I’m tired. I’m weak. I’m in an ICE age. Where to from here?

Steve Cadell

BPhysio, Masters of Rehabilitation (Physiotherapy) Student

Background: ICE/methamphetamine abuse in rural populations is becoming an increasingly serious phenomenon resulting in end stage renal failure (ESRF). Intradialytic therapies are fast becoming necessary to promote functional capacity and maximise quality of life in a younger patient population.

Aim: This systematic review seeks to ascertain whether the prescription of intradialyitic strengthening exercises in adults, (under the age of 65yrs with ESRF) may promote increased functional capacity and strength. Outcome measures include functional capacity assessments, muscle mass on cellular, molecular and tissue levels.

Method: Databases used for this review included SCIENCE DIRECT, PEDro & MEDLINE retrieving 4 appropriate articles based on exclusion criteria.  Exclusion criteria included: not a randomised control trial, abstract only, participants over the age of 65years, required payment, non-English or written before the year 2006.  Articles were rated as 1b evidence (NHMRC) and critically appraised using the PEDro tool.

Discussion/Recommendations: Evidence suggests intradialytic strength/resistance training in patients with ESRF under the age of 65years of age is effective in promoting muscle growth, strength and increased functional capacity. No research is specific to methamphetamine induced ESRF and associated deconditioning therefore further research is required. A qualitative approach understanding the behaviours and emotions associated with methamphetamine related renal failure is necessary to provide a holistic rehabilitation model of care. The ICE/methamphetamine epidemic will require us to manage an aging population concurrently with a prematurely aged demographic. How will we maximise future therapies and resource expenditure in order to preserve life and save “our village?”

Outcomes of the Ministerial Taskforce: Progressing expanded scope of practice

Liza-Jane McBride1, Belinda Gavaghan2 Julie Hulcombe3

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
3 Allied Health Professions’ Office Queensland, PO Box 2368, QLD, 4006, Julie.hulcombe@health.qld.gov.au

Background

The Queensland Health Ministerial Taskforce on health practitioner expanded scope of practice: final report (the taskforce) was released in June 2014. The report concluded that improvements to patient-centred care, as well as service effectiveness and efficiency, can and should be achieved by expanding allied health scope of practice. Six recommendations, focused on facilitating systematic and statewide change, were made to guide changes to allied health scope of practice and service delivery models over the two-year implementation period.

Progress

Early success achieved legislative changes enabling prescribing by endorsed podiatrists and requesting of plain-film x-rays by physiotherapists and podiatrists. However, a range of persistent legislative and policy barriers continue to inhibit allied health workforce reform and flexibility. Health services have made good progress in implementing a number of expanded scope models that have improved patient access to services and decreased waiting times in specialist outpatient and emergency departments. Despite this progress, these models are still not widespread and are often not sustained in the mid to long-term. Influencing Commonwealth funding models has proven difficult from a jurisdiction level. Negotiation of inclusion of incentives within service agreements to support allied health expanded scope models has also been challenging.

Next steps

A three-year expanded scope strategy has been developed to further progress Taskforce recommendations and embed expanded scope of practice for allied health professionals in Queensland. Work will focus on embedding proven models of care, investing in research and data collection systems, implementing sustainable workforce development pathways and addressing persistent barriers to expanded scope of practice.

Where is the voice of community in rural and remote allied health service and workforce design?

Debra Jones

Background

Rural and remote Australian communities can experience multiple and simultaneous allied heath disadvantages and service inequities. Engaging communities in the identification of their allied health needs and solutions to address these needs, and associated workforce shortages, is critical in enhancing service accessibility and acceptability.  New approaches that centrally locate communities in allied health service and workforce design are required however these voices can be marginalised in their own health care agendas.

Methods

Findings from a qualitative study that explored the impact and outcomes of participation in a rural community-campus partnership and associated allied health service-learning program that sought to address allied health service inequities in far west NSW have been drawn on in the identification of nine key features for enhanced community engagement in service and workforce design.

