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Clark PW, Williams LT, Brickley B, Ball L. Minimum reporting standards for process and outcomes assessments for private practice dietitians working in Australian primary care: The Thought Leader Consensus study. Nutr Diet 2023; 80:284-296. [PMID: 36217703 PMCID: PMC10952596 DOI: 10.1111/1747-0080.12776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/18/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022]
Abstract
AIM To identify minimum reporting standards for assessing the processes and outcomes of Australian primary care dietetics practice. METHODS A sequential, mixed-method, exploratory process with peer-nominated Australian 'thought leaders'. A literature review was undertaken to identify possible standards, followed by semi-structured qualitative interviews with thought leaders. Content analysis was used to identify a comprehensive group of items that could inform evidence-based reporting standards. Two rounds of a modified Delphi survey were conducted with the same thought leaders to seek consensus on the most relevant items. Individual items were analysed for content validity, and those with a rating of excellent item-content validity (index >0.78) were included as evidenced-based standards for primary care practice. RESULTS Twenty-six thought leaders (response rate: 87%) from all mainland Australian states completed a qualitative interview and two rounds of modified-Delphi consensus surveys. Items were identified and categorised into three domains: business, clinical, and implementation. Content analysis identified 216 items published or used in practice by the thought leaders. After two rounds of consensus review, 97 items (45 business, 33 clinical, and 19 implementation) achieved excellent consensus ratings. Combining these items into a standardised tool, the scale-content validity index average was >0.90, which is considered excellent content validity. CONCLUSIONS This study has identified minimum reporting standards for evidence-based process and outcome assessments in primary care dietetics practice in Australia. Incorporating such standards into a standardised tool could enable benchmarking across the dietetics workforce and contribute to a broader understanding of the dietetic impact on public health.
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Affiliation(s)
- Peter W. Clark
- Griffith University School of Allied Health Sciences, Parklands DriveSouthport, Gold CoastQueenslandAustralia
- Healthier You Pty. LtdPort MacquarieNew South WalesAustralia
| | - Lauren T. Williams
- Griffith University School of Allied Health Sciences, Parklands DriveSouthport, Gold CoastQueenslandAustralia
| | - Bryce Brickley
- Griffith University School of Allied Health Sciences, Parklands DriveSouthport, Gold CoastQueenslandAustralia
| | - Lauren Ball
- Griffith University School of Allied Health Sciences, Parklands DriveSouthport, Gold CoastQueenslandAustralia
- Griffith University, Menzies Health Institute QueenslandNathanQueenslandAustralia
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Cacioppo M, Lucas C, Dai S, Bailly R, Pérennou D, Varengue R, Houx L, Lempereur M, Kandalaft C, Chatelin A, Vagnoni J, Vuillerot C, Gautheron V, Dinomais M, Dheilly E, Bouvier S, Brochard S, Pons C, Mensah-Gourmel J, Génot A, Ropars J, Toullet P, De Lattre C, Klinger E, Laffont I, Sitruk C, Van Boagert P, Tessiot C. Parent satisfaction with medical and rehabilitation services for children with physical disabilities during lockdown. Ann Phys Rehabil Med 2023; 66:101726. [PMID: 36565595 DOI: 10.1016/j.rehab.2022.101726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Marine Cacioppo
- Service de Médecine Physique et de Réadaptation, CHRU Brest, Brest, France; Fondation Ildys, Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, Brest, France.
| | - Clémence Lucas
- Service de Médecine Physique et de Réadaptation, CHRU Brest, Brest, France
| | - Shenhao Dai
- Département de NeuroRéhabilitation Hôpital Sud, CHU Grenoble Alpes ; UMR CNRS 5105 Neuropsychologie et NeuroCognition,Université de Grenoble Alpes, Grenoble, France
| | - Rodolphe Bailly
- Fondation Ildys, Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, France
| | - Dominic Pérennou
- Département de NeuroRéhabilitation Hôpital Sud, CHU Grenoble Alpes ; UMR CNRS 5105 Neuropsychologie et NeuroCognition,Université de Grenoble Alpes, Grenoble, FranceDépartement de NeuroRéhabilitation Hôpital Sud, Université de Grenoble Alpes, UMR CNRS 5105 Neuropsychologie et NeuroCognition, CHU Grenoble Alpes, Cs 10217, Grenoble Cedex 9 38043, France
| | - Roxane Varengue
- Département de Neurologie Pédiatrique, CHU Angers, Angers, France
| | - Laetitia Houx
- Service de Médecine Physique et de Réadaptation, CHRU Brest, Brest, France; Fondation Ildys, Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, France
| | - Mathieu Lempereur
- Service de Médecine Physique et de Réadaptation, CHRU Brest, Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, France
| | | | | | - Jacky Vagnoni
- Fédération Française des Associations d'Infirmes Moteurs Cérébraux, France
| | - Carole Vuillerot
- Service de Médecine Physique et de Réadaptation Pédiatrique, Hôpital Mère-Enfant, Hospices Civils de Lyon, Bron 69500, France; Institut Neuromyogène CNRS UMR 5310 INSERM U1217, Université de Lyon, Lyon, France
| | - Vincent Gautheron
- Service de Médecine Physique et de Réadaptation Pédiatrique, CHU Saint-Etienne, Saint-Etienne, France; UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA7424, Université de Lyon, Saint-Etienne, France
| | - Mickael Dinomais
- Service de Médecine Physique et de Réadaptation, CHU Angers -Les Capucins, Angers, France; Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS) EA7315, Université d'Angers, Angers, France
| | - Elea Dheilly
- Service de Médecine Physique et de Réadaptation, CHRU Brest, Brest, France; Fondation Ildys, Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, France
