Characteristics of nursing and allied health student placements in the Northern Territory over time (2017-2019) and placement satisfaction

OBJECTIVE

Assess nursing and allied health student satisfaction with their remote Northern Territory integrated learning placement and consideration of future rural/remote work Describe the characteristics of these students Examine changes in student characteristics over time.

DESIGN

A cross-sectional survey of students and a review of student placement data.

SETTING

Northern Territory, Australia.

PARTICIPANTS

Former students having a work integrated learning placement of more than 1 week in the Northern Territory from 2017 to 2019.

MAIN OUTCOME MEASURE(S)

Agreement with the statements 'This placement has encouraged me to consider living and working in a rural or remote location after I graduate' and 'Overall, I was satisfied with my placement.' The administrative record review examined student numbers, and placement length over time.

RESULTS

A total of 341 students responded to the online survey. Overall satisfaction with the placement was very high (93%), and 84% agreed/strongly agreed that the placement had encouraged them to consider working in a rural or remote setting. High-quality clinical supervision and educational resources were associated with overall placement satisfaction. Overall placement satisfaction, prior interest in working remotely and satisfaction with educational resources were associated with consideration of working remotely. The number of students having a placement increased by 29% in 2017 to 2019. The number of placement weeks also increased (35%).

CONCLUSIONS

The number/placement time of nursing and allied health students has increased in the NT. Satisfaction with remote work integrated learning placements is an the important pathway to growing a local health professional workforce in remote and rural settings.

Research interest, experience and confidence of allied health professionals working in medical imaging: a cross-sectional survey

INTRODUCTION

There is growing interest in developing research culture and opportunities for allied health professionals working in medical imaging. However, little attention has been given to identifying the research interest and needs of this group relative to the other allied health professions. We aimed to measure self-reported research participation, interest, experience and confidence of allied health professionals working in medical imaging and compare the findings to clinicians working in allied health therapies.

METHODS

A cross-sectional survey of allied health professionals from medical imaging (radiographers, sonographers and nuclear medicine technologists) was conducted. The primary outcome, the Research Spider survey, measures 10 domains of research interest/experience/confidence on a 5-point Likert scale. Results were compared to allied health therapy data.

RESULTS

Responses were received by 82 medical imaging allied health professionals (65% response rate). Overall, medical imaging professionals rated themselves as having 'some interest' and 'little experience or confidence' in research. There was no difference in interest, experience and confidence among different imaging professions (interest P = 0.099, experience P = 0.380, confidence P = 0.212) or allied health therapists (interest P = 0.137, experience P = 0.363, confidence P = 0.791). Participants reported greatest interest in finding and reviewing literature and lowest interest in applying for funding.

CONCLUSION

There are strong similarities between medical imaging allied health professionals and allied health therapy professionals. Therefore, strategies used to promote research culture in allied health therapy professions could be leveraged to provide opportunities for medical imaging allied health professionals.

Impact of heritable disorders of connective tissue on daily life of children: Parent perspectives

AIM

The aim of this study was to investigate parent perspectives on how heritable disorders of connective tissue (HDCT) affect a child's everyday life. In addition, this study aimed to determine if parents seeking health professional services perceive their children with HDCT to have difficulties with activities reliant on hand function.

METHODS

This cross-sectional study used a questionnaire for parents to explore the impact of an HDCT on a child's ability to carry out everyday activities. Parents of children (8-18 years) attending a tertiary connective tissue dysplasia clinic, over a 12-month period, were invited to participate.

RESULTS

We analysed 100 surveys completed by parents. Children with Ehlers-Danlos syndrome-hypermobile type, joint hypermobility syndrome (48%) and osteogenesis imperfecta (42%) were the largest diagnostic groups represented. Pain (73%) and fatigue (68%) were the most common symptoms parents perceived to affect day-to-day activities. More parents were satisfied with their child's self-care (61%) than school participation (33%). Keeping up with handwriting (71%) and gross motor activities (70%) were the most frequently reported difficulties at school. Most parents (65%) reported leisure activity difficulties, with pain (64%) and fatigue (60%) as the main contributing factors.

CONCLUSIONS

This study has provided new knowledge about the concerns of parents with their child's engagement in everyday life including the impact of HDCT on hand function. Further research is needed on effective management strategies to reduce symptoms and improve hand function for these children.

Regional and rural allied health professionals in Australia need better information services training and support for evidence-based practice

BACKGROUND

Evidence-based practice requires health professionals to recognise situations of uncertainty in their practice, translate that uncertainty into answerable questions, and find and appraise information relevant to those questions. No research to date has explored the research-based information needs of allied health professionals (AHPs) in regional and rural Australia.

OBJECTIVE

To examine the information-seeking experiences and needs of AHPs in regional and rural Australia.

METHODS

A total of 80 AHPs, predominantly occupational therapists and physiotherapists, practising in regional and rural areas of Australia completed an online survey.

RESULTS

Almost all respondents reported having questions requiring research evidence, but most of their questions were worded non-specifically. Respondents practising in rural areas had greater perceived difficulty in obtaining relevant evidence than their regional counterparts. Many respondents reported wanting additional support to find relevant research evidence.

DISCUSSION

The findings offer insights regarding information-seeking challenges AHPs face and potential solutions, including improved training and increased health librarian support. However, due to sampling limitations, the results cannot be generalised to all allied health professions.

CONCLUSION

Allied health professionals may require more training and support to engage in efficient and effective information-seeking behaviours. Health librarians have a valuable role to play in providing this training and support.

Co-designing community-focused rural placements for collaborative practice

AIMS AND CONTEXT

As a University Department of Rural Health, we have identified recurrent areas of service need among vulnerable rural populations, specifically the need for allied health. Concurrently, we have also identified missed opportunities for deliberate collaborative practice in rural clinical placements. This paper provides a commentary on our work in progress as we work to leverage available opportunities to provide both service from and education for health profession students on rural clinical placements.

APPROACH

We developed a transdisciplinary placement model, informed by practice theory, which encompasses pre-placement preparation, student support, host sites and clinicians, and a structured evaluation strategy. This model aims to facilitate service provision alongside of student learning about community and collaborative practice. In particular, the co-design of the model is expected to facilitate student's sense of social accountability and reduce stigma in working with vulnerable population groups.

CONCLUSION

This paper highlights the need for greater alignment between rural health education and practice, describes a placement model that is working towards this and showcases how this has been enacted in a remote community in New South Wales. More cross-sector discussion and evaluation is needed to determine the implications of adopting this model more widely if service and learning opportunities are to be equally achieved, and to determine the ways in which training and service provision can be aligned with community need, as recommended in the recent Rural Health Commissioner Report.

Developing a community rehabilitation and lifestyle service for a remote indigenous community

PURPOSE

Community rehabilitation is an essential health service that is often not available to remote Australians. This paper describes the first cycle of a collaborative project, between local community members, allied health professionals and a university, to co-design a community rehabilitation and lifestyle service to support adults and older people to stay strong and age well in place.

METHODS

An action research framework was used to develop the service for adults in two remote communities, one being a discrete Aboriginal community. The first cycle involved planning for, and trialling of a service, with observations, reflections and feedback from clients, community members, university students and health service providers, to inform the subsequent service.

RESULTS

Over two years, stakeholders worked collaboratively to plan, trial, reflect and replan an allied health student-assisted community rehabilitation service. The trial identified the need for dedicated clinical and cultural supervision. During replanning, three key elements for culturally responsive care were embedded into the service: reciprocity and yarning; holistic community-wide service; and Aboriginal and Torres Strait Islander mentorship.

CONCLUSIONS

An action-research approach to co-design has led to the establishment of a unique community rehabilitation service to address disability and rehabilitation needs in two remote Australian communities.Implications for rehabilitationCo-design of community rehabilitation services between Aboriginal and Torres Strait Islander community members and the local allied health professionals can lead to development of an innovative service model for remote Aboriginal communities.Culturally responsive community rehabilitation services in Aboriginal and Torres Strait Islander communities requires holistic and community-wide perspectives of wellbeing.Incorporating Aboriginal and Torres Strait Islander ways of engaging and communicating, and leadership and mentorship for non-Indigenous allied health professionals and students are essential components for students-assisted culturally responsive services.

The effectiveness of implementation strategies for promoting evidence informed interventions in allied healthcare: a systematic review

BACKGROUND

Evidence based practice in health care has become increasingly popular over the last decades. Many guidelines have been developed to improve evidence informed decision making in health care organisations, however it is often overlooked that the actual implementation strategies for these guidelines are as important as the guidelines themselves. The effectiveness of these strategies is rarely ever tested specifically for the allied health therapy group.

METHODS

Cochrane, Medline, Embase and Scopus databases were searched from 2000 to October 2019. Level I and II studies were included if an evidence informed implementation strategy was tested in allied health personnel. The SIGN method was used to evaluate risk of bias. The evidence was synthesised using a narrative synthesis. The National Health and Medical Research Council (NHMRC) model was applied to evaluate the grade for recommendation.

RESULTS

A total of 490 unique articles were identified, with 6 primary studies meeting the inclusion criteria. Three different implementation strategies and three multi-faceted components strategies were described. We found moderate evidence for educational meetings, local opinion leaders and patient mediated interventions. We found stronger evidence for multi-faceted components strategies.

CONCLUSION

Few studies describe the effectiveness of implementation strategies for allied healthcare, but evidence was found for multi-faceted components for implementing research in an allied health therapy group population. When considering implementation of evidence informed interventions in allied health a multi-pronged approach appears to be more successful.

