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

Grasping sustainability in rural and remote areas: A case study.

Johnstone M1, Huxley C2, FitzGerald G3

1The Department of Health Queensland, Funding Strategy and Intergovernmental Relations Branch, Level 9, 160 Mary Street, Brisbane, 4000, Melissa.Johnstone@health.qld.gov.au
2The Department of Health Queensland, Capital Infrastructure Delivery Unit, Level 5, ANZAC Square, Brisbane, 4000, Craig.Huxley@health.qld.gov.au
3Queensland University of Technology, School of Public Health and Social Work, Faculty of Health, QUT Victoria Park Road, Kelvin Grove, Queensland, 4059, gj.fitzgerald@qut.edu.au

Aims and Objectives

An exploratory case study of a commercial, multidisciplinary organisation operating in 25+ locations was undertaken in two phases. A summary of phase 1 was presented at the National Allied Health Conference in 2015. The topic of this presentation is phase 2 which aimed to validate the findings from phase 1, and further explore the five key components found to impact sustainability: business, staff, work, environment and leadership.

Methods

All staff were invited to partake in an online questionnaire. Twenty employees (43.5%), whose roles included clinicians, managers, co-ordinators, receptionists and administration support with ages ranging from ‘<20’ to ‘51-60’ participated. All questions were generated as a result of phase 1; each one represented a broad category impacting sustainability. Response options were also generated following phase 1; free text was permitted to create new responses. Four of the five key questions asked respondents to rank their preferences, whilst one question asked them to ‘select all responses that apply’. Collated data was exported into a spreadsheet and a score for each response was generated. The popularity of each response was analysed, as well as the cross-over of answers relating to different aspects of the organisation’s model.

Results

Of the 66+ possible responses for the five key questions, six responses surfaced repeatedly. These included: income generation from multiple sources; multidisciplinary care provision; autonomy/independence; flexibility; community-tailored services; and relationships with key stakeholders.

Biography

Melissa began her career as a biomedical scientist, working in laboratories in Melbourne, Brisbane and the U.K. In 2011 her area of interest shifted to public health, and health service management – the focus of her Master’s degree. Melissa worked at Health Workforce Queensland in the Health Services Development for 4 years, and has recently joined Department of Health, Queensland.  Her primary interest is in allied health business models and service delivery sustainability.

Allied health as ambassadors for appropriate health care around Australia

Mulcahy A1, Giles G2

1Australian Commission on Safety and Quality in Health Care, 255 Elizabeth St, Sydney NSW 2000. Amanda.mulcahy@safetyandquality.gov.au
2 Australian Commission on Safety and Quality in Health Care, 255 Elizabeth St, Sydney NSW 2000. Gillian.Giles@safetyandquality.gov.au

Background

Allied health clinicians, our “village”, are collective health system ambassadors who ensure that evidence-based and appropriate care is always delivered. These professions are well-regarded in how they support consumers to make the right decisions about diagnostic and therapeutic interventions. This is important in the current politicised commitments to reduce unwarranted variation in healthcare interventions in rural, remote and metropolitan areas around Australia.

Method

The Australian Commission on Safety and Quality in Health Care worked with the National Health Performance Authority to analyse rates of 37 healthcare interventions from the Medicare Benefits Schedule, Pharmacuetical Benefits Scheme and Admitted Patient Collection data sets. Analysis was conducted by local geographical areas, with remoteness and socioeconomic status stratification.

Results

The Atlas of Healthcare Variation was released late 2015. For the first time, geographical variations in the rates of healthcare interventions were reported around Australia. Key implications for allied health include a 7-fold variation in rates of knee arthroscopies, 3-fold in computed tomography of the lumbar spine, 3-fold in opioid dispensing and 5-fold in chronic obstructive pulmonary disease hospital admissions. Many interventions were used more in areas of higher socioeconomic status.

Conclusions

Depending on where they live, or which health professionals they consult, people with the same health conditions may be managed differently. The Atlas maps show significant variation occurs in some healthcare diagnostics and treatments in Australia, which raises questions about appropriate care.  Allied health clinicians can act to drive appropriate care and reduce unwarranted variation in the health system in many ways.

Biography

Amanda Mulcahy works the Commission in Sydney on a range of projects helping to identify and reduce unwarranted variation in healthcare. She is also completing her Master of Health Policy at the University of Sydney. Prior to this, Amanda was a statewide project lead for the implementation of Activity Based Funding in WA Health. She also has experience in managing local health district strategic projects. Amanda continues to work clinically as an acute hospital physiotherapist and is the immediate past president of the WA Branch of the Australian Physiotherapy Association.

Which remote and rural Queensland towns have greatest health workforce needs? Development of a prioritisation tool

Jo Symons1, Melissa Johnstone1, Davina Sanders1

1Health Workforce Queensland GPO Box 2523 Brisbane, QLD 4001, jsymons@healthworkforce.com.au

People living in remote, rural and regional areas have poorer access to health care and worse health outcomes than their urban counterparts, with increasing remoteness generally associated with greater health inequity. When comparing communities the norm is to compare across one or two of the major risk factors such as population size, remoteness and socio-economic status. However, each of these factors are one dimensional and may miss other important elements related to workforce and community needs. Health Workforce Queensland undertook  their ‘Priority Communities’ project to develop a multi-dimensional tool to measure, rank and prioritise remote and rural communities in Queensland with the greatest health needs.

