigo, Australia

Abstract:

Background:
Diabetes-related foot disease causes significant morbidity and those in rural areas are disproportionately affected.  Total contact casts (TCC) or walkers made irremovable (iTCC) are the gold standard for managing neuropathic foot ulceration but are under-utilised, particularly in rural areas. The aim of this study was to evaluate a podiatrist-led service model (“PodCast”) for providing TCCs and iTCCs in a rural and regional setting.

Method:
A mixed methods evaluation approach was used over a 12 month period.  Outcome measures included: number of TCC/iTCCs provided; number of patients treated; wound healing data; and service cost. Qualitative measures included a focus group with podiatrists to explore service implementation barriers and enablers.

Results:
There was a two-fold increase in the number of TCCs/iTCCs provided and the number of patients treated, although demand at the rural site was lower than predicted.  Average time to wound healing was 50 days (n = 13; s.d. 39).  Costs with providing the service were similar to those associated with outsourcing the service. Workforce enablers identified included using more iTCCs as a simpler and cheaper alternative to TCCs and barriers included unpredictable demand in rural sites.

Significance of findings to allied health:
PodCast increased access to TCCs and iTCCs for patients in this rural and regional setting and healing times were comparable to other reported studies.  Increased use of iTCCs made the service model more efficient and cost effective while providing similar outcomes to TCCs.  This finding may inform the development of services in other rural and regional settings.

Biography:

Marcus Gardner is Manager of Podiatry and Allied Health Education and Research at Bendigo Health and a PhD candidate with the La Trobe Rural Health School.

Trialling a whole-of-person approach for improving retention of rural-based allied health professionals

Dr Cath Cosgrave1, Ms  Rachael Cooper2, Ms  Kathie Lowe3

1University Of Melbourne, Department Of Rural Health, Wangaratta, Australia, 2East Grampians Health Service, Ararat, Australia, 3Goulburn Valley Heath, Shepparton, Australia

Abstract:

Aim: Attracting and retaining allied health professionals (AHPs) is a ‘wicked’ problem facing most rural health services. Based on research conducted by Dr Cosgrave on factors influencing the retention of rural AHPs she developed a whole-of-person (WoP) retention improvement framework. In 2018 (The University of Melbourne – Department of Rural Health) established a partnership with two Victorian public health services (East Grampians Health Service and Goulburn Valley Health) to trial a retention improvement program targeting early-career and newly-arrived AHPs. The project’s aim is to reduce avoidable turnover of AHP staff by implementing strategies to improve job and personal satisfaction.

Method: A participatory action research methodology is being used. Each site has a co-funded Project Worker. The research commenced with Dr Cosgrave interviewing eligible staff and key informants to identify context-specific workforce issues. This data and the WoP framework were then analysed to develop a set of recommendations for each health service to improve retention of the AHP workforce and to establish early career AHP retention targets.

Results: This presentation will explain the WoP retention framework and present key findings from the data collected. Some of the current retention improvement activities being undertaken by the health services will be presented, including social connection strategies and early career AHP support programs.  The similarities and differences between the two sites and their turnover/retention data will be discussed. The challenges the two rural health services are experiencing leading this complex cultural change process will be presented. The experience of rural communities taking an active role in a workforce retention initiative will also be covered.

This presentation has broad relevance for health services, rural communities, and government agencies wanting to address the wicked problem of rural AHPs shortages.

Biography:

Cath Cosgrave
Dr Cosgrave is a social scientist & a qualitative researcher. Her research specialisations are rural health workforce, recruitment & retention of nursing & allied health professionals; sub-specialisations include early-career & health professionals from non-rural backgrounds. She undertakes applied research, working in partnership with health services to develop new, whole-of-person approaches to recruitment & retention & brokering community-based solutions for meeting the social &personal needs of professionals living in rural towns. She is committed to improving the quality of rural health services & the level of community inclusion for people from vulnerable population groups.

Rachael Cooper
Rachael is an Accredited Practising Dietitian who has worked in rural health for 17 years. She moved to Ararat from Melbourne after graduating & has a good understanding of the difficulties new staff have settling into rural life & working in sole allied health positions. Rachael commenced as project worker for the Whole-of-person retention project in October 2017.

Kathie Lowe
Kathie’s career experience is across public, private and community health sectors for over twenty years.  She has worked as a clinical physiotherapist in regional and metropolitan Victoria, Australia.  Although Kathie has post-graduate qualifications in Sports Physiotherapy, her ongoing clinical area of interest is Neurological Rehabilitation particularly in interprofessional care of clients in subacute rehabilitation.  Kathie’s current role is Allied Health (Therapy) Education and Research Coordinator at Goulburn Valley Health, Shepparton, Victoria.  In this role, she coordinates student clinical placements, work experience placements and staff education for allied health in acute, subacute and community programs.  This was a newly created role, so has included developing relationships with internal and external stakeholders, and developing processes and programs to address the educational needs of allied health staff and students at GV Health.  This role also includes supporting allied health staff in clinical research and service evaluation.