Identifying women at risk of weight gain after a breast cancer diagnosis: Results from a cohort of Australian women

ISSUES ADDRESSED

This study aimed to identify risk factors associated with weight gain post a diagnosis of breast cancer in a cohort of Australian women.

METHODS

In this retrospective clinical audit, objectively measured weight, age and menopause status, treatment type/s, grade, stage, oestrogen receptor and progesterone receptor (PR) status were extracted for 73 breast cancer patients from an ongoing breast cancer treatment quality assurance project. Weight gain or loss was classified as a body mass increase or decrease of ≥5% of weight at diagnosis.

RESULTS

When compared to weight at diagnosis, 57% of patients maintained, 22% gained, and 21% lost weight at 24 months post-diagnosis. Factors associated with weight gain were a diagnosis of grade II (P < .001) or grade III (P < .001) compared to grade I breast cancer, and refusal of radiotherapy (P < .001). Factors associated with weight loss were being postmenopausal compared to premenopausal (P = .033), PR positive compared to PR negative (P < .001), refusal of chemotherapy (P < .001) and radiotherapy recommended (P < .001).

CONCLUSIONS

The maintenance of weight in a majority of women in this cohort is a novel finding. Early identification of women at risk of weight gain post a breast cancer diagnosis can assist health professionals identify, and therefore assisting patients in the prevention and management of weight gain and associated sequela. Investigating the weight-related communications between a patient and specialist, their access to allied health professionals and social support may assist in understanding the overall positive changes in this cohort.

Enablers to Exercise Participation in Progressive Supranuclear Palsy: Health Professional Perspectives

Background: People living with progressive supranuclear palsy (PSP) can experience considerable difficulties with movement, walking, balance, and oculomotor control. The role of exercises and physical activities in mitigating the motor and non-motor symptoms of PSP remains uncertain. Aims: The aim of this study was to identify the perspectives and beliefs of health professionals about the benefits, enablers, and barriers to participation in exercise and physical activity across the course of disease progression of PSP. Methods: Qualitative methods, within a phenomenological framework, were used to obtain nursing and allied health professional perspectives and recommendations. Focus group and in-depth interview questions were derived from a systematic review on exercise for PSP. Expert opinions also guided the interviews, which were audio-recorded, transcribed verbatim, and de-identified. Two researchers independently conducted a thematic analysis. Results: Nineteen health professionals participated from the disciplines of nursing, physiotherapy, occupational therapy, and speech pathology. Four main themes emerged: (i) exercise and physical activities are important for living well with PSP; (ii) provision of information about the benefits of exercise and physical activities facilitates uptake; (iii) interdisciplinary teams work together to improve outcomes; and (iv) care partners can assist with the implementation of exercise and physical activities. Conclusion: Health professionals advocated physical therapies for people living with PSP. The expectation is that structured exercises and physical activities can help to optimize health and well-being, enabling people to continue to participate in social roles. The actual merits of such interventions must now be tested in large-scale controlled clinical trials.

Access to Healthcare Following Serious Injury: Perspectives of Allied Health Professionals in Urban and Regional Settings

Barriers to accessing healthcare exist following serious injury. These issues are not well understood and may have dire consequences for healthcare utilisation and patients’ long-term recovery. The aim of this qualitative study was to explore factors perceived by allied health professionals to affect access to healthcare beyond hospital discharge for people with serious injuries in urban and regional Victoria, Australia. Twenty-five semi-structured interviews were conducted with community-based allied health professionals involved in post-discharge care for people following serious injury across different urban and regional areas. Interview transcripts were analysed using thematic analysis. Many allied health professionals perceived that complex funding systems and health services restrict access in both urban and regional areas. Limited availability of necessary health professionals was consistently reported, which particularly restricted access to mental healthcare. Access to healthcare was also felt to be hindered by a reliance on others for transportation, costs, emotional stress and often lengthy time of travel. Across urban and regional areas, a number of factors limit access to healthcare. Better understanding of health service delivery models and areas for change, including the use of technology and telehealth, may improve equitable access to healthcare.

Evaluation of a Multidisciplinary Cachexia and Nutrition Support Service- The Patient and Carers Perspective

The Barwon Health Cachexia & Nutrition Support Service (CNSS) is an outpatient service focused on improving clinical outcomes and quality of life for patients with or at high risk of cancer cachexia. Patients see a multidisciplinary team, comprising a palliative medicine physician, physiotherapist, dietitian, and nurse practitioner. This study evaluated the service from patient and carer perspectives. In 2016/17, semistructured interviews were conducted with 12 patients and 9 carers attending the service, focusing on: (1) reflection on experience of the CNSS, and (2) describing how a cachexia-specific service can meet their needs and concerns. Analysis generated 4 superordinate themes: evolving perception of service value, empowerment through person-centered care, communication to patients and carers regarding health/disease information, and the importance of the multidisciplinary team-based approach. Generally, patients and carers reported overall positive experiences with the service, particularly with regard to improved communication and management of the patient. Findings confirmed the patient-centered and individualized approaches were particularly valued. These insights are a critical step in the development of recommendations for future clinical management of cancer cachexia.

Health Professional Student Placements and Workforce Location Outcomes: Protocol of an Observational Cohort Study

Background

The successful recruitment and retention of health professionals to rural and remote areas of Australia is a health policy priority. Nursing or allied health professional students’ learning placements in the Northern Territory (NT) of Australia, most of which is considered remote, may influence rural or remote work location decisions.

Objective

The aim of this study is to determine where allied health professionals and nurses who have had a student placement in the NT of Australia end up practicing.

Methods

This research is an observational cohort study, with data collection occurring at baseline and then repeated annually over 10 years (ie, 2017-2018 to 2029). The baseline data collection includes a demographic profile of allied health and nursing students and their evaluations of their NT placements using a nationally consistent questionnaire (ie, the Student Satisfaction Survey). The Work Location Survey, which will be administered annually, will track work location and the influences on work location decisions.

Results

This study will generate unique data on the remote and rural work locations of nursing and allied health professional students who had a placement in the NT of Australia. It will be able to determine what are the most important characteristics of those who take up remote and rural employment, even if outside of the NT, and to identify barriers to remote employment.

Conclusions

This study will add knowledge to the literature regarding rates of allied health and nursing professionals working in remote or rural settings following remote or rural learning placements. The results will be of interest to government and remote health workforce planners.

Trial Registration

Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000797976; https://www.anzctr.org.au/ACTRN12620000797976.aspx

International Registered Report Identifier (IRRID)

PRR1-10.2196/21832

Assessing health literacy among adult outpatients attending allied health clinics in western sydney: A cross-sectional survey using a multidimensional instrument

ISSUE ADDRESSED

Low health literacy disproportionately affects adults from culturally and linguistically diverse backgrounds. This study investigated the health literacy of adults attending outpatient allied health services in western Sydney, a highly diverse region in Sydney with residents from a range of cultural and linguistic backgrounds.

METHODS

A cross-sectional survey was undertaken between March and April 2017 using the Health Literacy Questionnaire (HLQ). Participants, aged over 18 years and with a primary language of English, Arabic, Chinese or Hindi, were recruited from outpatient allied health clinics at Westmead Hospital. Means (standard deviation) for each of the nine HLQ domains were calculated and associations with demographic variables were investigated using analysis of variance (ANOVA).

RESULTS

Two hundred and thirty people were included with mean age of 45.1 years (SD = 19.0), the majority were female (75.5%), over half were born overseas (55.7%) and 77.6% reported speaking English at home. The highest mean score on a HLQ domain (out of 5) was "Understanding health information well enough to know what to do" (M = 4.19; SD = 0.67), and the lowest mean score (out of 4) was "Appraisal of health information" (M = 2.97; SD = 0.54). Participants who did not speak English at home had significantly lower scores on seven of the nine HLQ domains.

CONCLUSIONS

Important health literacy strengths and limitations of a diverse sample of adults attending outpatient allied health services in western Sydney were identified. Findings should be considered in the light of the cross-sectional survey methodology with non-random sampling.

SO WHAT

Data will inform future interventions to improve health literacy and health outcomes among vulnerable population groups in western Sydney.

A Cross-Sectional Survey of Practice Patterns and Selected Demographics of Respiratory Therapists in India

BACKGROUND

Respiratory therapy was introduced to India in 1995. Respiratory therapists (RTs) work alongside doctors in hospitals. Of the 993 universities in India, a few have bachelor's or master's programs in respiratory therapy, but no studies have examined the demographics, geographical spread, or skills used by these RTs. This study assessed the demographics and services offered by RTs in India.

METHODS

This was a cross-sectional study based on a survey administered on paper, by telephone, or online. RTs were selected by convenience sampling from institutional databases and from WhatsApp groups of RTs in India, as well through snowball sampling of co-workers. A link to the online survey was shared on the author's personal social media channels. Of the invited RTs, 465 consented and participated; of those, 237 answered all questions.

RESULTS

Of the 237 respondents completing the survey, 73% had bachelor's degree, 16.5% had a master's degree, 4.6% had a diploma, 2.5% had mixed qualifications, 1.7% had post graduate diploma, 0.8% had a certificate, 0.4% had a master of business administration degree, and 0.4% had a PhD degree. Almost all (96.6%) worked as an RT or in a job that required respiratory therapy knowledge. Although individuals may have had multiple job roles, 77.6% worked as a hospital staff RT. The least frequently performed competencies were recommending diagnostic procedures, using evidence-based principles, initiating and conducting patient and family education, and administering home care and pulmonary rehabilitation; the most frequently performed competencies were support oxygenation and ventilation, ensuring infection control, and maintaining a patent airway.

