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Raymer M, Swete Kelly P, O'Leary S. Developing and embedding an advanced practice musculoskeletal physiotherapy service in public specialist outpatient services in Queensland: A health service masterclass. Musculoskelet Sci Pract 2024; 70:102917. [PMID: 38309180 DOI: 10.1016/j.msksp.2024.102917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/20/2024] [Indexed: 02/05/2024]
Abstract
INTRODUCTION The Musculoskeletal Physiotherapy Screening Clinic and Multi-disciplinary Service (MPSC&MDS) is an advanced practice physiotherapist-led model of care developed initially to address overburdened specialist orthopaedic outpatient public hospital services across Queensland, Australia. PURPOSE This Masterclass explores the experiences and success of embedding the MPSC&MDS state-wide across the Queensland public health system and its expansion in scale and reach to other specialist services. Key characteristics and development strategies are described that have collectively underpinned the expansion and sustainability of the service, using relevant stream sections and themes from a recommended musculoskeletal model of care framework. IMPLICATIONS The aim of this masterclass is to be informative for readers involved in the future development or refinement of similar models of care.
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Affiliation(s)
- Maree Raymer
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia.
| | - Patrick Swete Kelly
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia.
| | - Shaun O'Leary
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia; University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD 4072, Australia.
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Brandenburg C, Ward EC, Schwarz M, Palmer M, Hartley C, Byrnes J, Coccetti A, Phillips R, Wishart LR. 'The big value of it is getting the patient seen by the right person at the right time': clinician perceptions of the value of allied health primary contact models of care. Int J Qual Health Care 2024; 36:mzae021. [PMID: 38442741 DOI: 10.1093/intqhc/mzae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/18/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
Allied health primary contact clinic models of care have increasingly been used as a strategy to increase public health service capacity. A recent systematic review found little consistency or agreement on how primary contact clinics are evaluated. The concept of value of primary contact clinics, which has important implications for evaluation, has not yet been explored in-depth. To explore allied health clinicians' perceptions of the value of allied health primary contact clinics, with the goal of informing an evaluation framework, a descriptive qualitative approach utilizing semi-structured interviews was employed. Participants included allied health staff embedded in clinical lead roles within primary contact clinics across four acute care hospitals in a metropolitan health service located in South-East Queensland, Australia. Lead staff from 30 identified primary contact clinic models in the health service were approached to take part via email. All eligible participants who provided consent were included. An inductive thematic analysis approach was used. A total of 23 clinicians (n = 23) representing 22 diverse models of primary contact clinics participated. Most participants were physiotherapists, dietitians, or occupational therapists, although speech pathology, audiology, and podiatry were also represented. Participant perceptions of the 'value' of PCCs were a highly complex phenomenon, comprising five intersecting domains: (i) patient satisfaction; (ii) clinical outcomes; (iii) care pathway and resource use; (iv) health service performance; and (v) staff satisfaction and professional standing. These five core value domains were positively or negatively influenced by 12 perceived benefits and 8 perceived drawbacks, respectively. Value domains were also highly interrelated and impacted upon each other. The concept of 'value' relating to primary contact clinics involves multiple intersecting domains encompassing different perspectives. This study highlighted potential benefits and drawbacks of primary contact clinics that have not yet been measured or explored in the literature, and as such may be useful for healthcare administrators to consider. The findings of this study will inform an evaluation framework including health economics calculator for primary contact clinics.