Non-traditional roles in allied health: an under-explored way to meet rural patient needs and expand rural allied health career pathways?

Dr Anna Moran1, Dr Catherine Cosgrave2, Professor Susan Nancarrow3, Dr Rosalie Boyce4

1Albury Wodonga Health – University Of Melbourne, Albury, Australia, 2Department of Rural Health, University of Melbourne, Wangaratta, Australia, 3Southern Cross University, Bilinga, Australia, 4Barwon Health and South West Healthcare , Warrnambool, 4102

Abstract:

Aim:
“Wicked” problems in rural health include an ageing population, high-levels of multi-morbidity, poor access to health care and difficulty recruiting and retaining health staff. Compared to doctors and nurses, allied health professionals (AHPs) are twice as likely to leave their rural or remote position. With greater research and recognition, “Non-traditional roles” that sit outside profession specific roles e.g. complex care coordinators, may help to alleviate these issues.

Methods:
A cross sectional design was used to extract data from the Victorian Allied Health Workforce Research Project (AHWRP) and job descriptions from Careers.Vic (CV) to explore career opportunities available to AHPs in non-traditional roles across Victoria. Data were analysed using content and thematic analysis.

Results:
Despite an extensive dataset, 30 non-traditional titles were identified from AHWRP. Similarly from CV, 16 non-traditional roles (compared to 135 discipline-specific roles) were identified, of which 2 were rural specific. Non-traditional roles require experience (>2 yrs) but this was not always consistent with the postion’s pay/grading or role description. 12/16 roles were offered as nursing and/or AH, 3 were AH-specific and 1 was nursing only.

Significance:
Whilst these positions have the capacity to play a key role in meeting client needs, minimising pressure on our health services and supporting AH career-progression, they remain limited in number, particularly in rural-areas, and must be competed for with nurses. To support a case for expansion in rural services, more research is needed to understand the function and value of AHPs working in these non-traditional health roles in rural settings.

Biography:

Dr Anna Moran is a physiotherapist by background. She has been working in health services research for the past 10 years exploring the allied health workforce in the UK and Australia. Anna is currently employed in a jointly funded University of Melbourne, Department of Rural Health – Albury Wodonga Health position to help grow research capacity and capability in the region.

Advancing rural allied health practice through health service collaboration

Mr Daniel Baker1, Mrs  Alex Spiller2

1Bass Coast Health , Wonthaggi, Australia, 2Gippsland Southern Health Service, Leongatha, Australia

Abstract:

Aim:
Develop an ‘own grown’ specialist sub-regional workforce responsive to an identified service gap.

Method:
A pre-training evaluation of current skills, confidence and capacity of local allied health professionals who provide care to People with Autism was conducted using Survey Monkey ®. This evaluation explored confidence providing care to People with Autism, history of previous training in this field and confidence and capability to perform positive behaviour support therapy. Subsequently, an interprofessional cohort of Occupational Therapists, Speech Pathologists and Social Workers were recruited to share locally delivered training informed by the evaluation. A post-training evaluation was conducted to review the success of the training program and to identify areas that needed further support through mentoring and supervision.

Results:
Pre-training results showed 70% of clinicians felt underprepared to deliver positive behaviour support services for People with Autism with challenging behaviours and 90% of clinicians reported no previous formal training in supporting People with Autism with challenging behaviours. Post training evaluation results will be presented to show the outcome of the training program.

Significance for Allied Health:
Collaboration and joint applications for grants are a viable approach for smaller health services to develop service capabilities to meet community needs. This approach also provides opportunities for rural allied health professionals to pursue advancing practice opportunities, aiding in staff recruitment and retention.

A collaborative investigation into an interprofessional group’s training needs pre and post training intervention can show progression to advancing practice capability.

Biography:

Daniel is the Sub-Regional Allied Health Clinical Educator in South Gippsland. Daniel has a clinical background as a podiatrist and has completed post graduate studies in Public Health.

Development of an “Advanced Developmental Paediatric Practitioner” role – a one-stop-shop for children with developmental delay

Ms Kait Brown1

1South West Healthcare, Warrnambool, Australia

Abstract:

Aim:
Children’s development in their early years has a lasting impact on their learning and education outcomes later in life. In response to increasing referrals for children with developmental delays, South West Healthcare, with the support of DHHS “Advanced Practice in Allied Health Workforce” funding, developed an innovative Advanced Practice role.

A competency package was developed, to enable a Speech Pathologist to work in an Advanced Developmental Paediatric Practitioner (ADPP) role, by completing competencies in tasks that are traditionally done by an Occupational Therapist or Physiotherapist.