CONCLUSIONS

Most subjects were employed in south India and had a bachelor's degree. They worked as staff RTs with a focus on the acute care environment. Pneumonia, asthma, COPD, and ARDS were the most commonly managed diseases. Competencies such as recommending procedures, planning and providing pulmonary rehabilitation, and administering home-based care were the least frequently performed.

Evaluation of an Educational Intervention for Clinicians on Self-Harm in Older Adults

Clinicians may lack knowledge and confidence regarding self-harm in older adults and hold attitudes that interfere with delivering effective care. A 1-hour educational intervention for hospital-based clinicians and general practitioners (GPs) was developed, delivered, and evaluated. Of 119 multidisciplinary clinicians working in aged care and mental health at two hospitals, 100 completed pre/post-evaluation questions. There were significant improvements in knowledge, confidence in managing, and attitudes regarding self-harm in late life, and the education was rated as likely to change clinical practice. No GP education sessions could be conducted. A brief educational intervention had immediate positive impacts for hospital-based clinicians albeit with high baseline knowledge. The sustainability of these effects and effectiveness of the intervention for GPs warrant examination.

Reducing time between referral and diagnosis in paediatric outpatient neurodevelopmental and behavioural clinics

AIM

This study investigated the impact of a transdisciplinary advanced allied health practitioner (AAHP) in a public hospital general paediatric outpatient department for children referred for concerns with neurodevelopment, learning and/or behaviour. It was hypothesised that time from referral to initial consultation and diagnosis was reduced for children initially assessed by AAHP. It was also hypothesised that children seen by AAHP were less likely to require a medical specialist appointment.

METHODS

De-identifiable data were gathered from hospital records both retrospectively and prospectively for each group. Data were collected from: 75 children who attended a medical consultation only clinic in 2014; 75 children who attended an AAHP clinic and a medical officer in 2014 and 75 children who attended an AAHP clinic and a medical officer 2 years after establishment in 2016/2017.

RESULTS

On average, 52% children were managed independently by the AAHP. Wait time from referral to consultation significantly decreased from 169 days to 48 days. Similarly, time from referral to diagnosis significantly reduced by almost a half, from 57.2 to 30.59 weeks.

CONCLUSION

This study provides preliminary evidence that utilisation of transdisciplinary AAHPs in general paediatric outpatient departments may reduce waitlists, reduce amount of medical specialist appointments required and provide earlier diagnosis for children with neurodevelopmental, behavioural and/or learning difficulties.

Primary care pathway- a novel way to reduce the burden on orthopaedic fracture clinics within the pediatric subgroup: A Queensland multi-centered review

ABSTRACT

Emergency departments receive an increasing amount of musculoskeletal injuries, with the majority referred to a fracture clinic (FCs). A literature review revealed certain orthopaedic injuries can be safely managed away from the FC pathway by general practitioners (GPs) or allied health professionals (AHPs). The present study aims to review all paediatric presentations to FCs at 2 Queensland hospitals, identifying low risk injuries that could potentially be managed by GPs or AHPs. This study is a continuation from Cleary et al in which a primary care pathway (PCP) was proposed for the management of low risk adult orthopaedic injuries. A PCP has the potential to have significant savings to the health system.A retrospective study was conducted looking at paediatric patients (<16 years) referrals to 2 FCs over 8 weeks. Injuries were categorised into those requiring FC care supervised by an orthopaedic surgeon, and those that can be safely managed by GPs or AHPs via a PCP.Four hundred ninety (57.7%) of the 849 patients referred to FC were assessed as suitable for PCP care. The most common upper limb injury deemed suitable was radius and ulna buckle fractures (18.4%), while the most common lower limb injury is ankle sprains (8%). Total failure to attend rate in the PCP group was 6.7%.Adopting the PCP has the potential to significantly reduce FC referrals. With proven success of similar pathways abroad, the PCP may generate significant time and financial savings for both the health care system and patient.

Bullying in the Nuclear Medicine Department and During Clinical Nuclear Medicine Education

Workplace bullying (WPB) in the medical field is a significant occupational hazard and health-care safety concern, though many cases go unreported. Often regarded as a rite of passage to desensitize and toughen new employees and students, WPB causes psychologic harm and creates an unsafe working environment resulting in health complications, anxiety, depression, low self-esteem, difficulty concentrating, and self-harm. Decreased productivity, increased absenteeism, high turnover rates, and inappropriate patient care are linked to WPB, perpetrating organizational dysfunction. This research study evaluated WPB (prevalence, frequency, and behaviors; associated characteristics; effects on patient care; and awareness and enforcement of antibullying protocols) in nuclear medicine (NM) departments and clinical education. Methods: A quantitative single-group correlational analysis was used to survey certified NM technologists and students in the Nuclear Medicine Technology Certification Board e-mail database (n = 20,389). The highest response rate for any individual question was 836. Data were collected using the short version of the negative-acts questionnaire along with a researcher-created survey and analyzed using χ² testing and central tendencies. Results: WPB existed in varying degrees (46.8%) within the previous 6 mo, predominantly in the form of being ignored, excluded, and subjected to repeated reminders of errors and having information affecting performance withheld. NM professionals are more likely to witness and experience WPB than students and are more likely to be bullied by a fellow technologist. Some characteristics, such as sex, age, and occupation, were statistically significant, whereas others, such as race, height, body type, experience, and education, showed no significant correlation. Attention to patient care decreased (39.6%) when WPB was present. An 8% variation exists between enforcement and nonenforcement of antibullying policies, with 26% of professionals being unaware of whether antibullying policies exist at their workplace. Conclusion: Explanations for underreported WPB include fear of retaliation, nonenforcement and lack of awareness of antibullying policies, organizational complacency, and perceived hierarchic power. Recommendations to minimize WPB include adopting and publicizing a descriptive definition, implementing antibullying policies, using mediation procedures, and imposing noncompliance penalties. A decrease in the incidence of WPB correlates with an increase in employee satisfaction and retention, patient safety, and student success.

Long-term effects of high-intensity training vs moderate intensity training in heart transplant recipients: A 3-year follow-up study of the randomized-controlled HITTS study

The randomized controlled High-Intensity Interval Training in De Novo Heart Transplant Recipients in Scandinavia (HITTS) study compared 9 months of high-intensity interval training (HIT) with moderate intensity continuous training in de novo heart transplant recipients. In our 3-year follow-up study, we aimed to determine whether the effect of early initiation of HIT on peak oxygen consumption (VO_2peak ) persisted for 2 years postintervention. The study's primary end point was the change in VO_2peak (mL/kg/min). The secondary end points were muscle strength, body composition, heart rate response, health-related quality of life, daily physical activity, biomarkers, and heart function. Of 78 patients who completed the 1-year HITTS trial, 65 entered our study and 62 completed the study tests. VO_2peak increased from baseline to 1 year and leveled off thereafter. During the intervention period, the increase in VO_2peak was larger in the HIT arm; however, 2 years later, there was no significant between-group difference in VO_2peak . However, the mean change in the anaerobic threshold and extensor muscle endurance remained significantly higher in the HIT group. Early initiation of HIT after heart transplantation appears to have some sustainable long-term effects. Clinical trial registration number: NCT01796379.

Health service delivery and workforce in northern Australia: a scoping review

INTRODUCTION

Delivering health services and improving health outcomes of the 1.3 million people residing in northern Australia, a region spanning 3 million km2 across the three jurisdictions of Western Australia, Northern Territory and Queensland, presents specific challenges. This review addresses a need for systems level analysis of the issues influencing the coverage, quality and responsiveness of health services across this region by examining the available published literature and identifying key policy-relevant gaps.

METHODS

A scoping review design was adopted with searches incorporating both peer-reviewed and grey literature (eg strategy documents, annual reports and budgets). Grey literature was predominantly sourced from websites of key organisations in the three northern jurisdictions, with peer-reviewed literature sourced from electronic database searches and reference lists. Key articles and documents were also contributed by health sector experts. Findings were synthesised and reported narratively using the WHO health system 'building blocks' to categorise the data.

RESULTS

From the total of 324 documents and data sources included in the review following screening and eligibility assessment, 197 were peer-reviewed journal articles and 127 were grey literature. Numerous health sector actors across the north - comprising planning bodies, universities and training organisations, peak bodies and providers - deliver primary, secondary and tertiary healthcare and workforce education and training in highly diverse contexts of care. Despite many exemplar health service and workforce models in the north, this synthesis describes a highly fragmented sector with many and disjointed stakeholders and funding sources. While the many strengths of the northern health system include expertise in training and supporting a fit-for-purpose health workforce, health systems in the north are struggling to meet the health needs of highly distributed populations with poorly targeted resources and ill-suited funding models. Ageing of the population and rising rates of chronic disease and mental health issues, underpinned by complex social, cultural and environmental determinants of health, continue to compound these challenges.

CONCLUSION

Policy goals about developing northern Australia economically need to build from a foundation of a healthy and productive population. Improving health outcomes in the north requires political commitment, local leadership and targeted investment to improve health service delivery, workforce stability and evidence-based strengthening of community-led comprehensive primary health care. This requires intersectoral collaboration across many organisations and the three jurisdictions, drawing from previous collaborative experiences. Further evaluative research, linking structure to process and outcomes, and responding to changes in the healthcare landscape such as the rapid emergence of digital technologies, is needed across a range of policy areas to support these efforts.

