Tips on searching and locating evidence for busy clinicians

Professor Saravana Kumar1

1School of Health Sciences, International Centre for Allied Health Evidence (iCAHE), C7-61 City East Campus, University of South Australia, Adelaide, SA 5000,kumar@unisa.edu.au

 

With increasing focus on health care quality, health care stakeholders, including clinicians, are expected to underpin their health care with evidence-based practice (EBP). While clinicians are receptive to EBP, engage with and implementing EBP in health care poses numerous barriers. One such barrier is access to and locating best research evidence. However, with increasing quantity and quality of research evidence, barriers to accessing and locating research evidence is diminishing.  This presentation will showcase simple, practical and time efficient tips clinicians can use when searching for and locating best research evidence. These tips should assist busy clinicians engage with best research evidence in an effective and efficient manner.

Are the village people singing the same song? One Village…many people. The challenges of replicating a transdisciplinary early intervention playgroup across multiple sites in South Australia.

Jo Coombes1

1 Country Health SA. Yorke and Northern Region. Ernest Terrace Wallaroo SA 5556 jo.coombes@sa.gov.au

Background

If the rural context is our village…then the influences within and beyond it are ‘our people’

Play2Grow is a trauma informed supported playgroup operated by the CHSA Healthy Families Team across the Yorke and Lower North area of South Australia.

Using the Play2Grow model as an example, this presentation will discuss how an approach that developed at one location has now been implemented across 4 sites with a range of staff and different client groups.

The underpinning issues addressed throughout the process were:

How to (or should we) replicate a working model across different settings?
How to value and utilise the passion of the ‘idea owners’
How to convey that passion to others
How to preserving the integrity of the original ‘idea that works’ whilst also developing and growing it

Methods

The team participated in a facilitated workshop in September 2015. A pulse check and SWOT analysis were conducted to identify the key issues moving forward to ensure team ownership of the programme.

Some of these included:

The impact of episodic care on client engagement
The importance of client relationship and avoiding dependence
The pressure to work toward consistent approaches whilst acknowledging diversity in client and staff groups
The effect of organisational priorities on clinician motivation and energy

Discussion

The ‘Essence of Play2Grow’ was captured in a single document to guide the ongoing implementation of the group across our geography.

A Play2Grow package was proposed to support the further development of the programme, including evaluation tools, consumer input and facilitation guidelines.

The work continues.

Keeping culture at the centre of student support

Trevor-Tirritpa Ritchie

In early 2013, Indigenous Allied Health Australia (IAHA), a national not for profit, member-based Aboriginal and Torres Strait Islander allied health organisation, identified a need for targeted support for Aboriginal and Torres Strait Islander allied health students to enable them to complete their degrees and confidently enter the health workforce. This is particularly important for those students who wish to go back home to live and work in remote and rural locations upon graduation.

Since 2013 IAHA has held an annual HealthFusion Team Challenge (HFTC) specifically for Aboriginal and Torres Strait Islander health students – the first of its kind both nationally and internationally. The intensive two day event enables participants to engage with a diverse range of health disciplines, building valuable skills and knowledge in leadership, public speaking, collaborative team work and holistic person-centred care.

The IAHA HFTC is unique in that it is steered towards creating a culturally safe and responsive learning experience, where participants grow as future Aboriginal and Torres Strait Islander health professionals.   At university a participant may be one of very few Aboriginal and Torres Strait Islander people in their course, they find at the HFTC that they are in fact part of a vibrant and growing cohort of exceptional Aboriginal and Torres Strait Islander students across the nation.

Students from remote and rural areas are strongly encouraged and supported to attend the event, which holds culture as an essential component of Aboriginal and Torres Strait Islander health and wellbeing.  The IAHA HFTC is one way that IAHA contributes to building a workforce and a health system that is more effective, accessible and culturally responsive to the needs of Aboriginal and Torres Strait Islander peoples.

Biography

Trevor-Tirritpa Ritchie is a Kaurna man and an Occupational Therapist. He has previously worked in Corrections, Housing and Education. He is currently working at the University of South Australia as a Lecturer in Allied Health Aboriginal Health. He is also working in Paediatrics with Country Health SA providing services to remote communities on the far West South Australian Coast. He is a current board member for Indigenous Allied Health Australia.