Instead of children attending appointments with multiple team members (eg: Speech Pathologist, Occupational Therapist, Physiotherapist), the ADPP would provide a holistic “one-stop-shop” needs-based assessment across all developmental domains,  to minimise service duplication, and ensure timely access to early assessment and diagnosis.

Method:
A multidisciplinary team developed the clinical competency package. Clinical governance and risk management tools were also developed.

Results:
Implementation of the ADPP role resulted in:

  • Earlier identification of developmental issues not identified on original referrals
  • Earlier onward referrals
  • Increased therapy intensity
  • High client and staff satisfaction
  • Strengthened workforce collaboration.

Significance of findings to Allied Health:
The ADPP role is a valuable addition to paediatric services, particularly in rural and regional areas where access to an appropriately skilled and experienced workforce may be limited.

The competency package could also be expanded  to include learning and assessment for the “communication” domain, so that a Physiotherapist or Occupational Therapist could also be trained as an ADPP.

Biography:

Kait is currently the Manager of Allied Health and Ambulatory Rehabilitation at South West Healthcare. With a clinical background as a paediatric Speech Pathologist, Kait also has a wealth of experience in managing and developing healthcare services. Kait believes that Allied Health’s capacity for innovation and “thinking outside the square” are vital for the future of healthcare delivery, particularly in our rural and regional areas.

Best practice management of the hemiplegic upper limb: Utilising telehealth to provide education to allied health clinicians in regional Victoria

Ms Jan Quiney1

1 Royal Melbourne Hospital, Victoria

Aims: To develop, implement and evaluate an upper limb management course for regional clinicians using telehealth videoconferencing technologies.
Methods: A pre-existing upper limb management course, with both lecture and practical components, was modified for delivery to regional settings. Regional clinical ‘champions’ were identified and attended training to deliver the practical components of the course prior to the telehealth course. The course presenters delivered the lectures and facilitated the course in real time via telehealth from Melbourne. The practical components were completed simultaneously at respective sites by the regional ‘champions’. Participant feedback was collected following the course and at 3-months follow-up and compared to prior courses run on-site at the Royal Melbourne Hospital.
Results: The upper limb management course was successfully implemented simultaneously at three regional sites, involved the training of 12 regional ‘champions’ and 51 regional course participants. Participant feedback showed high level of satisfaction with the telehealth course; however, several scores were lower than those obtained from prior face-to-face courses, related to presentation quality and course facilities. Three month evaluation demonstrated a change in utilisation of hemiplegic upper limb management modalities.
Significance of the findings to Allied Health:
This study highlights the challenge of delivering clinical education via telehealth for allied health clinicians. The practical components and skill development were reliant on the ‘champions’ to deliver and limited any feedback the experts could provide towards the participants’ performance. Face-to-face delivery of the course was rated more positively compared to the telehealth version by participants and the expert educators in regards to quality for most of the presentations. These findings provide further opportunity to modify the course, to better meet the needs of regional physiotherapists and occupational therapists. A phase 2 study is currently underway.

Best practice management of the hemiplegic upper limb: Utilising telehealth to provide education to allied health clinicians in regional Victoria

Ms Jan Quiney1, Mr  Thao Nguyen1, Ms Samantha Plumb1, Ms Catherine  Granger1

1Royal Melbourne Hospital, Parkville, Australia

Aims: To develop, implement and evaluate an upper limb management course for regional clinicians using telehealth videoconferencing technologies.

Methods: A pre-existing upper limb management course, with both lecture and practical components, was modified for delivery to regional settings. Regional clinical ‘champions’ were identified and attended training to deliver the practical components of the course prior to the telehealth course. The course presenters delivered the lectures and facilitated the course in real time via telehealth from Melbourne. The practical components were completed simultaneously at respective sites by the regional ‘champions’. Participant feedback was collected following the course and at 3-months follow-up and compared to prior courses run on-site at the Royal Melbourne Hospital.

Results: The upper limb management course was successfully implemented simultaneously at three regional sites, involved the training of 12 regional ‘champions’ and 51 regional course participants. Participant feedback showed high level of satisfaction with the telehealth course; however, several scores were lower than those obtained from prior face-to-face courses, related to presentation quality and course facilities. Three month evaluation demonstrated a change in utilisation of hemiplegic upper limb management modalities.

Significance of the findings to Allied Health:

This study highlights the challenge of delivering clinical education via telehealth for allied health clinicians. The practical components and skill development were reliant on the ‘champions’ to deliver and limited any feedback the experts could provide towards the participants’ performance. Face-to-face delivery of the course was rated more positively compared to the telehealth version by participants and the expert educators in regards to quality for most of the presentations. These findings provide further opportunity to modify the course, to better meet the needs of regional physiotherapists and occupational therapists. A phase 2 study is currently underway.