An evidence-based methodology generated baseline data for each town using components identified as key health need drivers: demographics, medical workforce and remoteness. Key health drivers were given weightings and applied to each town to reflect differential need. Towns were further stratified using a ‘GP per weighted population’ ratio. Following this, a ‘multi criteria decision analysis’ matrix step was undertaken per town, comprising several measures of health service access to further disaggregate and rank the priority group.

The purpose of this presentation is to provide a snapshot of the tool and how it can be adapted for use for remote and rural allied health organisations, PHNs, or other organisations that have an interest in service provision according to health and workforce ‘need’.  We aim to outline the potential value of this robust ‘Priority Communities’ tool to assist address health inequities in rural and remote communities.

Biography

Jo Symons is a Physiotherapist with a breadth of rural and remote experience, having worked clinically and at all levels of management in a primary health care organisation based in Mount Isa, Qld. Jo has operated a consultancy business, specialising in primary health care service modeling that meets the experienced needs of rural and remote communities. Jo’s current role is Manager Health Workforce & Service Planning for Health Workforce Queensland, where she has the opportunity to develop sustainable service delivery models and workforce solutions for a broad range of clients in the rural and remote PHC sector.

Cost-effectiveness analysis of the utilization of 3-dimensional gait analysis (3DGA) to improve the pattern of follow-up treatment service utilization, costs and recovery of burns patients with complex movement disorders

Bharat Vaikuntam1, Robyn Grote 2

1School of Medicine, University of Queensland, QLD, 4029, bharat.vaikuntam@uqconnect.edu.au
2Queensland Motion Analysis Centre, MNHHS, Queensland Health, QLD, 4029, robyn.grote@health.qld.gov.au

Background

Gait analysis may be simply defined as the recorded quantification of human motion. The purpose is threefold: one, to understand the characteristics of human movement; two, to analyze the different components of human movement. In spite of the technological advances in 3-dimensional gait analysis (3DGA), it is not available widely and there are no current studies examining the application of gait analysis for burn victims. Burn patients have problems with their range of motion as well as walking, hand function and balance. So, it would be useful to examine, as this research is proposing to do, determine the cost-effectiveness of 3DGA to improve the pattern of follow-up treatment service utilization, cost and recovery of burn patients with associated complex movement disorders.

Methods/Design

Economic evaluation nested in a prospective randomized controlled clinical trial investigating the effect and cost-effectiveness of the utilization of 3DGA. Study participants will be randomly divided into two non-crossover groups on a turn-based basis, with the first patient who meets the inclusion criteria being placed in the experimental group. The primary outcome is the cost-effectiveness of the 3DGA relative to usual care. The secondary measures including self-rated health (EQ-5D) will also be collected for this analysis. A Cost-effectiveness analysis (CEA) will be performed from a health sector perspective.

Discussion

We hope to demonstrate the cost effectiveness of 3DGA relative to usual care and improve the patient outcomes. This study will provide evidence about the uncertainties underlying the degree of improvement and their subsequent impact on the cost of care.

 

Challenges in rural and remote allied health workforce planning

Ilsa Nielsen1, Mark Minnery2

1Allied Health Professions’ Office of Queensland, Queensland Department of Health, Level 6, 5B Sheridan St, Cairns, 4870. ilsa.nielsen@health.qld.gov.au
2Allied Health Professions’ Office of Queensland, Queensland Department of Health, Level 1, 15 Butterfield St, Herston, 4006

Background

Allied health workforce planning in rural and remote areas is complicated by small staffing numbers, limited data and complex outreach and inter-agency service models. This project aimed to map the access to public allied health services in Queensland and provide data and methods to support ongoing workforce planning.

Methods

Staffing establishment and average clinical service hours by location, and total telehealth and travel hours per fortnight were reported by health service managers in Queensland Hospital and Health Services. Data were analysed descriptively, and correlation and regression analyses were undertaken of staffing establishment and clinical hours data against selected health, social, demographic and service indicators.

Results

Although impacted by small data sets, the analysis failed to identify an indicator that was consistently correlated with staffing establishment or clinical services hours across professions.  Substantial ranges in workforce data were evident for most professions even within clinical service classification groups.  Approximately half of reported positions travelled to provide services, with an average of one day per fortnight allocated to travel for these positions.  A minority of allied health positions (17%) accounted for all telehealth service activity reported.

Discussion

This project demonstrates the challenges to feasibility and validity of ratio-based workforce planning for rural and remote allied health services.  The findings also indicated that the use of staffing establishment as an indicator of service access for consumers is undermined by outreach to and from rural centres and by telehealth services, although the extent of this limitation varies between professions.

Biography

Ilsa Nielsen is currently employed as Principal Workforce Officer in the Allied Health Professions’ Office of Queensland, Department of Health.  This role is based in Cairns and supports workforce policy, planning and development for rural and remote allied health services in Queensland Health.  Ilsa has post-graduate qualifications in public health, education, and health economics and policy.  Her former appointments include academic and clinical physiotherapy positions, and she maintains involvement in undergraduate teaching as an adjunct senior lecturer at James Cook University.