Development, implementation and evaluation of the role of dietetic assistants in tackling malnutrition: What worked, what didn’t and why it matters?

Antonella Jarvis1,2, Saravana Kumar1, Georgina Rassias2

1School of Health Sciences, International Centre for Allied Health Evidence (iCAHE), C7-61 City East Campus, University of South Australia, Adelaide, SA 5000, kumar@unisa.edu.au
2Clinical Dietetics Department, Royal Adelaide Hospital, North Tce, Adelaide, SA 5000

Background

With an ageing population requiring ongoing health care, the frequency of hospital visits continues to rise. Within these settings, malnutrition among the elderly is a well-recognised problem, which requires dietetic intervention. While the importance of addressing malnutrition through dietetic interventions are well recognised, due to lack of timely identification, competing clinical priorities, staffing issues, it is often not addressed. This is especially the case in rural and remote areas where access to care may be limited due to staffing and resource limitations. Dietetic assistants (DAs) could assist in tackling malnutrition and this project tested this new model of care.

Methods

A systematic scoping literature search was undertaken to identify the evidence for the role of DAs. A comprehensive change management strategy was adopted. A targeted training package was developed for and delivered to DAs within a large tertiary hospital by a senior dietitian. Qualitative and quantitative data were collected to demonstrate the impact of DAs across a range of measures.

Results

The literature evidence (n=5) highlighted the positive impact on acute patient nutritional intake, anthropometric indices and ability to assist in reducing mortality. Qualitative interviews with DAs (n=3) and dietitians (n=4) revealed support for this role in practice. Quantitative data indicated improved access to dietetic care and timely intervention with patients (n=25) satisfied with the DA interactions.

Discussion

Despite these positive findings, implementing a new model of care was fraught with challenges. While health reform and innovation continues to be at forefront, effectively translating these into practice continues to face barriers.

Biography

Antonella Jarvis is a clinical dietitian having worked for OPAL in the past and is now the Plastics,Vascular and Cardio dietitian at the Royal Adelaide Hospital (RAH). In addition to clinical dietetics, she is also conducting a patient trial of Arginine supplementation in relation to wound healing and undertaking a review, and updating, of wound healing guidelines. Antonella also works part-time at the University of South Australia as a research assistant and has assisted on several projects including the Transforming Health 7 day Allied Health, impact of allied health snapshots and the role of students during times of change

Utilising teleconferencing in the diagnosis of autism spectrum disorder: using technology to enhance clinical practice

Narelle Sarakinis1, Dr David G Thomas2

1Riverland Community Health Service, 21 Cornwall Street Berri SA 5343, narelle.sarakinis3@sa.gov.au
2Women’s and Children’s Hospital, 72 King William Road North Adelaide SA 5006, david.thomas@sa.gov.au

Background:

Autism Spectrum Disorder (ASD) is a growing phenomenon in Australia. With its rising prevalence, the need for ASD diagnostic assessments has increased. Coordinated, multi-disciplinary assessments are required for ASD, however, these are primarily offered in metropolitan settings. Families in rural and remote areas do not have access to these services in a consistent and timely manner. One way to address this inequity of access is through use of videoconferencing which allows local families access to a one stop shop for ASD diagnostic assessments and case management.

Method:

Six ASD diagnostic clinics were set up annually, providing up to 12 assessments per year. Access to the clinic was via referral to the Riverland Child Development Unit (CDU). Case history information was collected by a Paediatrician and a Speech Pathologist up to 4 weeks prior to the assessment. A face to face assessment was conducted by the Speech Pathologist, with the Paediatrician observing via videoconference, with the outcome notified to parents within a week and management options explored within a month.

Results:

Findings from the evaluation indicate that families were satisfied with the use of videoconferencing. In particular, the coordinated approach ensured access to timely care, reduced waiting times and early intervention opportunities. Families felt supported and the saving gained from travel time and costs were particularly appreciated.

Discussion:

Technology now provides an ideal alternative to historical models of care while ameliorating the traditional barriers to health care access that confronts those in rural and remote areas.