| | - Sandra Bouvier
- Service de Médecine Physique et de Réadaptation, CHRU Brest, Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, France
| | - Sylvain Brochard
- Service de Médecine Physique et de Réadaptation, CHRU Brest, Brest, France; Fondation Ildys, Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, France
| | - Christelle Pons
- Service de Médecine Physique et de Réadaptation, CHRU Brest, Brest, France; Fondation Ildys, Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, France
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- Service de Médecine Physique et de Réadaptation, CHRU Brest, Brest, France; Fondation Ildys, Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, France
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Shek DTL, Li X, Yu L, Lin L, Chen Y. Evaluation of Electronic Service-Learning (e-Service-Learning) Projects in Mainland China under COVID-19. APPLIED RESEARCH IN QUALITY OF LIFE 2022; 17:3175-3198. [PMID: 35600112 PMCID: PMC9103608 DOI: 10.1007/s11482-022-10058-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/20/2022] [Indexed: 05/25/2023]
Abstract
The use of electronic service-learning (e-Service-Learning or e-SL) is valuable under COVID-19 because we can provide the service without physical contact. Unfortunately, evaluation of e-SL is not widespread and there is no known study in different Chinese societies. Besides, there are many methodological limitations of the existing studies in the field. In this paper, we evaluated e-SL projects implemented in summer 2020 and 2021 in three sites in China. First, we examined service providers' changes based on pretest and posttest scores (i.e., objective outcome evaluation) and their perceptions of the e-SL projects (i.e., subjective outcome evaluation based on the service providers). Second, graduate student assessors in Chinese mainland universities and teachers of primary school students (i.e., service recipients) rated the SL program quality, service providers' performance and benefits to the service recipients after program completion (i.e., subjective outcome evaluation of SL projects based on other stakeholders). Third, trained graduate student assessors evaluated service quality during the implementation process (i.e., process evaluation). We found that university students (i.e., service providers) showed higher posttest scores in positive youth development attributes, leadership attributes and life satisfaction relative to pretest scores. Besides, service providers showed positive perceptions of their learning experience, own performance, benefits to the service recipients and themselves in the SL projects. Similarly, other stakeholders also had positive evaluation of the SL projects and related benefits. Finally, trained graduate student assessors had positive assessment of the quality of program implementation. The findings underscore the utility of e-SL involving both online teaching and learning as well as online service, particularly in a Chinese context.
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Affiliation(s)
- Daniel T. L. Shek
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Xiang Li
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Lu Yu
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Li Lin
- School of Graduate Studies and Department of Applied Psychology, Lingnan University, Tuen Mun, Hong Kong
| | - Yikang Chen
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Tawiah AK, Desmeules F, Finucane L, Lewis J, Wieler M, Stokes E, Woodhouse LJ. Advanced practice in physiotherapy: a global survey. Physiotherapy 2021; 113:168-176. [PMID: 34794584 DOI: 10.1016/j.physio.2021.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Advanced practice in physiotherapy represents a development in the practice of physiotherapy and has developed in different ways around the world. There is growing evidence to support advanced physiotherapy practice. In May 2019, the member organisations adopted the first World Physiotherapy policy on advanced practice in physiotherapy. However, to date, there is no evidence on the nature and extent of this practice globally. OBJECTIVES To investigate the extent to which advanced practice is present within the global physiotherapy community, to document the titles used, to describe the pathway to become an advanced physiotherapy practitioner and to investigate the barriers and facilitators to the development of the roles. DESIGN An online cross-sectional survey was sent to the various national associations of the World Physiotherapy. PARTICIPANTS Participants were the member organisations of World Physiotherapy. INSTRUMENT The survey comprised 14 questions. The questions were developed based on a review of the evidence around advanced practice and in-depth discussions with the expert group set up by World Physiotherapy. RESULTS A total of 82/112 MOs responded to the survey representing a 73% response rate. Fourteen respondents (14/82, 17%) indicated that they had formal roles in their country/territory. The terms specialist and advanced physiotherapy practitioner were often used interchangeably and were a source of confusion. Seventy-nine (11/14, 79%) percent stated that most advanced physiotherapy practitioners have a combination of clinical practice and a Master's or Doctoral degree. The major facilitators to the development and sustainability of the role were the research evidence, advocacy by the professional organisation, the need to reduce cost and the support received by the advanced physiotherapy practitioners from their employers. CONCLUSION The outcomes of this study provide a clearer understanding of how member organisations of World Physiotherapy defined advanced practice in physiotherapy and what titles are used. It provides insights into the barriers and facilitators to the development of advanced practice in physiotherapy.
