Stroke rehabilitation in country: Are we getting it right?

Alanna Grover1

1Whyalla Hospital & Health Service, PO box 267 Whyalla, SA 5600, alanna.grover@sa.gov.au

Background

Stroke is a major health care concern in Australia. Therefore there are best practice standards, informed by current best research evidence, on the management of stroke. Despite these standards, translating these into practice face numerous challenges, especially in rural and remote areas where access to health care is already compromised, resulting in poor health outcomes. A clinical audit project was undertaken to determine if the current physiotherapy practice adhered to current best practice for stroke patients in Country Health SA Local Health Network (CHSALHN) inpatient rehabilitation services.

Methods

Medical records documentation and client contact data from the three CHSALHN inpatient rehabilitation services for all patients admitted for inpatient stroke rehabilitation in the financial year 14/15 was audited. Compliance was measured against national clinical practice guidelines using a customised clinical audit tool.

Results

Findings from the data indicate that physiotherapy services are compliant for task specific training, retraining of sitting balance, transfers/gait, standing balance, progressive resisted strengthening and cardiovascular training. However, areas for improvement were identified including initial assessment, client/family-centred goals setting and decision making, intensity of therapy, prevention of shoulder subluxation, and intervention for somatosensory impairments.

Discussion

These findings highlight the ongoing challenges confronting rural and remote allied health clinicians in providing best practice care for stroke. While the challenges are evident, the solution to these issues remains difficult. This is because of the complexity of the health system, competing clinical priorities etc. If these issues are to be addressed, a system wide approach to change is required.

Biography

Alanna is the Clinical Senior Physiotherapist for Rehabilitation services in Country Health SA Local Health Network, and is based at the Whyalla Hospital.  She has worked in country South Australia since 2006 and is passionate about ensuring people from country South Australia have access to specialist rehabilitation services closer to home.

It takes a village: A partnership to provide speech pathology placements and clinical services

Michelle Smith-Tamaray1, Ruth Mulligan2, Chelsea Hillennaar3

1 School of Community Health, Charles Sturt University, PO Box 789, Albury, 2640. mchsmith@csu.edu.au
2 Alpine Health, 30 O’Donnell Avenue, Myrtleford, 3736. Ruth.mulligan@alpinehealth.org.au
3 Alpine Health, 30 O’Donnell Avenue, Myrtleford, 3736. Chelsea.hillennaar@alpinehealth.org.au

Background

Provision of allied health services within the residential care sector is an ongoing challenge due to a number of factors, including costs and access. This is particularly evident in rural settings, where availability of services is exacerbated by distance. A collaborative approach between a rural, multi-site health service and a university program has been developed to address an identified need for speech pathology services. This paper will present data from an ongoing evaluation of this student speech pathology service, and the challenges and benefits experienced by the stakeholders involved.

Method

A mixed method approach is being utilised, including audits, surveys, and interviews. The program is being evaluated from 3 perspectives: benefits to the service, benefits to the residents and benefits to the students. Descriptive statistics, content and thematic analysis are being undertaken.

Results

Preliminary data suggest positive outcomes for all stakeholders involved. The service has received an increased number of speech pathology consults, and has also assisted in identifying areas of focus for quality assurance initiatives. Students have reported positively on the program, both from the perspective of skill development as well as their attitudes to working within the aged care setting. Current data collection is focused on residents’ and nurses’ reports, as well as some of the challenges encountered, with ongoing evaluation being undertaken.

Discussion

This partnership has resulted in development of a model for increased opportunities for clinical placements, as well as provision of difficult to access speech pathology services for residential care in a rural area.

Biography

Michelle is a lecturer within the Speech Pathology program at Charles Sturt University. She has experience working in both generalist and adult-specific positions across a range of clinical settings, as well asundertaking management roles and student supervision. She has also served as a member on local health and education organisation boards, as well as Department of Health working parties. Michellehas an interest in rural health and equity issues, particularly in the provision of services to adults.

Accessibility of speech pathology services in non-metropolitan New South Wales and Victoria

Linda Wilson1, Michelle Smith-Tamaray2

1School of Community Health, Charles Sturt University, P.O. Box 789, Albury, 2640, liwilson@csu.edu.au
2School of Community Health, Charles Sturt University, P.O. Box 789, Albury, 2640, mchsmith@csu.edu.au

Background

Some years ago, we presented a paper at a SARRAH conference outlining a methodology for investigating the geographic accessibility of speech pathology services in non-metropolitan New South Wales (NSW) and Victoria. This presentation will consist of a summary of data obtained via this methodology, and a demonstration of how the different types of data can be used to document a range of accessibility issues.

Method

A custom-designed telephone survey was conducted with representatives of speech pathology departments within public health facilities across rural NSW and Victoria. Representatives were asked questions about the area serviced by their department, locations and frequency of services, client eligibility criteria, staffing numbers (etc.). Data were analysed for different client groups, such as preschool children and adult outpatients, via mapping processes, simple statistics, and thematic analysis of qualitative data.

Results

While clients living in some areas of non-metropolitan NSW and Victoria were provided with geographically accessible speech pathology services, clients in other areas were not. In addition, some areas that were provided with services received those services less frequently than would be required to properly manage common speech pathology conditions. Maps and other data will be used to illustrate these and other results.