Utilising simulated interprofessional practice (SIPP) to provide targeted education across the paediatric allied health workforce of Queensland

K.Kelly1, L.Findlay1,3, S.Goodman1,4,S.E.Wright1,2

SLIPAH, Level 7a, Lady Cilento Children’s Hospital, Brisbane, Qld, 4101,sarah.wright@health.qld.gov.au
Physiotherapy Dept, Level 7a, Lady Cilento Children’s Hospital, Brisbane, Qld, 4101
Occupational Therapy Dept, Level 7a, Lady Cilento Children’s Hospital, Brisbane, Qld, 4101
Speech Pathology Dept, Level 7a, Lady Cilento Children’s Hospital, Brisbane, Qld, 4101

Background

Interprofessional practice(IPP) results in improved communication, patient safety and care outcomes and reduced service duplication1-3. IPP relies on effective teamwork where complementary skills are shared in working partnerships. Interprofessional education(IPE) promotes IPP increasing job satisfaction and recruitment/retention rates in rural settings1,2, and  is most effective when contextualised to consider  regional issues/priority areas1-3. Paediatric healthcare education is a priority across Australia4, however the challenges to implementing IPE in rural/remote areas have been well documented.2

Aim

To facilitate IPP by provision of context/location specific paediatric IPE using SIPP delivered locally via the SLIPAH(Simulated Learning in Paediatrics for Allied Health) program.

Method

A combined approach of e-learning and SIPP were delivered across rural/remote locations in collaboration with experienced local therapists and subject matter experts.  IPP scenarios were derived based on local priorities, with emphasis on IP core compectencies5 and evidence-based practice. SIPP provided clinical opportunities to develop safe, effective performance; to refine existing skills and explore innovative solutions to local challenges and patient flow. Impact evaluation included change in participant’s self-efficacy across IP competency domains (teamwork, roles/responsibilities, values/ethics, communication).   Participant and manager feedback served to refine program delivery in terms of accountability, performance and responsiveness.

Results

SLIPAH collaborated with 8 Queensland Health facilities to deliver to 230 participants in 2015 totally 762 hours. Participants’ self-efficacy across IP core competencies significantly improved across all 4 domains (p<0.05).  Qualitative manger feedback was highly positive.

Discussion

SIPP developed in collaboration with rural/regional healthcare teams  is effective in teaching IP competencies and provides a responsive method for  problem-solving local priority issues.

References

  1. WHO study group on Interprofessional Education and Collaborative Practice and Baker, Peter G. (2010) Framework for action on interprofessional education and collaborative practice. Geneva, Switzerland: World Health Organisation Press .
  2. Cragg B, Jelley W, Burrows M & Dyer K. 2013. Implementing and sustaining a rural interprofessional clinical education program.  Journal of Research in Interprofessional Practice and Education.  3.2, August:  1-15.
  3. Thistlewaite J. 2012. Interprofessional education: a review of context, learning and research agenda.  Medical Education. 46:  58-70.
  4. Armstrong BK, Gillespie JA, Leeder SR, Rubin GL & Russel LM. Challenges in health and healthcare for Australia. Medical Journal of Australia. 187 (9):  485-489.
  5. Interprofessional Education Collaborative Expert Panel. 2011. Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative.

Biography

Sarah Wright is a Physiotherapist Consultant at Lady Cilento Children’s Hospital, Qld and has worked in the acute cardiorespiratory field for over 20yrs. She is currently also the SLIPAH (Simulated Learning in Paediatric Allied Health) Consultant involving the integration of technologically enhanced learning into the paediatric curriculum of 6 Queensland universities as well as rolling out training workshops state-wide. SLiPAH has a strong focus on interprofessional education and capabilities, while developing the knowledge, skills and attributes of all allied health clinicians.

Using key performance indicators to measure allied health expanded scope of practice activity

Liza-Jane McBride1, Belinda Gavaghan2

1 Allied Health Professions’ Office Queensland, PO Box 2368, QLD, 4006, liza-jane.mcbride@health.qld.gov.au
2 Allied Health Professions’ Office Queensland, PO Box 2368, QLD, 4006, belinda.gavaghan@health.qld.gov.au

Background

Allied health expanded scope of practice initiatives have been shown to improve the delivery of timely, effective and high value health services for Queensland communities. In order to measure the implementation of recommendations from the 2014 Ministerial Taskforce on health practitioner expanded scope of practice, key performance indicators were identified and statewide questionnaires distributed annually for three years.