Describing a Clinical Group Coding Method for Identifying Competencies in an Allied Health Single Session

Introduction

Competencies that integrate research findings and practice expertise are necessary to maintain comprehensive evidence-based practice for allied health professions, such as social work. The context of modern multidisciplinary healthcare, especially in acute or emergency settings, means that an individual clinician may only have a single session with a patient. Maximizing the benefit of single sessions requires advanced competence that extends beyond diagnostics and biomedical treatments to the impact of social systems on health outcomes; multi-level advocacy for reduction of existing health disparities and equity in access to health and mental health services; and “working knowledge” of non-pharmacological treatments.

Methods

This study employed a practice-based research methodology whereby health social workers group coded 32 simulation videos, drawn from an advanced social work practice course, to develop a practice-based competency framework that incorporates these advanced skills. Constructivist grounded theory was employed through a cyclical coding process of viewing video data, identifying and discussing skills and competencies, and summarizing/synthesizing the discussions for critical reflection.

Results

The resulting Clinician Group Coding Method utilized systematic and collaborative group coding of practice simulation videos by three clinicians and two researchers to identify relevant competencies for a single session. Emphasis was placed on the progressive phases of single-session patient interactions (eg, joining, working, ending), a practice format that frequently occurs in social work and other allied health professions. These phases include themes of preparing, agenda setting and refining, addressing context, providing education, planning the next steps, and encouraging success.

Discussion

The group coding process allowed for immediate discussions and clarifications, supporting the clinicians to synthesize their experiences toward shared understandings of “best practices” in single-session healthcare contexts. This approach facilitated the understanding of critical actions that allied health clinicians could undertake to improve single-session interactions. This practice-based competency framework may have significant utility for multidisciplinary healthcare education and practice.

The role of Allied Health Professions and Nursing Research Internships in developing a research culture: a mixed-methods exploration of stakeholder perspectives

BACKGROUND

Developing research capability and capacity within the healthcare professions is a challenge throughout diverse international settings. Within England, the National Institute for Health Research aimed to address these challenges through the Integrated Clinical Academic (ICA) research careers escalator for nurses, midwives and allied health professionals. Poor academic progression has been identified in the advanced stages of the pathway, though progression from the earlier entry point (Internship) has not previously been investigated. A national evaluation of four completed Internship cohorts was undertaken to explore stakeholder perspectives and progression beyond the Internship programme.

METHODS

A mixed methods project used sequential qualitative and quantitative data collection phases commencing with two stakeholder focus groups (n = 10); the findings informed the development of an online survey distributed to previous cohorts of interns (n = 104), their managers (n = 12) and academic mentors (n = 36). Eight semi-structured interviews subsequently explored the challenges and opportunities afforded by the internships. Thematic analysis was used to review qualitative data from focus groups and interviews, with survey data analysed and displayed using descriptive statistics. Synthesis of data from each phase is displayed within the four level evaluation framework outlined within the New World Kirkpatrick® Training Evaluation Model.

RESULTS

Important regional differences exist yet the internships are highly valued by all stakeholders. Representation varied between different professions, with nursing and some service-based professions poorly represented. All interns successfully completed the programme (n = 104), with evidence of positive impacts on interns, colleagues and patient care. Balancing research commitments with clinical activity was challenging; middle managers were seen as gatekeepers to programme success. Progression to the next stage of the ICA pathway is highly competitive and was achieved by only a quarter of interns; access to mentors outside of the funded programme is vital for a successful transition.

CONCLUSIONS

The Internship programme succeeds in providing a range of important early experiences in research, though progression beyond the programme is challenging due, in part, to a widening gap between Internship and the next level of the ICA framework. Vital mentorship support to bridge this gap is threatened by a lack of time and funding; therefore, the pursuit of a clinical-academic career will continue to be elusive for many nurses and allied health professionals. A partnership approach to clinical academic support at institutional level is needed with several international models offering alternative strategies for consideration.

Aboriginal dental assistants can safely apply fluoride varnish in regional, rural and remote primary schools in New South Wales, Australia

PROBLEM

There are significant inequalities in oral health status between Aboriginal and non-Aboriginal children in Australia, particularly where the children have insufficient access to various forms of fluoride. There has been a growing interest in seeing fluoride varnish programs used more widely for Aboriginal children due to proven effectiveness. Despite this, there has been limited scale-up of these programs in Australia. This study investigates the feasibility of using Aboriginal dental assistants to provide regular fluoride varnish applications for Aboriginal children in the primary school setting.

DESIGN

A mixed-methods approach including auditing the number of Aboriginal dental assistants were trained and then approved by the NSW Chief Health Officer to apply fluoride varnish, and collection and reporting of participant data on the each of the fluoride varnish days in the local patient management system.

SETTING

Six Aboriginal Community Controlled Health Services from regional NSW were invited to participate in the study. They also nominated a primary school and an Aboriginal dental assistant to participate in the study.

KEY MEASURES FOR IMPROVEMENT

Data were obtained from four 'fluoride varnish days' held at the schools over a 12-month period between December 2017 and December 2018. The number of Aboriginal dental assistants were trained and then approved by the NSW Chief Health Officer to apply fluoride varnish is also reported.

STRATEGIES FOR CHANGE

In total, 8 Aboriginal dental assistants were trained to apply fluoride varnish during the study. Overall, students participating in the study received three or more fluoride varnish applications.

EFFECTS OF CHANGE

Results showed that Aboriginal dental assistants are able to safely and effectively apply fluoride varnish in a school setting with remote supervision.

LESSONS LEARNT

This program can be scaled at the state level in NSW, and this could provide the basis for a nationally consistent program. Initial discussions have been held with several jurisdictions to lead this process via the Australian Health Ministers Advisory Council (AHMAC) based on the results of this study and the support of key stakeholders. The Poche Centre as part of its scale-up planning for the Fluoride Varnish Program is examining the feasibility of including the apply fluoride varnish skillset in its existing Aboriginal Dental Assistant Scholarship Program.

New-graduate physiotherapists' perceptions of their preparedness for rural practice

OBJECTIVE

Providing health care in a rural or remote setting requires physiotherapists to adapt to a number of unique challenges. New-graduates working in rural or remote settings must respond to these challenges in addition to those of being a novice practitioner. This study investigated the perceived preparedness of new-graduate physiotherapists for work in rural or remote settings.

DESIGN

A qualitative general inductive approach.

SETTING

Rural and remote Queensland.

PARTICIPANTS

New-graduate physiotherapists   working in rural or remote locations were contacted via a snowballing recruitment strategy.

MAIN OUTCOME MEASURE

Semi-structured interviews.

RESULTS

Four key themes emerged from the data: (a) adjusting to rural life, (b) embracing opportunities, (c) stepping up to the plate and (d) preparing through authentic experiences.

CONCLUSION

New-graduate physiotherapists perceived rural and remote practice to be a challenging but valuable opportunity with many social and professional rewards. The complex clinical demands and unique cultural factors inherent in rural and remote locations were experienced as additional obstacles to the transition from student to clinician. New-graduate physiotherapists were satisfied that their entry-level training provided the necessary skills required to practise rurally and remotely; however, they expressed 'shock' at the rapid adaptations needed to provide effective service in these settings. New-graduates are confident that exposure to authentic rural and remote clinical practice during their training was integral to their preparedness.

Psychosocial strategies for physiotherapy: A qualitative examination of physiotherapists' reported training preferences

Physiotherapists report using a range of psychosocial strategies in their practice, yet, barriers to implementation include lack of time, limited knowledge, and minimal training. This research aimed to establish what training physiotherapists have had with regards to psychosocial strategies, why they think they would benefit from more training, what training they want, and delivery preferences. Content analysis of answers to four open-ended, online survey questions collected from Australian physiotherapists (N = 208) was conducted. Physiotherapists reported having minimal training specific to psychosocial strategies. Physiotherapists reported wanting training in assessment and management of psychosocial issues, and practical application of specific psychosocial strategies. Didactic and interactive training delivered by experts who understand the psychosocial needs of their patients, and the constraints of physiotherapy practice was preferred. These findings suggest that training in psychosocial strategies at the undergraduate level and continued professional development are necessary. Specifically, training in the assessment and management of psychosocial factors, and in referral processes is warranted, and should be applicable and appropriate for rehabilitation settings. Training should be both didactic and interactive as outlined in the proposed framework.

Assisting patients experiencing family violence: A survey of training levels, perceived knowledge, and confidence of clinical staff in a large metropolitan hospital

Objectives:

Family violence is a public health issue. It occurs in many forms, is most commonly directed at woman and children, and contributes significantly to death, disability, and illness. This study was conducted in the clinical staff in a large metropolitan hospital and aimed to determine levels of family violence training, self-perceived knowledge and confidence, specific clinical skills, and barriers to working effectively in the area.

Methods:

A short, targeted online survey was designed to capture the required information. Descriptive statistics were calculated, and free-text responses were analyzed using qualitative content analysis.

Results:

Survey responses were received from 534 staff (242 nurses, 225 allied health, 67 medical). Sixty-five percent had received some form of family violence training, mostly of short duration (1–3 h); 72% reported having little or no confidence working in the area, while 76% indicated that they had little or no knowledge in the area. Longer duration training was associated with an increase in knowledge and confidence ratings. Family violence screening rates and knowledge of several specific family violence clinical skills (how to appropriately ask clients about family violence and family violence risk factors) were also low. Thirty-four percent indicated that they did not know what to do, when a patient disclosed experiencing family violence. The most commonly indicated barriers to working effectively in this area were suspected perpetrators being present, perceived reluctance of patients/clients to disclose when asked, and time limitations.