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Affiliation(s)
- Caitlin Brandenburg
- Centre for Functioning and Health Research, Metro South Health, 199 Ipswich Road, Brisbane, Queensland 4102, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Health, 199 Ipswich Road, Brisbane, Queensland 4102, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Fred Schonell Drive, Brisbane, Queensland 4072 Australia
| | - Maria Schwarz
- Allied Health, Metro South Health, Cnr Armstrong and Loganlea Roads Brisbane, Queensland 4131 Australia
| | - Michelle Palmer
- Nutrition and Dietetics, Logan Hospital, Metro South Health, Cnr Armstrong and Loganlea Roads, Brisbane, Queensland 4131, Australia
| | - Carina Hartley
- Occupational Therapy, Logan Hospital, Metro South Health, Cnr Armstrong and Loganlea Roads, Brisbane, Queensland 4131, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, 1 Parklands Dr, Gold Coast, Queensland 4215, Australia
| | - Anne Coccetti
- Metro South Health, QEII Jubilee Hospital, Cnr Kessels and Troughton Roads, Brisbane, Queensland 4108, Australia
| | - Rachel Phillips
- Metro South Health, Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Queensland 4102, Australia
| | - Laurelie R Wishart
- Centre for Functioning and Health Research, Metro South Health, 199 Ipswich Road, Brisbane, Queensland 4102, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Fred Schonell Drive, Brisbane, Queensland 4072 Australia
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Lewis KJ, Coppieters MW, Vicenzino B, Hughes I, Ross L, Schmid AB. Occupational Therapists, Physiotherapists and Orthopaedic Surgeons Agree on the Decision for Carpal Tunnel Surgery. Int J Health Policy Manag 2022; 11:1001-1008. [PMID: 33590739 PMCID: PMC9808184 DOI: 10.34172/ijhpm.2020.227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/23/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Therapist-led pathways have been proposed as waitlist management strategies prior to surgery for conditions such as carpal tunnel syndrome (CTS) in public hospitals. These models of care typically shift the initial care of patients and decision-making from surgeons to therapists and, have been shown to reduce the number of patients requiring surgery and improve wait-times. This occurs despite limited evidence of surgeon-therapist agreement on key decisions, such as the need for surgery. The purpose of this was study was to assess the agreement between therapists and orthopaedic surgeons regarding the need for surgery for patients who have CTS. METHODS This blinded inter-rated agreement study was embedded in a multicentre randomised parallel groups trial of 105 patients with CTS referred to four orthopaedic departments and waitlisted for an appointment. The trial evaluated the effect of a therapist-led care pathway on the need for surgery and outcomes related to symptoms and function. Patients were randomised to either remain on the orthopaedic waitlist or receive group education, a splint and home exercises. The decision on the need for surgery at 6 months was made by a member of the orthopaedic consultant team or by one of the 14 participating therapists. The therapists and surgeons were blinded to each other's decision. Agreement was determined using percentage agreement, kappa coefficients (k), prevalence-adjusted and bias-adjusted kappa (PABAK), and Gwet's first-order agreement coefficient (AC1). RESULTS Substantial agreement was seen between therapists and surgeons regarding the need for surgery (PABAK=0.74 (0.60-0.88)). Agreement was significantly associated with experience (P=.02). Therapists with advanced experience and scope of practice demonstrated perfect agreement with surgeons (PABAK=1.00 (95% CI: 1.00-1.00)). Mid-career therapists demonstrated substantial agreement (PABAK=0.67 (95% CI: 0.42-0.91)) and early-career therapists demonstrated fair agreement (PABAK=0.43 (95% CI: -0.04-0.90)). CONCLUSION Therapists with advanced scope of practice make decisions that are consistent with orthopaedic surgeons.
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Affiliation(s)
- Karina J. Lewis
- Occupational Therapy Department, Gold Coast University Hospital, Southport, QLD, Australia
| | - Michel W. Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, QLD, Australia
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Brisbane, QLD, Australia
| | - Ian Hughes
- Office of Research Governance and Development, Gold Coast University Hospital, Southport, QLD, Australia
| | - Leo Ross
- Division of Allied Health, Queen Elizabeth II Jubilee Hospital, Brisbane, QLD, Australia
| | - Annina B. Schmid
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Hall AE, Brandenburg C, Ward EC, Pokorny MA, Trafford K, Seabrook M, Whitfield BCS. Evaluation of health service outcomes for an audiology first point of contact retrocochlear clinic: a 6-year retrospective cohort study. Int J Audiol 2022:1-9. [DOI: 10.1080/14992027.2022.2073477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Amber E. Hall
- Speech Pathology and Audiology Department, Logan Hospital, Meadowbrook, Australia
| | - Caitlin Brandenburg
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
| | - Elizabeth C. Ward
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Michelle A. Pokorny
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Katye Trafford
- Speech Pathology and Audiology Department, Logan Hospital, Meadowbrook, Australia
| | - Marnie Seabrook
- Speech Pathology and Audiology Department, Logan Hospital, Meadowbrook, Australia
| | - Bernard C. S. Whitfield
- Integrated Specialist ENT Service, Department of Otolaryngology Head and Neck Surgery, Logan Hospital, Meadowbrook, Australia
- School of Medicine, Griffith University, Southport, Australia
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Mutsekwa RN, Wright C, Byrnes JM, Canavan R, Angus RL, Spencer A, Campbell KL. Measuring performance of professional role substitution models of care against traditional medical care in healthcare-A systematic review. J Eval Clin Pract 2022; 28:208-217. [PMID: 34405492 DOI: 10.1111/jep.13613] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/26/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify outcome measures used to evaluate performance of healthcare professional role substitution against usual medical doctor or specialist medical doctor care to facilitate our understanding of the adequacy of these measures in assessing quality of healthcare delivery. METHODS Using a systematic approach, we searched Medline, Cochrane Central Register of Controlled Trials, Embase, CINAHL, and Web of Science from database inception until May 2020. Studies that presented original comparative data on at least one outcome measure were included following screening by two authors. Findings were synthesized, and outcome measures classified into six domains which included: effectiveness, safety, appropriateness, access, continuity of care, efficiency, and sustainability which were informed by the Institute of Medicine dimensions of healthcare quality, the Australian health performance framework, and Levesque and Sutherland's integrated performance measurement framework. RESULTS One thirty five articles met the inclusion criteria, describing 58 separate outcome measures. Safety of role substitution models of care was assessed in 80 studies, effectiveness (n = 60), appropriateness (n = 40), access (n = 36), continuity of care (n = 6), efficiency and productivity (n = 45). Two-thirds of the studies that assessed productivity and efficiency performed an economic analysis (n = 27). The quality and rigour of evaluations varied substantially across studies, with two-thirds of all studies measuring and reporting outcomes from only one or two of these domains. CONCLUSIONS There are a growing number of studies measuring the performance of non-medical healthcare professional substitution roles. Few have been subject to robust evaluations, and there is limited evidence on the scientific rigour and adequacy of outcomes measured. A systematic and coordinated approach is required to support healthcare settings in assessing the value of non-medical role substitution healthcare delivery models.
