Talking EPC - speech pathologists' views of the Enhanced Primary Care items four years on

Aligned or misaligned: Are public funding models for speech-language pathology reflecting recommended evidence? An exploratory survey of Australian speech-language pathologists

Government subsidised funding arrangements serve as an essential medium for families to access private speech-language pathology (SLP) services in Australia. This study aimed to investigate whether, from a provider perspective, contemporary public funding models (PFMs) align with best-available scientific evidence for management of children and young persons with swallowing and communication disorders within Australian private-practice settings. This exploratory study was distributed to paediatric speech-language pathologists throughout Australia via an online survey. A total of 121 valid surveys were completed by Australian speech-language pathologists with divergent career experiences. In comparing three familiar PFMs using mixed effects logistic regression models to estimate odds ratios, results indicated that perceived congruence with recommended scientific evidence for SLP management varied across PFMs: the odds of failing to align with scientific evidence was 4.92 times higher for Medicare's Chronic Disease Management Plan (MBS_CDMP) than for the National Disability Insurance Scheme; and 7.40 times higher in comparison to Medicare's Helping Children with Autism initiative. This study is the first to report on (in)congruence between PFMs that provide access to independent Australian SLP services for children and young persons and best available scientific evidence to inform clinical practice. Participants identified that: (a) four out of seven contemporary PFMs were unfamiliar to speech-language pathologists; and (b) MBS_CDMP initiative failed to align with the evidence-base for best scientific SLP management.

Regional and remote occupational therapy: a preliminary exploration of private occupational therapy practice

BACKGROUND/AIM

Private providers of Medicare funded services are an integral part of the Australian primary health-care system. Evidence on private occupational therapy practice in rural and remote Australian settings is sparse.

METHODS

Providers of private occupational therapy services in outer regional and remote areas were surveyed regarding location and type of services provided, practice models and demographics. Descriptive statistics were used to summarise the findings.

RESULTS

Thirty-seven respondents completed the survey. In remote areas a number of occupational therapy services are not provided and no practices are based in very remote towns. One quarter of respondents visit at least five towns each week and one third had other paid employment. Nearly half indicated they will leave private practice within the next five years and nearly one third believed they could not sustain their practice. Medicare Chronic Disease Management was the main income source of only around half the respondents.

CONCLUSIONS

There is a potential market failure of private occupational therapy in rural and remote areas, impacting on people who need these services and on workforce replacement. Contributing factors include population imbalance between cities and regional/remote areas, financial implications where only face-to-face contact is paid for and low incomes and levels of health insurance in regional/remote areas. Potential strategies include addressing the lack of reimbursement for travel, enabling private providers to overcome barriers to providing student placements and recognising rural practice as a specialist field.

The Enhanced Primary Care program and falls prevention: perceptions of private occupational therapists and physiotherapists

AIM

To investigate the processes involved for private occupational therapists (OTs) and physiotherapists (PTs) to implement Medicare items from the Enhanced Primary Care (EPC) program within their practice, for the purpose of falls prevention interventions for older people.

METHODS

Qualitative study using a grounded theory approach employing semistructured interviews with five private occupational therapists and five private physiotherapists from across the Sydney area and the Hunter region.

RESULTS

The following key themes emerged in relation to the potential for the EPC to be used to access falls prevention: (i) interdisciplinary communication and communication with consumers; (ii) best practice in community-based falls prevention using the EPC program; and (iii) administrative and organisational challenges of the EPC program.

CONCLUSION

Participants supported the EPC program, and saw its potential for delivering falls prevention interventions in the community. However, findings suggest that the EPC program needs to be further refined to be more effective.