Conclusion:

This research provides a useful snapshot of clinical staff perceptions of their family violence skill levels in a large metropolitan Australian tertiary hospital. It highlights the need for further in-depth training in clinical health professionals in family violence. The research will allow for family violence training to be tailored to the needs of the professional discipline and clinical area.

Mechanisms to achieve a successful rural physiotherapy public-private partnership: a qualitative study

INTRODUCTION

Longstanding gaps in physiotherapy service delivery exist in rural areas across Australia. In response to this, a large public rural health organisation contracted a private physiotherapy business to implement a public-private partnership (PPP) to supply physiotherapy to hospital inpatients, aged care facility residents and outpatients in four outer regional Australian towns. Treatment rooms were provided by the health organisation for the private physiotherapists to see clients. This study explored how stakeholders defined the success of a PPP model of service delivery in a rural setting and examined if the model was successful according to stakeholder definitions. Barriers and enablers (mechanisms) were identified and linked to stakeholder-defined success measures.

METHODS

A qualitative study was conducted using a constructive inquiry design. Participants were purposively recruited, via email invitation and telephone follow-up. Participants comprised managers and clinicians from the rural public health organisation and the private physiotherapy business involved in setting up, working within or alongside the partnership. Semi-structured interviews were undertaken with all participants. Data were transcribed verbatim and analysed using framework analysis. Program logic was used to synthesise all information.

RESULTS

Individual interviews were conducted with five staff from each partnering organisation, including managers and clinicians (total n=10). Two main themes and three subthemes were identified. All participants described the model as being successful. Elements of success included improved access to local services, and satisfied stakeholders. There were three mechanisms identified to successfully implement the service delivery model. The first mechanism was the provision of human and several other resources, which included the workforce model and the use of several resources for the partnership. The second mechanism was stakeholder engagement, which included having motivated stakeholders and consistent stakeholders. The third mechanism was streamlined processes, which included the content of the contract and referral schedule, streamlined administration processes for contracting and accounting, having processes for managing private therapists in a public setting as well as processes for communication.

CONCLUSION

This study demonstrates that an innovative physiotherapy PPP model of service delivery can be a successful way to improve access to physiotherapy services in rural areas. Success of service models varies depending on the viewpoint of the stakeholder and achieving success for all stakeholders is contingent on mechanisms such as those identified in this study. PPPs have potential to address service gaps in hospitals, residential aged care and primary care in rural areas.

Context Matters: Findings from a Qualitative Study Exploring Service and Place Factors Influencing the Recruitment and Retention of Allied Health Professionals in Rural Australian Public Health Services

Chronic health workforce shortages significantly contribute to unmet health care needs in rural and remote communities. Of particular and growing concern are shortages of allied health professionals (AHPs). This study explored the contextual factors impacting the recruitment and retention of AHPs in rural Australia. A qualitative approach using a constructivist-interpretivist methodology was taken. Semi-structured interviews (n = 74) with executive staff, allied health (AH) managers and newly recruited AHPs working in two rural public health services in Victoria, Australia were conducted. Data was coded and categorised inductively and analysed thematically. The findings suggest that to support a stable and sustainable AH workforce, rural public sector health services need to be more efficient, strategic and visionary. This means ensuring that policies and procedures are equitable and accessible, processes are effective, and action is taken to develop local programs, opportunities and supports that allow AH staff to thrive and grow in place at all grade levels and life stages. This study reinforces the need for a whole-of-community approach to effectively support individual AH workers and their family members in adjusting to a new place and developing a sense of belonging in place. The recommendations arising from this study are likely to have utility for other high-income countries, particularly in guiding AH recruitment and retention strategies in rural public sector health services. Recommendations relating to community/place will likely benefit broader rural health workforce initiatives.

Implementation of a Multidisciplinary Allied Health Optimisation Clinic for Cancer Patients with Complex Needs

This study examined the feasibility of implementing a multidisciplinary allied health model of care (MOC) for cancer patients with complex needs. The MOC in this retrospective study provided up to eight weeks of nutritional counselling, exercise prescription, fatigue management and psychological support. Implementation outcomes (acceptability, adoption, fidelity and appropriateness) were evaluated using nine patient interviews, and operational data and medical records of 185 patients referred between August 2017 and December 2018. Adoption, including intention to try and uptake, were acceptable: 88% of referred patients agreed to screening and 71% of eligible patients agreed to clinic participation. Fidelity was mixed, secondary to inpatient admissions and disease progression interrupting patient participation. Clinician compliance with outcome assessment was variable at program commencement (dietetic, 95%; physiotherapy, 91%; occupational therapy, 33%; quality of life, 23%) and low at program completion (dietetic, 32%; physiotherapy, 13%; occupational therapy, 10%; quality of life, 11%) mainly due to non-attendance. Patient interviews revealed high satisfaction and perceived appropriateness. Adoption of the optimisation clinic was acceptable. Interview responses suggest patients feel the clinic is both acceptable and appropriate. This indicates a multidisciplinary model is an important aspect of comprehensive, timely and effective care. However, fidelity was low, secondary to the complexities of the patient cohort.

Interprofessional education: a unique approach to addressing the challenges of student assessment

There is emerging evidence on the value of interprofessional education (IPE) for health professional students; however, there is less focus on assessing students on IPE experiences in clinical placement contexts. Researchers have focused on student attitudes to, or readiness for, IPE. Multiple other elements need to be assessed, including formative student assessment, profession-specific competency standards, and students' interprofessional (IP) capabilities. Effective and authentic IP-assessment models are needed that can both demonstrate student learning, and facilitate successful sharing of assessment amongst professionals. Supervisor's perspectives on successful sharing of assessment amongst professions have not been addressed to date in the literature. This article describes one approach for IP-Assessment, using a complex theory framework and based on an iterative cycle of developing, implementing, and evaluating a student assessment tool within an international IP placement, which could be utilized in a range of settings. A qualitative research approach explores the strengths, challenges, and outcomes of IP-Assessment from the perspective of the supervisors. Three overarching themes were identified: acknowledging the student journey, interprofessional authenticity, and collective and collaborative learning. The process of developing and implementing IP-Assessment enabled the articulation of placement and assessment priorities and provided learning opportunities for both supervisors and students.

Setting priorities for rural allied health in Australia: a scoping review

INTRODUCTION

The allied health workforce is one of the largest workforces in the health industry. It has a critical role in cost-effective, preventative health care, but it is poorly accessible in rural areas worldwide. This review aimed to inform policy and research priorities for increasing access to rural allied health services in Australia by describing the extent, range and nature of evidence about this workforce.

METHODS

A scoping review of published, peer-reviewed rural allied health literature from Australia, Canada, the USA, New Zealand and Japan was obtained from six databases (February 1999 - February 2019).

RESULTS

Of 7305 no-duplicate articles, 120 published studies were included: 19 literature reviews, and 101 empirical studies from Australia (n=90), Canada (n=8), USA (n=2) and New Zealand (n=1). Main themes were workforce and scope (n=9), rural pathways (n=44), recruitment and retention (n=31), and models of service (n=36). Of the empirical studies, 83% per cent were cross-sectional; 64% involved surveys; only 7% were at a national scale. Rural providers were shown to have a breadth of practice, servicing large catchments with high patient loads, requiring rural-specific skills. Most rural practitioners had rural backgrounds, but rural youth faced barriers to accessing allied health courses. Rural training opportunities have increased in Australia but predominantly as short-term placements. Rural placements were associated with increased likelihood of rural work by graduates compared with discipline averages, and high quality placement experiences were linked with return. Recruitment and retention factors may vary by discipline, sector and life stage but important factors were satisfying jobs, workplace supervision, higher employment grade, sustainable workload, professional development and rural career options. Patient-centred planning and regional coordination of public and private providers with clear eligibility and referral to pathways facilitated patient care. Outreach and telehealth models may improve service distribution although require strong local coordination and training for distal staff.

CONCLUSION

Evidence suggests that more accessible rural allied health services in Australia should address three key policy areas. First, improving rural jobs with access to senior workplace supervision and career options will help to improve networks of critical mass. Second, training skilled and qualified workers through more continuous, high quality rural pathways is needed to deliver a complementary workforce for the community. Third, distribution depends on networked service models at the regional level, with viable remuneration, outreach and telehealth for practice in smaller communities. More national-scale, longitudinal, outcomes-focused studies are needed using controlled designs.

Graduate level health professions education: how do previous work experiences influence perspectives about interprofessional collaboration?

Understanding how previous experiences with interprofessional education and collaboration inform health care provider perspectives is important for developing interprofessional interventions at the graduate level. The purpose of this study was to examine how previous work experiences of graduate level health professions students inform perspectives about interprofessional education and collaboration. Drawing from program evaluation data of two separate graduate level interprofessional education interventions based in primary care and home health care, we conducted a qualitative secondary data analysis of 75 interviews generated by focus groups and individual interviews with graduate students from 4 health professions cadres. Using directed content analysis, the team coded to capture descriptions of interprofessional education or collaboration generated from participants' previous work experiences. Coding revealed 173 discrete descriptions related to previous experiences of interprofessional education or collaboration. Three themes were identified from the analysis that informed participant perspectives: Previous educational experiences (including work-based training); previous work experiences; and organizational factors and interprofessional collaboration. Experiences varied little between professions except when aspects of professional training created unique circumstances. The study reveals important differences between graduate and undergraduate learners in health professions programs that can inform interprofessional education and collaboration intervention design.