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Affiliation(s)
- Rumbidzai N Mutsekwa
- Nutrition and Food Service Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.,Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, Nathan, Queensland, Australia
| | - Charlene Wright
- Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, Nathan, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Joshua M Byrnes
- Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, Nathan, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Russell Canavan
- Gastroenterology Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Rebecca L Angus
- Nutrition and Food Service Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.,School of Allied Health Sciences, Griffith University, Southport, Queensland, Australia
| | - Alan Spencer
- Nutrition and Food Service Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Katrina L Campbell
- Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, Nathan, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia.,Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
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Evaluation of occupational therapy-led advanced practice hand therapy clinics for patients on surgical outpatient waiting lists at eight Australian public hospitals. J Hand Ther 2021; 33:320-328. [PMID: 30857889 DOI: 10.1016/j.jht.2019.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This is a prospective cohort study. INTRODUCTION Evidence is emerging that advanced practice hand therapy clinics improve patient outcomes. PURPOSE OF THE STUDY The aim of this study was to evaluate an advanced practice hand therapy model of care for patients with chronic hand conditions on surgical outpatient waiting lists at eight Australian public hospitals. METHODS Nonurgent and semiurgent patients were screened and treated, as required, by an advanced practice hand therapist and then discharged from the surgical outpatient waiting list as appropriate. Outcomes included patient safety, impact on the waiting list, patient satisfaction, and patients' perception of change as measured by Global Rating of Change (GROC). The GROC score was also compared across diagnoses. The relationship between the waiting time and need for surgical review during hand therapy treatment was also assessed. As appropriate, T-tests and analysis of variance were used for statistical analyses. RESULTS A total of 37.2% of patients who commenced hand therapy were removed or discharged from the surgical outpatient waiting lists. Of the subset of patients who completed hand therapy (n = 1116), 28.4% were discharged without requiring surgical follow-up. A further 7.53% requested return to the waiting list despite discharge being recommended. The model of care was safe, and patient satisfaction was above 90%. The mean GROC score was +2.09 (±3.58) but varied across diagnoses with trigger finger or trigger thumb showing the greatest improvement (+4.21 ± 2.92, P < .01). Patients who did not require surgical consultation during hand therapy had a shorter wait time for their initial hand therapy appointment (P < .001). CONCLUSIONS The advanced practice hand therapy model of care was safe and effective in reducing hospital surgical outpatient waiting lists. Patients reported high satisfaction.
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Glasgow C, Cox R, Laracy S, Green K, Ross L. A cohort investigation of patient-reported function and satisfaction after the implementation of advanced practice occupational therapy-led care for patients with chronic hand conditions at eight Australian public hospitals. J Hand Ther 2021; 33:445-454. [PMID: 32241626 DOI: 10.1016/j.jht.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/04/2019] [Accepted: 08/28/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Prospective cohort. INTRODUCTION Patients referred to medical specialist outpatient clinics in Australian public hospitals often wait longer than the recommended timeframe for their first appointment. This study examines the use of advanced hand therapy practitioners to facilitate access to care for long-waitlisted patients with chronic hand conditions. PURPOSE OF STUDY To examine patient-reported function and satisfaction outcomes with advanced practice hand therapy. METHODS Data was collected from eight public hospital outpatient departments in Queensland, Australia. Patients with chronic hand conditions were screened from waitlists at each site and invited to participate in the hand therapy program while waiting to see a medical practitioner. RESULTS A total of 1947 patients were screened from the waitlists, and 1116 patients completed advanced practice therapy. Patients completing hand therapy were older (P ≤ .001) and more likely to have more than one diagnosis (P ≤ .001). They reported a significant improvement in function using the Michigan Hand Questionnaire (P ≤ .001) and demonstrated increased grip strength (left injuries P = .016, right injuries P = .001). Ninety-three percent were satisfied or highly satisfied with hand therapy care. Some variation in Michigan Hand Questionnaire scores was observed across different diagnoses, with those with carpal tunnel syndrome and trigger finger reporting the best outcomes. CONCLUSIONS Advanced practice hand therapy for long-waitlisted patients with chronic hand conditions was associated with improvements in patient function and satisfaction. Further research is warranted to study the specific response of different diagnostic groups to intervention using this model of care.