Methods

A self-administered questionnaire was distributed to Directors of Allied Health across all Queensland Hospital and Health Services in June 2014 (baseline), 2015 and 2016. Directors were asked to measure expanded scope activity, including undertaking primary contact roles, prescribing and administering scheduled medicines, ordering diagnostic investigations and undertaking new procedures. The survey also explored Directors perceptions of the enablers and challenges of implementing and sustaining allied health expanded scope roles. Survey findings were compared to baseline results.

Results

Preliminary findings indicate that while the number of allied health professionals working in primary contact roles and undertaking new procedures has increased since the implementation of Taskforce recommendations, the percentage of the workforce engaged in these roles remains small. Barriers to expanded scope roles were consistent with baseline findings and include legislation and accreditation standards, funding restrictions, workforce training models and health service culture.

Discussion

While there has been a slight increase in expanded scope roles across the state, implementation has been slow and inconsistent and the number of professions remains small. A number of real and perceived barriers continue to inhibit workforce reform. The findings from this survey will be used to prioritise funding and guide the implementation of initiatives to embed expanded scope of practice for allied health professionals.

Biography

Liza-Jane McBride is a team leader with the Allied Health Professions’ Office of Queensland, with statewide responsibility for allied health clinical education. Liza-Jane has significant experience working in a variety of healthcare settings in Australia and the United Kingdom. She is a registered physiotherapist.

Thriving vs surviving after acquired brain injury- the efficacy of telehealth delivery of a group community rehabilitation program in rural/remote Queensland

Areti Kennedy1, Ben Turner1Stephanie Fletcher1, and Melissa Kendall1

1Acquired Brain Injury Outreach Service, Princess Alexandra Hospital, Metro South Hospital and Health Service, PO Box 6053, Buranda, 4102

Aim

To examine the efficacy of home-based telehealth technology for STEPS Skills Program delivery to adults with Acquired Brain Injury (ABI) in rural/remote communities in Queensland.

Since inception in 2008, the STEPS Program- a specialist rehabilitation group program addressing community re-integration following ABI- has developed a strong presence in many regional communities. However, access for adults in rural/remote areas remains a challenge.

Methods

A multi-methods design examined experiences and outcomes for two groups completing the STEPS Skills Program: a control group (n = 8) via usual face-to-face delivery, and an experimental group (n = 5) via telehealth.

Participants completed outcome measures before and after the 6-week program and in-depth semi-structured interviews afterwards.  Non-parametric statistical analyses were used for quantitative data and a case study approach utilising 4-staged thematic analysis for qualitative data.

Results

Control group participants recorded significant improvement over time on Satisfaction with Life Scale.  While improvements were observed over time, no other statistically significant differences were found for either control or telehealth groups.  Interestingly, telehealth participants typically scored higher than control on outcome measures pre and post program. 

Qualitatively, both groups benefited from: shared learning environment, peer support, and peer-professional leadership structure.  All telehealth participants successfully managed the videoconferencing software, which they preferred to teleconferencing.  However, major connectivity issues compromised videoconferencing reliability, impacting on program participation (e.g., hesitancy to contribute to discussions due to fear of dropping out).

Conclusion

This study supports the use of home-based telehealth technologies in STEPS Skills Program delivery.  Improving reliability of connectivity will enhance outcomes over time.

Biography

Areti Kennedy Bachelor of Physiotherapy, Grad Dip Health ScienceWorking in brain injury rehabilitation for the past 19 years, Areti has had several roles at the Acquired Brain Injury Outreach Service (ABIOS), most recently as Skills To Enable Peole and Comunities (STEPS) Program manager. The STEPS Program uses an innovative peer/professional partnership model for group rehabilitation program delivery in local Queensland communities. Areti is passionate about peer/professional partnerships, believing the interplay of lived experience and health expertise provides an environment which enhances shared learning and fosters sustainable, ongoing, relevant, local community participation for adults with acquired brain injury.