What students and new graduates perceive supports them to think, feel and act as a health professional in a rural setting

OBJECTIVE

Clinical placements in rural locations are perceived by students to provide positive learning experiences to support their transition to practice. This study explores how clinical placements in a rural health setting might influence students and new graduates to think, feel and act as a health professional.

DESIGN

A qualitative study comprising focus group discussions was conducted.

SETTING

The study was conducted in a rural health service in Queensland, Australia.

PARTICIPANTS

Allied health students (n = 12) on placement and new graduates (n = 11) working in a regional health service.

MAIN OUTCOME MEASURES

This study identified allied health student and new graduate perspectives on clinical placement factors which support them to think, feel and act as a health professional.

RESULTS

Thematic analysis was used to understand student and new graduate perceptions of how rural placements support thinking, feeling and acting as a health professional. Suggestions for supporting learning included the following: Development of learning partnerships between students and clinical educators with inbuilt expectations and opportunities for reflection and supervision. Creating a culture where students are welcomed, valued and encouraged to take meal breaks with the team supported connectedness. The importance of balancing student autonomy with educating and grading support to increase independence.

CONCLUSIONS

Findings show clinical placement experiences identified by allied health students and new graduates which support them to begin to think, feel and act as a health professional. Suggestions provided by students and new graduates can be used to inform implementation of clinical placement experiences.

Development and evaluation of a health literacy training program for allied health professionals: A pre-post study assessing impact and implementation outcomes

ISSUE ADDRESSED

We developed and evaluated a health literacy training program for allied health professionals, and explored the feasibility of a train-the-trainer model to support dissemination.

METHODS

The program combined didactic and experiential teaching methods and behaviour change techniques, with a focus on teach-back and developing easy-to-understand written materials. Outcomes included participant reactions, confidence (range: 6-30), behavioural intentions (range: 6-42), and dissemination of training content. Implementation outcomes were evaluated using the Normalization MeAsure Development (NoMAD) tool, assessing the constructs of coherence (range: 4-20), cognitive participation (range: 4-20), collective action (range: 7-35) and reflexive monitoring (range: 5-25).

RESULTS

Of the 29 allied health professionals who participated, 90% rated the program as 'excellent'/'very good', and 97% said the information was 'extremely'/'very' helpful for their everyday practice. We observed increases in confidence (mean difference [MD] = 6.3, standard deviation [SD] = 2.7, t₂₅  = 11.87, P < .001) and intentions (MD = 3.6, SD = 8.1, t₂₃  = 2.2, P = .04) related to health literacy practices after 6 weeks. Improved confidence was retained over 6 months (MD = 7.1, SD = 5.2, t₁₈  = 5.96, P < .001). After 6 months, 95% of participants (n = 19) reported using teach-back and 50% (n = 10) reported having used a readability formula. Eight-five per cent of participants (17/20) had trained others in health literacy, reaching n = 201 allied health professionals and students. NoMAD scores were highest in relation to cognitive participation (/20) (M = 18.2, SD = 2.1) and lowest in relation to collective action (/35) (M = 25.4, SD = 3.0).

CONCLUSIONS

A train-the-trainer model appears to be a feasible method to disseminate health literacy training, but additional work may be needed to improve the collective work done to enable health literacy practices in real-world clinical contexts.

SO WHAT

Staff training is particularly important in highly diverse areas where patients are disproportionately affected by low health literacy.

Feasibility of a Randomized Controlled Trial of Paediatric Interdisciplinary Pain Management Using Home-Based Telehealth

Purpose

Chronic pain is common in adolescents. Evidence-based guidelines recommend interdisciplinary treatment, but access is limited by geography. The development of hybrid programs utilizing both face-to-face and videoconference treatment may help overcome this. We developed a 7-week hybrid pediatric interdisciplinary pain program (Hybrid-PIPP) and wished to compare it to individual face-to-face sessions (Standard Care). Our objective was to test the feasibility of a protocol that used a matched pair un-blinded randomized controlled design to investigate the efficacy and cost-effectiveness of the Hybrid-PIPP compared to Standard Care.

Patients and Methods

Parent-adolescent dyads were recruited from tertiary pediatric clinics and matched by disability before randomization to minimize allocation bias. The adolescents (aged 11-17) had experienced primary pain for >3 months. Hybrid-PIPP involved 11 hrs of group therapy and 4 individual videoconference sessions. Standard care was provided by the same clinical team, using the same treatment model and similar intensity as the Hybrid-PIPP. The intention was to recruit participants for 3 Hybrid-PIPP groups with a comparison stream. Recruitment was ceased after 2 groups due to the high participant disability requiring more intensive intervention.

Results

Eighteen dyads were screened and 13 randomized (7 Hybrid-PIPP, 6 Standard Care, 2 unsuitable, 3 unallocated when the study was stopped). The study met a priori feasibility criteria for staff availability; recruitment rate; treatment completion; and data collection. Global satisfaction ratings were similar in both streams (SC median 7, range 5-9 and Hybrid-PIPP median 8.5, range 5-10). Challenges were identified in both streams. A future modified Hybrid-PIPP was considered acceptable if the intensity is increased to manage the high level of disability. Standard care was considered inefficient. No adverse events were reported.

Conclusion

The study determined that the protocol met a priori feasibility criteria, but to be practicable in a real world, health environment requires significant modifications.

Registration

ANZTR(ACTRN2614000489695).

The Whole-of-Person Retention Improvement Framework: A Guide for Addressing Health Workforce Challenges in the Rural Context

People living in rural places face unique challenges due to their geographic isolation and often experience poorer health outcomes compared to people living in major cities. The struggle to attract and retain an adequately-sized and skilled health workforce is a major contributing factor to these health inequities. Health professionals' decisions to stay or leave a rural position are multifaceted involving personal, organisational, social and spatial aspects. While current rural health workforce frameworks/models recognise the multidimensional and interrelated influences on retention, they are often highly complex and do not easily support the development of strategic actions. An accessible evidence-informed framework that addresses the complexity but presents the evidence in a manner that is straightforward and supports the development of targeted evidence- and place-informed retention strategies is required. The 'Whole-of-Person Retention Improvement Framework' (WoP-RIF) has three domains: Workplace/Organisational, Role/Career and Community/Place. The necessary pre-conditions for improving retention through strengthening job and personal satisfaction levels are set out under each domain. The WoP-RIF offers a person-centred, holistic structure that encourages whole-of-community responses that address individual and workforce level needs. It is a significant response to, and resource for, addressing avoidable rural health workforce turnover that rural health services and communities can harness in-place.

The health care utilization and out-of-pocket expenditure associated with asthma amongst a sample of Australian women aged over 45 years: analysis from the '45 and up' study

OBJECTIVE

This study aims to describe the prevalence of health care utilization (including conventional medicine, self-care and complementary medicine treatments) for the management of asthma by women aged 45 years and over and their associated out-of-pocket expenditure.

METHODS

A self-reported mail survey of 375 Australian women, a cohort of the national 45 and Up Study, reporting a clinical diagnosis of asthma. The women were asked about their use of health care resources including conventional medicine, complementary medicine, and self-prescribed treatments for asthma and their associated out-of-pocket spending. Spearman's correlation coefficient, student's t-test and chi-square test were used as appropriate. Population level costs were created by extrapolating the costs reported by participants by available national prevalence data.

RESULTS

Survey respondents (N = 375; response rate, 46.9%) were, on average, 67.0 years old (min 53, max 91). The majority (69.1%; n = 259) consulted at least one health care practitioner in the previous 12 months for their asthma. Most of the participants (n = 247; 65.9%) reported using at least one prescription medication for asthma in the previous 12 months. The total out-of-pocket expenditure on asthma treatment for Australian women aged 50 years and over is estimated to be AU$159 million per annum.

CONCLUSIONS

The breadth of conventional and complementary medicine health care services reported in this study, as well as the range of treatments that patients self-prescribe, highlights the challenges of coordinating care for individuals living with asthma.

Impact of transition to an individualised funding model on allied health support of participation opportunities

Introduction: The National Disability Insurance Scheme is the new consumer-controlled funding system for people with disability in Australia, and is expected to enhance participation outcomes of people with disability. This research explored participation opportunities for people with disability during the formative period of transition to the scheme, through stakeholder accounts of changes in allied health service contexts.Materials and methods: Qualitative data were generated during interviews, workshops and meetings with industry, policy, practice and education stakeholders involved in scheme services. Inductive coding explored key themes within the data. The International Classification of Functioning model was then applied as a deductive coding framework to illuminate how the scheme was perceived to be impacting participation opportunities for recipients of scheme funding.Results and discussion: Using the International Classification of Functioning helped us illuminate whether changes resulting from scheme transition posed participation opportunities or barriers for scheme recipients. Research participants often framed these changes negatively, even when examples suggested that changes had removed participation barriers for scheme recipients. Some participants viewed changes as obstructing equitable and quality professional practice. We explore potential opportunities to resolve tensions that also optimise the participation outcomes of individuals who receive services through individualised funding.IMPLICATIONS FOR REHABILITATIONThe introduction of individualised funding has removed barriers to participation for many National Disability Insurance Scheme recipients.Efforts must be made to build the trust of stakeholders involved in National Disability Insurance Scheme service provision regarding how fee-for-service funding can lead to good participation outcomes for scheme recipients.Transparency around the shared processes of clinical governance and equitable service access operating in Australia's individualized disability funding scheme are suggested to build trust.A visible commitment to maintaining a broad range of services is also indicated to build trust for stakeholders involved in the scheme.