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Affiliation(s)
- Celeste Glasgow
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
| | - Ruth Cox
- Metro South Hospital and Health Service, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Queensland, Australia
| | - Sue Laracy
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Kathy Green
- Metro South Hospital and Health Service, Logan Hospital, Meadowbrook, Queensland, Australia
| | - Leo Ross
- Metro South Hospital and Health Service, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Queensland, Australia
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Burton C, Palmer MA, Fanton L, Cox R, Wishart LR. Multi-site evaluation of advanced practice hand therapy clinics for the management of patients with trigger digit. J Hand Ther 2021; 35:655-664. [PMID: 34334276 DOI: 10.1016/j.jht.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 05/11/2021] [Accepted: 06/17/2021] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Prospective cohort design. BACKGROUND Patient time on Australian public hospital surgical outpatient department (SOPD) waitlists often exceeds clinical recommendations for chronic hand conditions. Diversion to allied health is an alternative option, however evidence regarding patient and organizational outcomes in hand therapy is lacking. PURPOSE OF THE STUDY To evaluate clinical and organizational efficacy, patient outcomes and satisfaction of diversion of referrals for patients with trigger digit (TD) from SOPD waitlists to Advanced Practice Hand Therapy (APHT) at 3 Australian hospitals. METHODS Data was collected from eligible patients with TD through chart reviews and telephone satisfaction surveys. Data included number of patients requiring SOPD review, repeat referral to SOPD in the 12 months following APHT discharge, patient-rated outcomes, satisfaction scores, wait times to SOPD review and conversion to surgery-rates. Mann Whitney-U, t-test, Pearson's chi-squared test and a Binary Logistic Regression analysis were performed. RESULTS 104 patients completed APHT treatment. Seventy patients (67%) did not require return to the SOPD waitlist. Repeat referral to SOPD within 12 months of APHT discharge occurred for only 1 patient. Patients requiring SOPD review after APHT treatment were seen within target time frames and demonstrated 88% conversion to surgery-rates. Michigan Hand Outcome Questionnaire scores showed greater improvement in those not requiring SOPD review (P< .001~25.9 vs 4.2). Regression analysis identified a negative association between initial total Michigan Hand Outcome Questionnaire scores and unfavorable discharge outcomes (OR 0.96, P= .007). Most (81%-93%) patients indicated satisfaction with the APHT service. CONCLUSION Diversion of referrals for TD from SOPD to APHT is an effective waitlist management strategy, with the propensity to reduce waiting times, improve patient flow, whilst resulting in favorable clinical and patient-rated outcomes and satisfaction.
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Affiliation(s)
| | - Michelle A Palmer
- Queensland Health, Logan Hospital, Meadowbrook, Queensland, Australia
| | - Lauren Fanton
- Queensland Health, Logan Hospital, Meadowbrook, Queensland, Australia
| | - Ruth Cox
- Queensland Health, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Queensland, Australia
| | - Laurelie R Wishart
- Queensland Health, Centre for Functioning and Health Research, Buranda, QLD, Australia
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Nucifora J, Howard Z, Weir KA. Do patients discharged from the physiotherapy-led pelvic health clinic re-present to the urogynaecology service? Int Urogynecol J 2021; 33:689-695. [PMID: 34287655 DOI: 10.1007/s00192-021-04912-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 05/31/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The physiotherapy-led pelvic health clinic (PLPHC) is an advanced practice clinic that manages women from the urogynaecology waitlist with pelvic organ prolapse (POP) and/or urinary incontinence (UI) at Gold Coast Health, Australia. This study was aimed at determining re-referral rates and reasons for re-presentation of women previously managed and discharged from the PLPHC. We hypothesised that there would be low representation rates for the same condition within 12 months of discharge. METHODS A retrospective audit was undertaken of all (n = 209) patients discharged between 1 January and 31 December 2017. Re-presentation rates and reasons for re-referral for women seen in the PLPHC and discharged without requiring urogynaecology medical specialist review were analysed and descriptive analysis performed. RESULT Of the 209 patients, 67 were referred to, or had, urogynaecology medical specialist review after their initial physiotherapy care and were removed from further analysis. Of the remaining 142 patients, who were initially managed by physiotherapy only, 10 (7.1%) women were re-referred to specialist medical outpatient gynaecology and urology out-patient departments, for management of a different diagnosis, and 10 (7.1%) for their original diagnoses, within 12 months of discharge. Of the latter, 1 patient required further physiotherapy and urogynaecologist management; 7 patients required ongoing pessary management; 1 patient continued with urologist medical management; and 1 failed to attend. CONCLUSION This study presents novel data on low re-presentation rates in the 12 months following discharge for patients with POP or UI managed in a PLPHC; and provides further support for advanced scope of practice physiotherapy gynaecological service models.