Discussion

This research was the first attempt to document the accessibility of speech pathology services in Australia. The data obtained are very powerful, and can be used for advocacy and for planning for improved accessibility of existing services. A similar methodology could be used to document the accessibility of other allied health services in rural areas.

Biography

Linda Wilson is a lecturer in speech pathology at Charles Sturt University, who has conducted research into telehealth delivery of speech pathology services. She has also worked with colleagues and research higher degree students to research the accessibility of speech pathology services in rural areas. Most recently, she has developed a Masters-level subject in which students engage with concepts related to geographic, institutional and cultural accessibility, in order to better understand how practice decisions can affect clients’ abilities to access services.

Geriatric, adult rehabilitation and stroke service (GARSS) day therapy model of care

Dr Nisal Gange1, Samantha Gollan2, Frances Mattocks3

1Geriatric, Adult Rehabilitation and Stroke Service, Toowoomba Hospital, PMB2, Toowoomba, 4350, nisal.gange@health.qld.gov.au
2Geriatric, Adult Rehabilitation and Stroke Service, Toowoomba Hospital, PMB2, Toowoomba, 4350, sam.gollan@health.qld.gov.au
3Geriatric, Adult Rehabilitation and Stroke Service Toowoomba Hospital, PMB2, Toowoomba, 4350, frances.mattocks@health.qld.gov.au

Background

Day therapy (DT) services have been shown to improve patients’ ability to undertake activities of daily living and reduce risk of deterioration post discharge from hospital. The Toowoomba Hospital DT team recently underwent extensive service reform with a number of new initiatives implemented. The goals of the reform were:

  • To ensure holistic multi-disciplinary patient-centred care
  • To maximise efficiency to cater for increasing demand and patient complexity and acuity;
  • To improve patient flow.

The purpose of this project was to evaluate whether these goals were achieved.

Method

A retrospective cross-sectional study was conducted. Effectiveness of service parameters were evaluated and compared for a 3 month period pre (2012) and post (2014) implementation of changes.

Results

A 31% increase in referral numbers post implementation of changes was observed. The proportion of clients who had a multi-disciplinary needs assessment increased 2.5 times. Average waiting times were also reduced with Multi-disciplinary needs assessment completed in 4 days compared to 22, and median waiting time from referral to the first appointment reduced from 40 to 22 days.  Whilst patients required a similar number of admissions to hospital in the 6 months following DT service, the median acute length of stay was reduced from 8 to 3 days and the sub-acute length of stay reduced from 13 to 0. This equates to an approximate cost saving of $173,304 in a 3 month period.

Discussion

The introduction of an advanced Trans-disciplinary role, early multidisciplinary screening and streamlining of processes and procedures have resulted in improvements in the efficiency and effectiveness of the DT service. This has allowed for a streamlined respond to the increasing service demand, improved patient-centred practice and timely access to clinically appropriate multidisciplinary care.

Biography

Fran Mattocks is an Occupational Therapist with 13 years experience working in rural health. Currently employed as the Advanced Allied Health Practitioner within the Geriatric Adult Rehabilitation and Stroke Service (GARSS) at Toowoomba Hospital, with a clinical focus on sub acute care.

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.

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.

The first rural and remote subacute service; inception to implementation

Helen Wassman1, Elaine Heffernan2

1South West Hospital and Health Service , 197 – 234 McDowall St 4455  helen.wassman@health.qld.gov.au
2South West Hospital and Health Service , 197 – 234 McDowall St 4455  eliane.heffernan@health.qld.gov.au

The South West Hospital and Health Service (SWHHS) covers 319,870 square km and provides services to an estimated population of over 27,000 people.  The Service consists of 11 hospitals, four outpatient clinics, two residential aged care facilities and two community health centres.  In order to provide increased subacute access to the people in the SWHHS a new 7 bed sub-acute care unit at Roma Hospital commenced in 2014. It was the first such unit to be established within a Queensland Health rural and remote Hospital and Health Service. The Subacute Rehabilitation Unit provides rehabilitation, transition care, geriatric evaluation and management, stroke, psychogeriatric and palliative services. The unit has a hub-spoke relationship with major secondary and tertiary hospitals. There is a committed telehealth model in place with geriatrician support. This unique unit did not spring up overnight. To make our dream a reality it took time to identify need, as well as research to create our model. Our successes to date have come through a united vision of a dedicated and diverse group of clinicians working towards our single purpose, to deliver high quality care safely in our local communities. This presentation seeks to outline the challenges and opportunities the Subacute Service faced from inception to implementation. Building a new health service in rural and remote Queensland has not been without its challenges. The result now is, however, a valuable, responsive and resourceful service that would not exist without the partnership between the community and the South West Hospital Health Service.

Biography

Helen Wassman Service Director,Community & Allied Health Adult Services RomaI have more than 30 years’ experience as an occupational therapist in hospital and community settings. More recently, I completed postgraduate studies in palliative care at Flinders University. I relocated to South West Queensland three years ago to gain further experience in rural and remote healthcare and prior to this I worked at the Royal Darwin Hospital. I am motivated by the desire to constantly find better ways to deliver health services and to ask ‘what is possible’. The patient experience is the forefront of quality health care.

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