Results

The nine features of engagement are: 1) responding to community need, 2) acquiring a sense of rural place, 3) provision of services of value, 4) community innovation, 5) community leadership, 6) reputation and trust, 7) continuity and continuums, 8) multi-directional knowledge transference, translation and generation, 9) and adaptability.

Discussion

A failure by health and higher education systems to address these features contributes to mal-aligned services to community needs, practice to contexts, and lack of service accessibility and acceptability. These engagement features need to be addressed if we are to enhance systems’ capacity to engage with rural and remote communities, support the active collaboration of communities in allied health service and workforce design, and ultimately improve rural and remote health outcomes.

Biography

Debra Jones is a registered nurse by background with extensive experience in rural and remote Australian health care. Debra has held senior management positions in both state health organisations and higher education institutions.   Debra has been involved in a number of rural and remote health service and workforce innovations that have sought to align health service to community identified needs and develop health professionals to provide services in these contexts. Debra holds a Master of Indigenous Health (with Distinction) and is currently undertaking a PhD.

Falls risk screening and assessment: Barriers and enablers for rural physiotherapists

Robyn Gill1, Meredith Stewart 2, Paul O’Callaghan3, Nicholas Petch4

1 Senior Clinical Educator, Physiotherapy, Country Health SALHN/ Flinders University of SA, PO Box 2100 Adelaide SA 5001 robyn.gill@sa.gov.au
2 Falls Prevention Project Manager, Country Health SALHN, PO Box 270 Angaston SA 5353 meredith.stewart@sa.gov.au
3 Paul O’Callaghan, Master of Physiotherapy student, Flinders University of SA
4 Nicholas Petch, Master of Physiotherapy student, Flinders University of SA

Background

This study explored perceived barriers and enablers of the use of the Falls Risk for Older People in the Community (FROP-Com) screening and assessment tools among physiotherapists in the Country Health South Australia Local Health Network (CHSALHN).

Methods

In 2015, a survey was sent to all CHSALHN physiotherapists to determine perceived barriers and enablers of the FROP-Com screening and assessment tools.

Results

Fifty one physiotherapists completed the survey (52%). Overall there was a positive attitude toward the FROP-Com tools. The majority of respondents reported that referral pathways for falls risk screening and assessment had been developed for their region (90%). However, results suggested a breakdown in referral pathways and an increased reliance on physiotherapists to complete the FROP-Com tools. The greatest enabler for screening was staff interest in falls management (70%). Superior falls education (71%) was the greatest enabler for assessment with barriers identified as time (89%) and prioritisation (73%).

Discussion and recommendations

Understanding physiotherapists’ perceptions concerning the FROP-Com tools is an important platform in contributing to an effective falls management system. This research presents a number of recommendations to improve the adherence and process of performing FROP-Com screening and assessments, most pertinent being further education of staff around use of the tools and recording practice. Other recommendations include a review of referral pathways and amendments to the FROP-Com tools. Further research around falls intervention uptake in other health networks and across disciplines may guide increased adherence to falls screening and assessment and improve delivery of rural patient care.

Biography

Robyn joined Country Health SA in 2014 as Senior Clinical Educator in Physiotherapy for CHSALHN/ Flinders University.Her role is to support Flinders Uni Physiotherapy CHSALHN clinical placements.Robyn has been an educator of Physiotherapy students for over 25 years at both Flinders University and Uni SA.Robyn holds a Master of Applied Science in Physio (Manipulative Physio) from the Uni of SA.Areas of interest are Rural/ Remote Health; Musculoskeletal Physiotherapy; education in the discipline of Physiotherapy especially Clinical Simulation, blended learning and giving feedback.

Village hopping without a hitch

Ruth Neagle1, Claire Easterbrook2, Fiona Murray3

1 Podiatrist, Inner Northern Community Health Service, PO Box 196 Gawler SA 5118, ruth.neagle@sa.gov.au
2 Senior Podiatrist, South East Regional Community Health Service, PO Box 267 Mount Gambier SA 5290, Claire.easterbrook@sa.gov.au
3 Advanced Clinical Lead Podiatrist, Country Health SA, Community Health Service, Angaston Hospital, 29 North Street Angaston SA 5353, Fiona.murray@sa.gov.au

The successful implementation of the Country Health South Australia (CHSA) Clinical Supervision Framework and ongoing work to build one cohesive podiatry team has had a significant impact on our ability to provide seamlessly integrated clinical care for Podiatry clients across country South Australia.  The Country South Australia regions have come together to create one podiatry ‘village’ and this in turn has seen better patient outcomes and improved patient satisfaction.