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Affiliation(s)
- Jennifer Nucifora
- Physiotherapy Department, Allied Health Outpatients, D Block, Ground Floor, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia.
| | - Zara Howard
- Physiotherapy Department, Allied Health Outpatients, D Block, Ground Floor, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Kelly A Weir
- Allied Health Research, Gold Coast Hospital and Health Service, Southport, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland & Allied Health Sciences, Griffith University, Gold Coast Campus, Queensland, Australia
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Stute M, Moretto N, Waters R, Raymer M, Sam S, Bhagwat M, Banks M, Comans T, Buttrum P. Allied health primary contact services: results of a 2-year follow-up study of clinical effectiveness, safety, wait times and impact on medical specialist out-patient waitlists. AUST HEALTH REV 2021; 45:344-352. [PMID: 33271059 DOI: 10.1071/ah19225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 08/25/2020] [Indexed: 11/23/2022]
Abstract
Objective Long specialist out-patient waitlists are common in public health facilities, but not all patients require consultation with a medical specialist. Studies of single allied health primary contact services have shown they provide timely, appropriate care and reduce demand on medical specialist out-patient waitlists. This study evaluated the collective benefits across multiple allied health primary contact services and models to determine their clinical effectiveness, safety, timeliness of care and impact on medical specialist out-patient waitlists. Method Using a prospective observational study design, data were collected and analysed for patients attending 47 allied health primary contact services in Queensland public hospitals over a 2-year period. Outcomes reported are global status, adverse events, wait times and impact on medical specialist out-patient waitlists. Results In all, 10634 patients were managed in and discharged from the allied health services. Most adult patients (80%) who attended at least two consultations reported an improvement in health status. No adverse events were attributed to the model of care. Approximately 68%, 44% and 90% of urgent, semi-urgent and non-urgent out-patients respectively were seen within clinically recommended time frames. Between 35% and 89% of patients were removed from out-patient waitlists without medical specialist consultation across the service models. Conclusions Allied health primary contact services provide safe, effective and timely care. The impact on medical specialist out-patient waitlists varied depending on service model and pathway characteristics. What is known about this topic? Most studies of allied health primary contact services have focused on the management of patients on orthopaedic specialist out-patient waitlists by a physiotherapist. These studies of either individual services or groups of services with the same model cite benefits, including reduced waiting times, high levels of patient and referrer satisfaction, improved conversion to surgery, cost-effectiveness and more effective utilisation of medical specialists. What does this paper add? This paper highlights that, collectively, allied health primary contact services are safe, effective and provide timely care. The proportion of patients independently managed and removed from various medical specialist out-patient waitlists and the services involved are reported, demonstrating the variety of service models. This study reports outcomes for primary contact services for which there is a dearth of published literature, including dietician services for patients on gastroenterology waitlists, speech pathology and audiology services for patients on ear, nose and throat waitlists, occupational therapy hand services for patients on orthopaedic waitlists and physiotherapy led pelvic-health services for patients on gynaecology waitlists. Possibilities for efficiency gains are identified and discussed. What are the implications for practitioners? Health service managers should consider allied health primary contact services as a viable option to increase specialist out-patient capacity. Service model characteristics that maximise impact on medical specialist out-patient waitlist management are highlighted to inform resource allocation.
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Affiliation(s)
- Michelle Stute
- Metro North Hospital and Health Service, Butterfield Street, Herston, Qld 4029, Australia. ; ; ; ; ; ; and Corresponding author.