Thriving communities and the role of allied health

Mr David Butt

Chief Executive Officer, National Mental Health Commission PO Box R1463 Royal Exchange, NSW 2000, david.butt@mentalhealthcommission.gov.au

The National Mental Health Commission’s Review of Mental Health Programmes and Services – Contributing Lives, Thriving Communities – highlighted the existing complexity, inefficiency and fragmentation of Australia’s mental health system.  It presented a compelling case for long term sustainable reform and overall system redesign.

Central to this reform and system redesign is a person-centred approach to mental health care, and the development of integrated care pathways to improve outcomes for people experiencing mental ill health and their families.  A greater focus on prevention and early intervention in community and primary health services is a key enabler for this person-centred service model.  This will support people and carers to lead fulfilling productive lives.

Allied health professionals have a key role in linking people with the services that they need, and joining services in ways that suit the needs of individuals, rather than individuals needing to make do with traditional service approaches.  Care teams will be designed that are required by the individual – for example, Psychologists and other Allied Health Professionals, Aboriginal Health Workers, Non-Clinical service providers, Psychiatrists and Community Mental Health Services.

The Commission’s findings, and the Australian Government response outlining comprehensive reform of the mental health system, will be presented.  This reform will transform the way services are planned and delivered within three years.  The need for action is critical when almost four million people across Australia will experience a mental illness each year.

Biography

David Butt was appointed CEO of the National Mental Health Commission in January 2014.  David has 30 years of experience in the health system, much of it at CEO and Executive level.Prior to the Commission, David was Deputy Secretary of the Australian Department of Health from August 2011, head of Rural and Regional Health Australia, and the Commonwealth’s first Chief Allied Health Officer.This followed 15 years as CEO of three major health organisations: Australian Capital Territory (ACT) Health and Community Care, National CEO of Little Company of Mary Health Care (the Calvary group), and Australian General Practice Network.

The use of a remote footwear manufacturing facility in China to provide high quality, cost effective footwear for residents in South Australia.

Fiona Murray1, Claire Easterbrook1, Johnathon Hereen2

1Country Health South Australia Local Health Network 22 King William Street Adelaide SA 5000   fiona.murray@health.sa.gov.au
2Comfootcare, 2 Dunalbyn Drive Aberfoyle Park.  Comfootcare@qq.com

The provision of appropriate footwear for clients with clinically high-risk feet is a key strategy in reducing recurrent ulcerations and maintaining independence.

Background

Footwear prescribed by podiatrists in Country Health South Australia (CHSA) has historically been provided by traditional boot makers. Each boot maker uses different measuring and construction methods, which are traditional hand crafting techniques; dependent on the experience of the boot maker. They are time and labour intensive which is reflected in the cost of the footwear. Most boot makers are located in Adelaide, which can mean multiple, long trips for many clients in order to obtain shoes.

Methods

A partnership was developed with a pedorthotist based in China who has developed the ‘SmartFit Scanning System©’.  This system consists of a portable 3D foot scanner with a bespoke software application that produces a 3D image of the foot which can be digitally adjusted. By utilising this unique technology it means that footwear can be manufactured  remotely without the pedorthotist actually seeing the client. This has required the development of a unique partnership approach between the pedothotist in China and the Podiatrist working in CHSA.

Results

Clients that received footwear using the SmartFit Scanning System©, found it more comfortable and aesthetically pleasing. There was a 30-50% reduction in costs, delivery time averaged 6-8 weeks versus 3-6 months.

Discussion

This project supports the concept of remote manufacturing to provide access to  timely, cost effective, aesthetically pleasing and functionally appropriate footwear,  for clients in even the most remote areas in Australia.

Biography

Originally from the UK I moved to South Australia in 2012 to take up the post of Advanced Clinical Lead Podiatrist for Country Health South Australia (CHSA).  Since qualifying in 1988 I have worked in many different clinical settings covering the whole scope of podiatry practice. I have published and presented on different aspects of the Diabetic Foot, wound healing and patient psychology.Since my move to CHSA I have focused on driving consistency in clinical care and the introduction of objective measures for clinical care to improve quality of care for people in Country South Australia.

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