An example of this is when Judith, a client from Mount Gambier, was diagnosed with Charcot Neuroarthropathy (CN).  Management of CN requires blood tests, x-rays, weekly foot monitoring and Total Contact Casting (TCC) as gold standard treatment. TCC (generally required for several months) commenced in Mount Gambier but 4 months into her treatment Judith wanted to travel by bus 450kms to visit her daughter in the Barossa Valley for two weeks. Prior to the ‘Podiatry Village’ Judith would have either needed to cease TCC treatment for 2 weeks, return home after one week to attend an appointment or register as a temporary resident with a Barossa Valley GP to be referred as a new client to the Gawler Podiatry service. Now, because she is a ‘podiatry villager’, all that is required is a simple phone call and email handover to the Podiatrists in Gawler and Judith is able to travel away from home to visit family without interruption in her therapy.  Strengthened networking and communication channels and documentation across CHSA are responsible for this success and is an achievement worth celebrating.

Biography

Ruth is a passionate podiatrist with a Graduate Diploma in Wound Care.  She has ten years of experience working with high risk feet and more than half of those years has been spent working in rural and remote areas of South Australia and Queensland.

Understanding nutrition as a patient safety problem: an audit of South Australian practices

Michelle Schilling

Country Health SA Local Health Network (Port Lincoln site) PO Box 630, Port Lincoln, SA, 5606, michelle.schilling@sa.gov.au

Background

There is evidence to indicate that poor nutritional care can threaten the safety of people in hospital and community settings leading to increased mortality and morbidity (1). Nutritional care crosses diagnostic, professional and jurisdictional boundaries and can impact a range of health care stakeholders. The aim of this initiative was to provide an overview of, and quantify, the number of nutrition-related patient safety incidents reported in SA Health’s Safety Learning System (SLS) and a summary of themes and contributing factors reported in this data.

Methods

Incidents reported in the SLS as occurring during one calendar year (2015) were searched for nutrition-related keywords using a free text search. Nineteen nutrition-related keywords were used to generate incident reports which were reviewed for nutrition-related incidents against the nutrition-related patient safety incident definition.  Nutrition-related incidents were attributed to one or more key themes.

Results

The findings from this audit indicated that the most commonly reported patient safety nutrition-related incident themes were aspiration/choking, problem with meal or feed preparation and/or delivery, and fasting-related. Contributing factors were poor and lack of timely communication between staff and departments/services, and problems relating to ordering (misinterpretation or incorrect ordering), incorrect/delayed prescription and delivery of feed/food/fluids.

Discussion

Health care organisations should recognise that poor nutrition care practices can cause unnecessary harm to patients, resulting in poor quality health care. Despite its impact, currently nutrition-related patient safety incidents are under reported and/or hidden in other patient safety incident areas resulting in missed opportunities for improvements.

  1. Dietitians of Australia. Evidence based practice guidelines for the nutritional management of malnutrition in adult patients across the continuum of care. Nutr Diet 2009; 66(Suppl.): S1-S34.

Biography

Michelle Schilling is a local Port Lincoln resident with a Masters in Nutrition and Dietetics. She has been working as a Dietitian in South Australia for the past 15 years within country and metropolitan health services. Michelle’s current job role focuses on the quality, safety and effectiveness of Dietitian services across Country Health South Australia Local Health Network. Her contribution to the Dietetics profession involves an earlier history of Dietitians Association of Australia committee work, journal publications and more recently within South Australia’s diminished community nutrition / public health areas.