| | - Nicole Moretto
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital Campus, Woolloongabba, Qld 4102, Australia. ;
| | - Rebecca Waters
- Metro North Hospital and Health Service, Butterfield Street, Herston, Qld 4029, Australia. ; ; ; ; ;
| | - Maree Raymer
- Metro North Hospital and Health Service, Butterfield Street, Herston, Qld 4029, Australia. ; ; ; ; ;
| | - Sonia Sam
- Metro North Hospital and Health Service, Butterfield Street, Herston, Qld 4029, Australia. ; ; ; ; ;
| | - Marita Bhagwat
- Metro North Hospital and Health Service, Butterfield Street, Herston, Qld 4029, Australia. ; ; ; ; ;
| | - Merrilyn Banks
- Metro North Hospital and Health Service, Butterfield Street, Herston, Qld 4029, Australia. ; ; ; ; ;
| | - Tracy Comans
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital Campus, Woolloongabba, Qld 4102, Australia. ;
| | - Peter Buttrum
- Metro North Hospital and Health Service, Butterfield Street, Herston, Qld 4029, Australia. ; ; ; ; ;
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Mutsekwa R, Ostrowski S, Canavan R, Ball L, Angus R. Health service usage and re-referral rates: comparison of a dietitian-first clinic with a medical specialist-first model of care in a cohort of gastroenterology patients. Frontline Gastroenterol 2020; 12:175-181. [PMID: 33912331 PMCID: PMC8040499 DOI: 10.1136/flgastro-2020-101435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/10/2020] [Accepted: 04/19/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The dietitian-first gastroenterology clinic (DFGC) is an expanded scope of practice initiative implemented in response to increased gastroenterology specialist demand. This study examined re-referral rates to gastroenterology and overall health service usage up to 24 months post management in DFGC compared with a traditional, gastroenterology specialist-first model. METHODS Patients discharged from DFGC in the first year were matched with those seen in the traditional model. Demographic, clinical and process-related service characteristics were compared, and logistic regression analysis was undertaken to model re-presentation and model of care (MoC) as the variable of interest considering covariates in univariate analyses. Analyses were performed at 12, 18 and 24 months post discharge. RESULTS The DFGC (122 patients) and traditional-model (62 patients) cohorts had similar baseline demographic characteristics. Wait-times (68.6 vs 272.9 days; p<0.001), treatment-times (89.4 vs 259.9 days; p<0.001) and usage of other services (1.4 vs 2.1 specialities; p=0.01) were lower in DFGC. Re-referral rates were low in both DFGC and traditional models at 12 months (0.82% vs 1.61%), 18 months (2.46% vs 6.45%) and 24 months (4.91% vs 8.06%), respectively, with no significant difference between the models at any time point. CONCLUSION Most patients do not re-present for similar conditions within 2 years when managed in the DFGC or traditional medical model. Patients managed in DFGC have lower overall health service usage compared with patients managed in the traditional model. These findings support the safety and effectiveness of a DFGC model as one strategy to manage specialist gastroenterology service demands.
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Affiliation(s)
- Rumbidzai Mutsekwa
- Nutrition Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia,Centre for Applied Health Economics, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
| | - Szymon Ostrowski
- Gastroenterology Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Russell Canavan
- Gastroenterology Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Lauren Ball
- Menzies Health Institute Queensland, Griffith University Faculty of Health, Gold Coast, Queensland, Australia,School of Allied Health Sciences, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
| | - Rebecca Angus
- Nutrition Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia,School of Allied Health Sciences, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
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Seaton J, Jones A, Johnston C, Francis K. Allied health professionals' perceptions of interprofessional collaboration in primary health care: an integrative review. J Interprof Care 2020; 35:217-228. [PMID: 32297811 DOI: 10.1080/13561820.2020.1732311] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This integrative review synthesizes research studies in order to explore the perceptions of allied health professionals regarding interprofessional collaboration in primary health care. A comprehensive literature search was conducted using three electronic databases and a manual search of the Journal of Interprofessional Care. The Crowe Critical Appraisal Tool was used to assess the quality of included papers. Study findings were extracted, critically examined and grouped into themes. Twelve studies conducted in six different countries met the inclusion criteria. Thematic analysis revealed five themes: (1) shared philosophy; (2) communication and clinical interaction; (3) physical environment; (4) power and hierarchy; and (5) financial considerations. This review has identified diverse key elements related to interprofessional collaboration in primary health care, as perceived by allied health professionals. Opportunity for frequent, informal communication appeared essential for interprofessional collaboration to occur. Allied health professionals working in close proximity to health practitioners from other professions had more regular interprofessional interactions than those who were geographically separated. Co-location of multiple primary health care services within the same physical space may offer increased opportunities for interprofessional collaboration. Future research should avoid reporting on allied health professionals in primary health care collectively, and isolate data to the individual professions. Direct observational methods are warranted to investigate whether allied health professionals' perceptions of interprofessional collaboration align with their actual clinical interactions in primary health care settings.