Assessment of Health Research Capacity in Western Sydney Local Health District (WSLHD): A Study on Medical, Nursing and Allied Health Professionals

Background

Research should inform clinical decision-making and evidence-based practice for all health professionals. To build research capacity among all health professionals, there is a need to measure the levels of research capacity and identify the gaps and needs of health-care professionals. The aim of the study was to better understand the research culture and capacity of health professionals (medical, nursing and allied health) in Western Sydney Local Health District, Sydney, Australia.

Methods

A research capacity and culture tool (RCCT) survey was electronically distributed to all health staff in WSLHD. Data were collected between November 2016 and January 2017. Participants were surveyed through a 10-point Likert scale that measured research capacity at the individual, team and organisational levels.

Results

A total of 393 health staff responded to the study: allied health practitioners (46.3%), nursing staff (35.4%) and medical practitioners (18.3%). Females made 76% of the sample, and 54% were aged between 35 and 54 years. Individual responses were different across professions, with an average median score for medical 6.3 (95% CI 5.8-6.9), allied health 5.3 (95% CI 4.9-5.7) and nursing 4.5 (95% CI 4.1-5.0) after adjustment for age and gender. Team responses for medical staff (average median score 5.9 95% CI 5.3-6.4) were higher than allied health (4.1 95% CI 3.7-4.6) and nursing (4.3 95% CI 3.8-4.8), after adjusting for age and gender. However, there were no differences between the three professions for the organisational responses. Allied health and nursing staff were less confident in obtaining research funding, submitting ethics applications, writing for publication and mentoring colleagues about research.

Conclusion

This study demonstrates the individual research capacity for medical, allied health and nursing professionals are different. Research capacity building needs to be individually tailored to the specific needs of each profession. This research will inform future capacity building activities and training for health professionals in a large public health organisation of Sydney, Australia.

Factors associated with rural work for nursing and allied health graduates 15-17 years after an undergraduate rural placement through the University Department of Rural Health program

INTRODUCTION

Very little is known about the long term workforce outcomes, or factors relating to these outcomes, for nursing and allied health rural placement programs. The positive evidence that does exist is based on short term (1-3 year) evaluations, which suggest that undergraduate rural placements are associated with substantial immediate rural practice of 25-30% graduates practising rurally. These positive data suggest the value of examining long term practice outcomes, since such data are necessary to providing an evidence base for future workforce strategies. The objective was to measure long term (15-17 year) rural practice outcomes for nursing and allied health graduates who had completed an undergraduate rural placement of 2-18 weeks through a university department of rural health (UDRH).

METHODS

This was a longitudinal cohort study, with measures taken at the end of the placement, at one year and at 15-17 years post-graduation. Participants were all nursing and allied health students who had taken part in a UDRH rural placement, who consented to be followed up, and whose practice location was able to be identified. The main outcome measure was factors associated with location of practice as being either urban (RA 1) or rural (RA 2-5).

RESULTS

Of 776 graduates initially surveyed, 474 (61%) were able to be contacted in the year after their graduation, and 244 (31%) were identified through the Australian Health Practitioner Regulation Agency, 15-17 years later. In univariate analysis at the first graduate year, previously lived rural, weeks in placement, discipline and considering future rural practice all had significant relationships with initial rural practice. In multivariate analysis, only rural background retained significance (odds ratio (OR) 3.19, confidence interval (CI) 1.71-5.60). In univariate analysis 15-17 years later, previously lived rural and first job being rural were significantly related to current rural practice. In multivariate analysis, only first job being rural retained significance (OR 11.57, CI 2.77-48.97).

CONCLUSION

The most significant long term practice factor identified in this study was initial rural practice. This suggests that funding to facilitate a rural pathway to not just train but also support careers in rural nursing and allied health rural training, similar to that already established for pharmacy and medicine, is likely to have beneficial long term workforce outcomes. This result adds to the evidence base of strategies that could be implemented for the successful development of a long term rural health workforce.

First year allied health student transition to a regional university

OBJECTIVE

Students from regional and remote backgrounds are more likely to stay and work in regional and remote locations. Health students transition and retention at university impacts the retainment of a competent rural health workforce. This study aimed to examine the perceptions of allied health students as they reflected upon their first six weeks at university and identified strategies which enhanced these experiences.

DESIGN

A cross-sectional study. Surveys were administered to students who then completed a reflection exercise. Data were analysed using Pearson correlation coefficient and chi-squares.

SETTING

An Australian regional university.

PARTICIPANTS

First year occupational therapy, physiotherapy and speech pathology students.

MAIN OUTCOME MEASURES

Factors influencing the first 6 weeks at university.

RESULTS

One hundred and forty-three students participated. Homesickness was the major challenge in transitioning to university life. Subthemes identified were adjusting to being away from home, adjusting to university culture and the mature-aged student. Specific issues included a lack of familiarity with university campuses and services, being unprepared for the workload and confusion while learning new skills.

CONCLUSION

Orientation week activities assist students transition into university and age-appropriate and family-friendly activities should be considered for mature-age students. All students were found to benefit from support to address economic pressures and skill development focusing on coping with university workload. The development of regional university policy including these strategies is likely to enhance student success.

Scoping the Scene: What Do Nurses, Midwives, and Allied Health Professionals Need and Want to Know About Genomics?

Introduction: Rapid changes in genomic technology are transforming healthcare delivery. Although it has been well established that many health professionals lack the adequate knowledge, skills, and confidence to adapt to these changes, the specific educational needs of Australian allied health professionals, nurses, and midwives are not well understood. This diverse group of health professionals is primarily involved in the management of symptoms and psychosocial care of patients with genetic conditions, rather than risk assessment and diagnosis. The relevance of genetics and genomics to their clinical practice may therefore differ from medical practitioners and specialists.

Materials and Methods: This paper reports on a study undertaken to identify the perceived genetic knowledge and education needs for this group of health professionals. Allied health professionals, nurses, and midwives were recruited from throughout New South Wales (NSW) and invited to participate in semi-structured telephone or face to face interviews.

Results: A total of 24 geographically and professionally diverse individuals (14 allied health, 6 nurses, and 4 midwives) were interviewed. Interview recordings were transcribed and using thematic qualitative analysis recurring themes were identified. The results show that this is a diverse group that is keen to know more about genomics and genetic services but unsure of reliable sources.

Discussion: The need for a generic update from a trustworthy source was identified and suggested topics to be covered included genetic fundamentals, recognizing common genetic conditions, and psychosocial/ethical aspects of genetics/testing including informed consent. In addition, the challenge of incorporating education into highly clinical roles was identified as a key barrier and having a readily accessible, accredited learning resource would help overcome this. Findings from this study are informing the development of a targeted, interactive e-learning resource for allied health professionals, nurses, and midwives.

Temporal trends in exercise physiology services in Australia-Implications for rural and remote service provision

OBJECTIVE

To assess temporal trends in service provision by Accredited Exercise Physiologists based on remoteness classification using Australian Bureau of Statistics remoteness classifications of Major Cities, Inner Regional, Outer Regional, Remote and Very Remote.

DESIGN AND PARTICIPANTS

Cross-sectional analysis of publicly available Medicare Benefits Schedule datasets, for Medicare item number 10953 from 2012-2013 to 2016-2017.

MAIN OUTCOME MEASURE(S)

Number of claims, benefits paid, fees charges and number of providers for Medicare item number 10953.

RESULTS

Accredited Exercise Physiologist service delivery demonstrates growth across all areas of remoteness classification. Rebates and fees mirror service delivery trends. The rate of service growth was significantly greater in Major Cities compared with all other remoteness classifications. Provider numbers show a steady increase from 2012-2013 to 2016-2017 but number remains higher in Major Cities compared with all other remoteness locations.

CONCLUSION

Given the high proportion of chronic and complex illness in rural and remote areas, and the limited access to allied health care services, we propose more needs to be done to position Accredited Exercise Physiologists in these regions of increasing need. These findings have implications for future development of the Accredited Exercise Physiologist profession.

The Changing Nature of Palliative Care: Implications for Allied Health Professionals' Educational and Training Needs

CareSearch is an Australian Government Department of Health funded repository of evidence-based palliative care information and resources. The CareSearch Allied Health Hub was developed in 2013 to support all allied health professionals working with palliative care clients in all clinical settings. This cross-sectional online survey sought to elicit allied health professionals palliative care experiences and subsequent considerations for educational and clinical practice needs. The survey was disseminated nationally via a range of organisations. Data was collected about palliative care knowledge, experience working with palliative care clients and professional development needs. Data were evaluated by profession, experience and practice setting. In total, 217 respondents answered one or more survey questions (94%). Respondents (65%) reported seeing >15 palliative care clients per month with 84% seen in hospital and community settings. Undergraduate education underprepared or partially prepared allied health professionals to work with these clients (96%) and 67% identified the need for further education. Access to postgraduate professional development was limited by available backfill and funding. Study findings support the importance of free, accessible, relevant educational and professional development resources to support clinical practice. This is particularly relevant for allied health professionals who have limited opportunities to attend formal professional development sessions.