Best practice management of the hemiplegic upper limb: Utilising telehealth to provide education to allied health clinicians in regional Victoria

Mr Thao Nguyen1, Ms Jan Quiney1, Ms Samantha Plumb1, Ms Catherine Granger1

1Melbourne Health, Parkville, Australia

Aims: To implement and evaluate an upper limb management course for regional physiotherapists and occupational therapists using audio-visual technology and a skilled facilitator.

Methods: This project continues the work of ‘Best practice management of the hemiplegic upper limb: Utilising telehealth to provide education to clinicians in regional Victoria’ (Quiney et al 2016). The method of course delivery was modified in response to feedback. This modified version utilised a recording of the course, in conjunction with a skilled facilitator instead of regional clinical ‘champion’ to deliver the practical components. The facilitator visited two regional sites in Victoria. One site was involved in the original telehealth course and their feedback was sought comparing delivery methods. Feedback from the second regional site, which had previously not participated in any course, was compared to prior face-to-face courses at the Royal Melbourne Hospital.

Results: Participant feedback following each course suggested a high level of satisfaction with this modified delivery, with scores equivalent to face-to-face courses and higher than for the original telehealth course. This course and delivery method was more fluent and clear and the skilled facilitator fostered better engagement with participants than the telehealth course.

Significance of the findings to Allied Health: This study demonstrates that skilled facilitation of practical components and engagement with course participants provides a better quality learning experience when using telehealth modalities. This may inform the design of future courses for the education and development of regional allied health professionals.

Stress and anxiety management group for GEM inpatient rehabilitation: A pilot study

Miss Taylor Crotch2, Mr James Naismith1, Ms Melissa Mew1, Dr Danielle Hitch2

1Barwon Health, North Geelong, Australia, 2Deakin University, Geelong, Australia

Aim: Some Geriatric Evaluation & Management (GEM) inpatients struggle to engage in therapy due to stress and anxiety impacting on rehabilitation outcomes. Literature suggests older adults benefit from relaxation interventions to alleviate anxiety and depression, however, benefits and feasibility of these interventions are unclear in the current healthcare climate.  This pilot study aimed to evaluate a 6 week trial of a 2 week relaxation and stress management group program jointly run by occupational therapy and clinical psychology staff on a 34 bed subacute GEM ward.

Method:  A convenience sample was evaluated using mixed methods.  Patients’ pre-post Hospital Anxiety and Depression Scales were analysed using descriptive statistics.  Patient surveys administered post program and staff surveys administered post 6 week trial were analysed thematically and triangulated.  Rosalind Franklin Qualitative Research Appraisal Tool was used for rigor.

Results: Patients’ anxiety improved from 45% normal (18% mild and 36% moderate) pre-group (n=11) to 71% normal (14% moderate and 14% severe) post group (n=7).  Similarly, depressive symptoms improved from 45% normal (9% mild, 45% moderate) to 71% normal (0% mild, 29% moderate).   Patients (n=8) reported positively in terms of satisfaction, content, environment, social benefits, timing of group and self management of anxiety.  Staff (n=4) were also positive but uncertain regarding impact of group on client rehabilitation outcomes. Results were confounded with 4 patients lost to follow up, group cancellations and inadequate marketing.  One patient deteriorated, however cause was unclear.

Significance of the findings to Allied Health: Preliminary results look promising.  Further work is planned to refine the group, logistical processes and re-evaluate.

 

Providing the right health care to the right people at the right time

Ms Courtney Ward-Jackson1

1Northeast Health Wangaratta, Wangaratta, Australia

Aim: Northeast Health Wangaratta (NHW) is committed to providing high quality rural health care.  The Community Health Speech Pathology Service at NHW provides single disciplinary assessment and intervention to children birth to school age, and adults over 18 years with swallowing and communication difficulties.

As of January, 2016, NHW Community Health Speech Pathology Services waiting times were significant, with 28 Priority 1 referrals (for example, people referred for swallowing difficulties or stuttering) waiting 11 months for an initial assessment and 129 Priority 2 referrals (for example, people referred for articulation or voice concerns) waiting 22 months for an initial assessment.  Consequently a review of the Speech Pathology service delivery model was recommended.

Method: Between January and June, 2016 the Speech Pathology Services processes, therapy pathways and intervention options were reviewed and updated.  This was achieved through consultation with peer organisations and best practice research.

Results: In July, 2016 the NHW Community Health Speech Pathology Service introduced its reviewed service delivery model which included the introduction of weekly, fortnightly and monthly therapy options, along with Allied Health Assistant lead therapy, group therapy, home programs, and periodic review pathways.  After 3 months of implementation, the service saw both Priority 1 and 2 referrals waiting less than 4 weeks for an initial assessment.

Significance of the finding to allied health: Innovative service delivery, paired with evidence based intervention provides quality and timely, evidenced based health care in rural Victorians.

 

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