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Affiliation(s)
- Jack Seaton
- Discipline of Physiotherapy, College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Anne Jones
- Discipline of Physiotherapy, College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Catherine Johnston
- Discipline of Physiotherapy, School of Health Sciences, the University of Newcastle, Callaghan, Australia
| | - Karen Francis
- Discipline of Nursing, College of Health and Medicine, The University of Tasmania, Launceston, Australia
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13
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Moretto N, Stute M, Sam S, Bhagwat M, Raymer M, Buttrum P, Banks M, Comans TA. A uniform data set for determining outcomes in allied health primary contact services in Australia. Aust J Prim Health 2020; 26:58-69. [PMID: 31954431 DOI: 10.1071/py18104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/23/2019] [Indexed: 11/23/2022]
Abstract
The project aim was to develop and implement a set of metrics to capture and demonstrate the performance of newly established allied health primary contact services. Selection of the metrics and performance indicators was guided by an existing state-wide data collection system and from a review of the published literature. The metrics were refined after consultation with a working group of health service managers and clinicians. The data collection and reporting framework were developed for use in allied health primary contact services and implemented at public health facilities in Queensland, Australia. The set of metrics consists of 18 process and outcome measures. Patient-reported metrics include the global rating of change scale and patient satisfaction. Service metrics include wait times; referral source; triage category; diagnosis; occasions of service; referrals and investigations initiated; effects; care duration; discharge status; waitlist reinstatement reasons; treatment non-completion reasons; and expedited care. Safety, patient demographics and service improvement metrics were included. The metrics will enable analysis of the effectiveness of allied health primary contact services and will facilitate reporting, advocacy, service improvement, service continuity and research. The metrics are suitable for use by all providers of allied health primary contact services in hospital and primary care settings.
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Affiliation(s)
- Nicole Moretto
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital campus, Woolloongabba, Qld 4102, Australia; and Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia; and Corresponding author
| | - Michelle Stute
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Sonia Sam
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Marita Bhagwat
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Maree Raymer
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Peter Buttrum
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Merrilyn Banks
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Tracy A Comans
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital campus, Woolloongabba, Qld 4102, Australia; and Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
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14
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Mutsekwa RN, Canavan R, Whitfield A, Spencer A, Angus RL. Dietitian first gastroenterology clinic: an initiative to reduce wait lists and wait times for gastroenterology outpatients in a tertiary hospital service. Frontline Gastroenterol 2019; 10:229-235. [PMID: 31281623 PMCID: PMC6583570 DOI: 10.1136/flgastro-2018-101063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The demand for outpatient gastroenterology medical specialist consultations is above what can be met within budgetary and staffing constraints. This study describes the establishment of a dietitian first gastroenterology clinic to address this issue, the patient journey and its impact on wait lists and wait times in a tertiary gastroenterology service. DESIGN A dietitian first gastroenterology clinic model was developed and a mixed-methods approach used to evaluate the impact of the service over a 21-month period. SETTING Gold Coast University Hospital, Queensland, Australia (a public tertiary hospital). PATIENTS 658 patients were triaged to the clinic between June 2016 and March 2018. INTERVENTION A dietitian first gastroenterology clinic for low-risk gastroenterology patients. MAIN OUTCOME MEASURES We examined demographic, referral, wait list, wait time and service activity data, patient satisfaction and patient journey. RESULTS At the time of audit, 399 new (67.9% female) and 307 review patients had been seen. Wait times for eligible patients reduced from 280 to 66 days and the percentage of those in breach of their recommended wait times reduced from 95% to zero. The average time from referral to discharge was 117.8 days with an average of 2.4 occasions of service. 277 patients (69.4%) had been discharged to the care of their general practitioner and 43 patients (10.7%) had an expedited specialist medical review. Patient surveys indicated a high level of satisfaction. CONCLUSION A dietitian first gastroenterology model of care helps improve patient flow, reduces wait times and may be useful elsewhere to address outpatient gastroenterology service pressures.