Training the next generation of allied health professionals in innovative service delivery

Lauren Jeffery1, Professor Deborah Theodoros2, Professor Trevor Russell3

1Telerehabilitation Clinic Manager & Clinical Educator, University of Queensland, Brisbane, QLD, 4067, l.harms1@uq.edu.au
2Co-Director Telerehabilitation Clinic, Centre for Research in Telerehabilitation, University of Queensland, Brisbane, QLD, 4067, d.theodoros@uq.edu.au
3Co-Director Telerehabilitation Clinic, Centre for Research in Telerehabilitation, University of Queensland, Brisbane, QLD, 4067, t.russell@uq.edu.au

The Telerehabilitation Clinic (TRC) is an innovative teaching and learning clinic for Allied Health students enrolled in the School of Health and Rehabilitation Sciences at the University of Queensland. The aim of the TRC is to provide audiology, occupational therapy, physiotherapy and speech pathology services to people in rural and regional Australia, where access to therapy is diminished.

A key objective of the TRC is to train the next generation of allied health practitioners to be creative and to deliver therapy via alternative modes. While there are challenges in delivering telerehabilitation services across Australia, creative solutions and ‘out there’ ideas are beginning to change what clinicians believe is possible via telerehabilitation. Research conducted in the TRC is taking these creative ideas and providing the evidence base for their use. There may be controversy when challenging people’s beliefs about traditional therapy services, but the health impacts that are possible via telerehabilitation outweigh the difficulties faced.

Students provide valuable input into our clinic through their creative thinking in the use of technology and how services might be delivered. By establishing the TRC and delivering allied health services via telerehabilitation to people in the wider community, we are able to reform services and the role of Allied Health practitioners. Telerehabilitation will become mainstream in health services within Australia in the years to come, and it is imperative that allied health graduates have the education and clinical experience in this innovative mode of service delivery.

Biography

Lauren is the University of Queensland Telerehabilitation Clinic Manager and Clinical Educator.  Lauren is a physiotherapist, with an interest in developing new programs & innovative ideas to deliver allied health services to people in rural and regional areas. Lauren has been involved with establishing audiology, occupational therapy, physiotherapy and speech pathology services within the Telerehabilitation Clinic (TRC). The TRC aims to provide exposure opportunities and service delivery for Allied Health students through learning modules and clinical placements.

This is community and allied health – strengthening the way we work

Joshua W Freeman

South West Hospital and Health Service, 44-46 Bungil Street, Roma 4455, josh.freeman@health.qld.gov.au

The South West Hospital and Health Service Community and Allied Health Division is made up of over 170 staff providing both inpatient and outpatient services to close to 30,000 people in South West Queensland.  In late 2015 and early 2016 the Division went through an organisational redesign aligning its organisational architecture to support services delivered at the clinical coalface. Culture and structure are important to establish and maintain clarity of practice.  The change in organisational architecture was compelled by the lack of cultural affinity staff felt by a structure that did not support their work practices.  There is clear evidence of the link between leadership and a range of important outcomes within health services (West, 2015).  It was for this reason reforming services focused on geographic and service wide models to drive a supportive culture of performance.  Organisational change is challenging and the key was to establish a clear purpose for change that people could understand.  The core components of the change management process were driven by the C4 Pillars which represent Clients, Clinicians, Clarity and Consistency.  Outcomes of the change included cementing workforce performance outcomes, capability and development, strategic plan objectives and government programs into every day work practices to drive a culture of excellence in rural and remote community and allied health services.

Biography

Josh Freeman has a background in public and not-for-profit leadership roles. He holds a Bachelor of Pharmacy, Post Graduate Certificate in Medicines Management (University of Otago) and a Master of Business Administration (University of South Australia). Josh is passionate about transformational leadership and has interests in organisational culture. Josh is a Graduate of the AustralianInstitute of Company Directors, is a member of the Australian Institute of Management, has completed the Queensland Health Emerging Clinical Leaders Program and has recently attended the European Summer School for Advanced Management (ESSAM) through Loughborough University (UK).