Powerless facing the wave of change: the lived experience of providing services in rural areas under the National Disability Insurance Scheme

INTRODUCTION

Australia's National Disability Insurance Scheme (NDIS) is the catalyst for a significant shift in the delivery of disability services to people with a disability and their families, including those residing in rural and remote parts of Australia. Allied health services in rural areas of Australia are often limited, existing services are characterised as being of a generalist nature and demand for services often exceeds service capacity. This shift in the delivery of disability services with the rollout of NDIS could have a poignant impact on the rurally based allied health providers delivering these services. The aim of this study was to explore in depth the experiences of providing clinical services under the NDIS in a rural area.

METHODS

Accessing the publicly available NDIS register, the authors purposively sampled service providers delivering services in rural or remote areas of the state of New South Wales (NSW). Participants consented by email to participate in a semi-structured interview during which they were asked about their lived experience providing services under the NDIS in rural NSW. Data collection and analysis were guided by phenomenology of practice. Interviews were audio-recorded and transcribed verbatim, and data were then thematically analysed.

RESULTS

Eight service providers were interviewed, representing the disciplines of occupational therapy, nutrition and dietetics, speech pathology and physiotherapy. The locations of their service delivery varied across a range of rural and remote areas of NSW. Data analysis yielded three themes: (1) 'Beyond my depth', which described service providers' limited influence on the funding process their clients were now required to navigate as participants of the NDIS; (2) 'A sea of uncertainty', which described the inconsistencies demonstrated by the NDIS and its impact on service providers; and (3) 'Drowning in the wave', which described increases in service demand and changes to case mix as experienced by service providers. Additionally, the essence of providing services within the NDIS in a rural area was identified as 'Powerless facing the wave of change'.

CONCLUSION

These findings offer insights into the particular challenges for rural clinicians in providing services under the NDIS. While there is improved funding support for people with a disability, this places additional pressure on rural clinicians who are already likely to be working at or beyond their workload capacity. Issues with recruitment and retention of new clinicians into rural and remote areas appear to be ongoing, which was identified as compounding the impact of the NDIS on existing service providers. Supporting the rural and remote workforce appears critical to avoid de-registration of existing NDIS service providers.

PodCast: A rural and regional service model for podiatrist-led total contact casting

PROBLEM

Diabetes-related foot disease causes significant health system costs and is a leading cause of morbidity and disproportionately affects rural populations. Total contact casts or instant total contact casts are gold standard for management of foot ulcerations resulting from diabetes-related foot disease. The aim of this study was to evaluate the impact of a podiatrist-led casting service model within a rural and regional setting.

DESIGN

The implementation of the service model was evaluated over a 12-month period using a quality improvement approach, informed by multiple methods. Quantitative and qualitative methods were used.

SETTING

An outpatient high-risk foot clinic and community-based podiatry services within a large regional health service. The location was central Victoria, servicing rural communities within the Loddon Mallee region.

KEY MEASURES FOR IMPROVEMENT

Patient-related data included information relating to demographics, diabetes and foot pathologies. Service-related data included occasions of service, locations and the number and type of casts applied.

STRATEGIES FOR CHANGE

Upskilling podiatrists to provide the service in a safe, supportive and sustainable manner and ensuring the podiatrist-led casting service model was sufficiently adaptable for patients to access at the rural sites.

EFFECTS OF CHANGE

Increased access to total contact casts and instant total contact casts, comparable wound healing times to other studies and the model was able to be sustained.

LESSONS LEARNT

Podiatrist-led casting resulted in increased utilisation of total contact casts and instant total contact casts. The increased use of instant total contact casts in particular may help address the lack of uptake of this treatment for people with diabetes-related foot disease, thereby improving rural health outcomes.

Delivering allied health services to regional and remote participants on the autism spectrum via video-conferencing technology: lessons learned

Context and issues: The introduction of individualised funding under the National Disability Insurance Scheme in Australia aimed to increase individual choice and control over how people received disability supports. An increase in the allied health disability workforce was anticipated; however, disability workforce sector reports have consistently indicated difficulties in attracting and retaining sufficient allied health staff to satisfy current and future demand. Autism spectrum disorder is the most prevalent primary diagnosis of participants receiving individualised funding to date and requires support staff to have specialised skills and experience. Given that overall staff attraction and retention issues are reported to be exacerbated in regional and remote areas of Australia, it is important to seek innovative ways of supporting individuals on the autism spectrum in their local communities. Technology has the potential to provide a timely and low-cost alternative that extends access to specialist services for people in remote locations. The current project aimed to identify the feasibility, essential requirements and potential barriers in delivering therapy support to regional and remote participants on the autism spectrum via video-conferencing technology. Lessons learned: A multidisciplinary team (speech pathologist, occupational therapist, psychologist and a special educator) were recruited and trained to deliver tele-therapy services to 16 participants on the autism spectrum, in collaboration with their families and local support teams. Participants resided in two northern, nine western and one southern regional area in New South Wales (NSW), Australia. There were three sets of siblings. One participant resided on remote Lord Howe Island off the coast of northern NSW. Researchers used semi-structured telephone interviews to gain insight into the program from key stakeholder groups including parents, education staff, allied health professionals and tele-therapists. A general inductive approach to data analysis was used under five project evaluation areas. The evaluation focused on five areas including: development of the tele-health delivery team, understanding the role of collaboration, examining the need for autism-specific support, establishing the need for in-person contact and identifying barriers to success. The project evaluation found that investment in staff training and support was key to building a competent tele-therapy team and delivering successful tele-therapy services under a sustainable model. For many families and support team members, collaboration was reported as an important part of the tele-therapy program, with families and teachers finding it helpful to work together with the same information. The evaluation confirmed that access to autism-specific knowledge and support was novel and regarded as beneficial for families and support teams living in regional and remote areas. There were mixed responses to the inclusion of in-person support as part of a tele-therapy service. While some families felt a tele-therapy service was no different to in-person services, other families and tele-therapists indicated that the addition of at least one in-person session would help to increase rapport. Barriers within the tele-therapy model included scheduling and local staff changes, as well as the delivery of intervention requiring physical support. Technology was not seen as a barrier in the current study. This research adds to the growing body of information supporting the use of tele-practice for geographically isolated regions. Ideally, tele-therapy should not replace in-person services; however, it is necessary when no other comparable service option is available locally. Larger scale research is needed to compare blended, online and in-person models so that an optimal ratio can be established.

Learning from those who have gone before: strengthening the rural allied health workforce in Aotearoa New Zealand

Context and issues: The pipeline for the allied health, scientific and technical workforce of Aotearoa New Zealand is under growing pressure, with many health providers finding recruitment and retention increasingly difficult. For health providers in rural settings, the challenges are even greater, with fewer applicants and shorter tenures. As the health needs of rural communities increase, along with expectations of uptake of technologies and the Ministry of Health's strategy to ensure care is provided closer to home, being able to retain and upskill the diminishing workforce requires new ways of thinking. Lessons learned: Understanding the activity that has been undertaken by medical and nursing workforces in New Zealand and abroad, as well as the work of the Australian allied health workforce provides context and opportunities for New Zealand. The challenge is for educators, professional bodies, the Ministry of Health and health providers to develop new ways of thinking about developing a rural workforce for the allied health scientific and technical professions.

Surveying Allied Health Professionals Within a Public Health Service: What Works Best, Paper or Online?

Poor response rate, self-selection bias, and item noncompletion negatively impact the generalization of results from surveys. This study examined differences in these factors between a paper and online survey among allied health clinicians. Clinicians within a large local health district were initially invited to complete the Research Capacity in Context Tool online via an e-mail link. Following a lower-than-expected response rate, potential selection bias, and item noncompletion, the survey was readministered in paper form to the same cohort of clinicians 6-12 months later. The response rate to the paper survey was higher than to the online survey (27.6% vs. 16.5%). Selection biases were evident, characterized by seniority and discipline: Junior clinicians responded at rates significantly less than expected to the online survey but as expected to the paper survey. Occupational therapists, speech pathologists, and podiatrists responded more highly to the online survey, while other disciplines responded more highly to the paper survey. The rate of item noncompletion was higher for online than paper survey (6.72% vs. 3.8% questions not completed, respectively), with patterns of noncompletion also differing. These data suggest paper surveys are likely to produce less biased and more generalizable data from allied health clinicians.

Implementing an allied health team intervention to improve the care of older adults in the emergency department: protocol for a process evaluation

INTRODUCTION

Health and social care professionals (HSCPs) have increasingly contributed to enhance the care of patients in emergency departments (EDs), particularly for older adults who are frequent ED attendees with significant adverse outcomes. For the first time, the effectiveness of a HSCP team intervention for older adults in the ED has been tested in a large randomised controlled trial (Clinicaltrials.gov, NCT03739515), providing an opportunity to explore the implementation process for this type of intervention. This protocol describes a process evaluation that will to investigate the implementation, delivery and impact of an HSCP team intervention in the ED.

METHODS AND ANALYSIS

Using the Medical Research Council Framework for process evaluations, we will employ a mixed-methods approach to provide a description of the process of implementation and delivery of the HSCP intervention in the ED, evaluate its fidelity, dose and reach and explore the perceptions of key staff members in relations to the mechanisms and contexts of impact at the levels of individuals, physical environment, operations, communication and the broader hospital and healthcare system.

ETHICS AND DISSEMINATION

Ethical approval for this study was received from the HSE Mid-Western Regional Hospital Research Ethics Committee (Ref: 103/18). All participants will be invited to read and sign a written consent form prior to participation. The results of this review will be disseminated through publication in a peer-review journal and presented at relevant conferences.