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Affiliation(s)
- Rumbidzai N Mutsekwa
- Gold Coast Hospital and Health Service, Nutrition and Food Service Department, Hospital Boulevard Southport, Southport, Queensland, Australia
| | - Russell Canavan
- Gold Coast Hospital and Health Service, Gastroenterology Department, Hospital Boulevard Southport, Southport, Queensland, Australia
| | - Anthony Whitfield
- Gold Coast Hospital and Health Service, Gastroenterology Department, Hospital Boulevard Southport, Southport, Queensland, Australia,Health Sciences, Griffith University, Southport, Queensland, Australia
| | - Alan Spencer
- Gold Coast Hospital and Health Service, Nutrition and Food Service Department, Hospital Boulevard Southport, Southport, Queensland, Australia
| | - Rebecca L Angus
- Gold Coast Hospital and Health Service, Nutrition and Food Service Department, Hospital Boulevard Southport, Southport, Queensland, Australia,Health Sciences, Griffith University, Southport, Queensland, Australia
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15
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Burley S, Cox R, Di Tommaso A, Molineux M. Primary Contact Occupational Therapy Hand Clinics: The pull of an occupational perspective. Aust Occup Ther J 2018; 65:533-543. [PMID: 30132914 DOI: 10.1111/1440-1630.12507] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIM Primary contact models of care are an emerging area of occupational therapy practice that aim to respond to the changing health-care landscape. There is a dearth of literature exploring an occupational perspective in primary contact roles, and literature in the broader scope of hand therapy has recognised that occupational therapists' practice often aligns with the biomedical worldview. Therefore, this study aimed to explore the practice of occupational therapists within Primary Contact Occupational Therapy Hand (PCOTH) Clinics from an occupational perspective. METHOD This ethnographic study gathered in-depth data through observations of primary contact hand therapy sessions, review of progress notes and interviews with occupational therapists. Qualitative data analysis was conducted using a three-stage process first at the item level, then pattern level and finally at the structural level. The research team collaboratively discussed all codes and then themes. RESULTS The push of the biomedical culture and the pull of an occupational perspective was conceptualised as an overarching theme shaping occupational therapists' practice in the primary contact clinics. Five themes emerged: bottom-up approach to an occupational perspective, an occupational perspective via informal discussion, occupational therapists' expectations of patients, occupational perspective on autopilot and blurred professional identity. CONCLUSION Occupational therapists working in primary contact roles were pushed by the biomedical culture of the setting. Despite this, there was still a pull towards an occupational perspective. This research provides an initial exploration of primary contact clinics, and highlighted the added bonus of an occupational perspective. The findings present a timely opportunity for occupational therapists to critically reflect on practice in PCOTH clinics.
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Affiliation(s)
- Samantha Burley
- Mental Health Services, South West Healthcare, Warrnambool, Victoria, Australia.,Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Queensland, Australia
| | - Ruth Cox
- Occupational Therapy Department, Queen Elizabeth II Jubilee Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Amelia Di Tommaso
- Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Queensland, Australia
| | - Matthew Molineux
- Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Queensland, Australia
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16
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Shaw BR, Heywood SE, Page CJ, Phan UM, Harding PA, Walter K, Terrill DL, Granger CL. Advanced musculoskeletal physiotherapy: Barriers and enablers to multi-site implementation. Musculoskeletal Care 2018; 16:440-449. [PMID: 30113766 DOI: 10.1002/msc.1358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/28/2018] [Accepted: 06/30/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Advanced musculoskeletal physiotherapy (AMP) services are a safe, effective model of care, but without broad-scale healthcare implementation to date. The aim of the present study was to identify the barriers and enablers to implementation of 12 AMP services from the perspective of clinical staff. METHODS In a qualitative study, 12 participants (physiotherapists), from 12 different healthcare networks (seven metropolitan, three regional, two rural), were included. Their departments implemented AMP services (orthopaedic postoperative joint replacement review, n = 10; general orthopaedic, n = 1; emergency, n = 1; and neurosurgery n = 1) over a 12-month period. Participants completed a structured survey specifically designed for the study. Thematic analysis was used, with themes mapped to the validated Theoretical Domains Framework. RESULTS Nine major themes emerged from the data regarding barriers and enablers to the implementation of the AMP services from the perspective of clinical staff. These were: demand/capacity; model of care; the organization; stakeholders; communication; planning and processes; evaluation; workforce; and learning and assessment framework. Important enablers included engagement and buy-in from key stakeholders and medical staff, and well-established AMP learning frameworks for training and operational frameworks. Barriers included competitive funding environment, and issues that hindered effective communication. The knowledge, skills, availability, motivation and experience of the advanced musculoskeletal physiotherapists had a large impact on the implementation. CONCLUSIONS The study identified a number of factors that should be considered for successful implementation of AMP services across healthcare services or wider healthcare networks.
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Affiliation(s)
- Bridget R Shaw
- Department of Physiotherapy, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Sophie E Heywood
- Department of Physiotherapy, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.,University of Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, QLD, 4556, Australia
| | - Carolyn J Page
- Department of Physiotherapy, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Uyen M Phan
- Department of Physiotherapy, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, 3052, Australia
| | - Paula A Harding
- Department of Physiotherapy, The Alfred, PO Box 315, Prahran, VIC, 3181, Australia
| | - Kerrie Walter
- Department of Physiotherapy, The Alfred, PO Box 315, Prahran, VIC, 3181, Australia
| | - Desiree L Terrill
- Department of Health and Human Services, Health and Wellbeing Workforce Reform, 50 Lonsdale Street, Melbourne, VIC, 3000, Australia
| | - Catherine L Granger
- Department of Physiotherapy, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, 3052, Australia.,Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville, VIC, 3010, Australia
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