Restructure of the model of care in a regional psychology department, in order to increase provision of service to consumers

Rachel Bega

Queensland Health, 475 Bridge Rd, QLD, 4740, Rachel.bega@health.qld.gov.au

Most Allied Health departments in the public health system adopt one of two models of care: a centralised referral system where all referrals are received through a single point of contact and then triaged and allocated to staff, or an allocation of staff to the various units or areas within the hospital. This latter model was the one initially adopted at the Mackay Base Hospital, which resulted in an inefficient use of very limited resources. A restructure of the model of care was implemented, which included two major changes: 1) A change from allocation of staff to various units, to a central referral system and 2) a change in semantics. These changes resulted in an increase of 100% in the number of patients seen by the psychology department. It is suggested that this model of care is ideal in a regional setting, where limited resources are available.

Background

The Psychology Department at the Mackay Base Hospital comprises 6 staff members, typically allocated to various units such as the Renal unit, Diabetes clinic, Paediatrics etc. This led to an inefficient use of clinician time as staff would for example be allocated to a unit for 2 days a week but only be utilised at 25%. Flexibility to shift the workforce to areas of greater need was limited, due to the fact that they had been allocated to a specific unit. This model also limited access for patients who would only be provided with Psychological Services if they were already receiving services from the units that had an allocated psychologist. It was very conservatively estimated that approximately $67000 in labour was being wasted every year by utilising this model.

Methods

A centralised request system was established whereby requests were accepted from all areas of the Mackay Hospital and Health Service (both inpatients and outpatients).

A distinction was made between referrals and requests. Whilst a referral implies the patient’s care is being handed over, a request allowed us to provide services in a variety of ways: direct service to the patient, consultation with the treating team and occasionally redirection to a more appropriate service.

All requests were actioned.

This model enabled increased flexibility in the allocation of psychological services by allowing the department to move its labour resources according to demand. In some cases, where it was deemed that a single clinician would be more beneficial in order to ensure excellency in patient care, an individual psychologist continued to be allocated. For units that did not have an allocated psychologist, every effort was made to triage referrals from specific units to a single clinician in order to encourage relationship-building within the unit. For example, the majority of the oncology referrals were sent to a specific clinician who also attended oncology clinical reviews. At times of high demand from the oncology department however, we were able to draw upon other psychologists.

Results

The number of Occasions Of Service (OOS) were utilised as a measure of the effectiveness of this model of care.A survey is also currently being developed in order to collect qualitative data regarding satisfaction levels with the use of the service.

As a result of the new model of care, we were able to double the number of Occasions Of Service, resulting in approximately 100 patients receiving psychological services over a period of 3 months, who would not have previously benefited from psychological input.

Discussion

Modelling suggests that our Health System will come under increased pressure with an ageing population. It has also been suggested that the growth required is unsustainable.

It is therefore important that we identify models of service that maximise on our resources, especially in regional, rural and remote areas, where resources can be limited.

This model of service did not require any additional funding, yet resulted in a 100% improvement in efficiency.

Biography

Rachel Bega holds a Masters in Clinical Psychology and a Certificate in Business Management. She initially trained and worked in South Africa, then Melbourne, across both the public and private health sectors, as well as as the penal system. She currently heads the psychology department in the Mackay Hospital and Health Service.

How to develop the next generation of Australian rural and remote physiotherapists

Kerstin McPherson

Charles Sturt University, Leeds Parade , Orange NSW 2800 kermcpherson@csu.edu.au

There is a growing number of graduates from Australian universities in Physiotherapy. With fewer opportunities in metropolitan areas, graduates will seek work in sole rural and remote positions.  Throughout their training, how do we to ensure that all graduates are ready for the unique demands for rural and remote practice in Australia?

This presentation will describe an “embedded approach” to rural and remote Physiotherapy education. Where challenges and opportunities are explored through a transformative learning approach to teaching – where students are guided through clinical and professional practice but  also explore their own values and beliefs to be able to  develop partnerships required  to negotiate through  challenging and changing work location and practices upon graduation.

Biography

Kerstin is a Physiotherapist and has worked in rural and metropolitan locations in Australia and the UK. Since 2010, Kerstin has been teaching into the undergraduate Physiotherapy program at Charles Sturt University in Orange, NSW and is the current Discipline Lead of Physiotherapy. She is also a current Board member of SARRAH.