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Affiliation(s)
- Andrews K Tawiah
- Faculty of Rehabilitation Medicine, University of Alberta, Canada
| | | | | | - Jeremy Lewis
- School of Health and Social Work, University of Hertfordshire, Hatfield AL10 9AB, Hertfordshire, United Kingdom; Therapy Department, Central London Community Healthcare National Health Service Trust, London, United Kingdom; Department of Physical Therapy & Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar
| | | | - Emma Stokes
- Department of Physical Therapy & Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar; World Physiotherapy, London, United Kingdom.
| | - Linda J Woodhouse
- Faculty of Rehabilitation Medicine, University of Alberta, Canada; School of Physiotherapy and Exercise Science, Curtin University, Australia
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Ross V, Mathieu S, Hawgood J, Turner K, Stapelberg NJC, Welch M, Davies A, Sveticic J, Walker S, Kõlves K. Consumer and Carer Perspectives of a Zero Suicide Prevention Program: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10634. [PMID: 34682380 PMCID: PMC8535550 DOI: 10.3390/ijerph182010634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 11/17/2022]
Abstract
This study explored the experiences of healthcare consumers who had recently attempted suicide, and their carers, following placement on a Suicide Prevention Pathway based on the Zero Suicide framework. Qualitative interviews were conducted with 10 consumers and 5 carers using a semi-structured interview schedule. Interviews were transcribed and thematic analysis was applied to identify prominent themes and sub-themes. Three interrelated themes were identified. The first theme was 'Feeling safe and valued' with the associated sub-theme pertaining to perceived stigmatizing treatment and self-stigma. The second was 'Intersection of consumer and staff/organizational needs' with a related sub-theme of time pressure and reduced self-disclosure. The final theme was 'Importance of the 'whole picture', highlighting the relevance of assessing and addressing psychosocial factors when planning for consumer recovery. Overall, consumers and their carers reported a favorable experience of the Suicide Prevention Pathway; however, there were several areas identified for improvement. These included reconciling the time-pressures of a busy health service system, ensuring consumers and carers feel their psychosocial concerns are addressed, and ensuring that adequate rapport is developed. Key to this is ensuring consumers feel cared for and reducing perceptions of stigma.
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Affiliation(s)
- Victoria Ross
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Brisbane, QLD 4122, Australia; (S.M.); (J.H.); (K.K.)
| | - Sharna Mathieu
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Brisbane, QLD 4122, Australia; (S.M.); (J.H.); (K.K.)
| | - Jacinta Hawgood
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Brisbane, QLD 4122, Australia; (S.M.); (J.H.); (K.K.)
| | - Kathryn Turner
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Nicolas J. C. Stapelberg
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Matthew Welch
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Angela Davies
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Jerneja Sveticic
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Sarah Walker
- Mental Health and Specialist Services, Gold Coast Hospital and Health Services, 1 Hospital Blvd, Southport, QLD 4215, Australia; (K.T.); (N.J.C.S.); (M.W.); (A.D.); (J.S.); (S.W.)
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Brisbane, QLD 4122, Australia; (S.M.); (J.H.); (K.K.)
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Clark PW, Williams LT, Kirkegaard A, Brickley B, Ball L. Perceptions of private practice dietitians regarding the collection and use of outcomes data in primary healthcare practices: A qualitative study. J Hum Nutr Diet 2021; 35:154-164. [PMID: 34605085 DOI: 10.1111/jhn.12950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/31/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dietitians working in private practices in primary settings provide nutrition care to support individuals with the prevention and management of chronic disease. A better understanding of the type and usage of data collected by dietitians in this setting may provide insights to optimise the effectiveness and impact of the workforce. The present study explored the perceptions of leading Australian private practice dietitians on the collection and usage of data in their practice. METHODS A qualitative descriptive study of Australian private practice dietitians, recruited by snowball sampling, was conducted on their perceptions and attitudes towards collecting and using data. Data were collected by semi-structured interviews and all interview data were thematically analysed. RESULTS Twenty-three dietitians participated. Five themes emerged: (i) collecting data is challenging, nuanced, unclearly defined and therefore not routinely carried out; (ii) consistent data collection processes are impeded by the diversity of practise and practices; (iii) business-related data collection is essential for sustainable dietetic services; (iv) clinical outcomes are fundamental to dietetic services; and (v) standardised, integrated systems are needed to enable routine data collection and synthesis. CONCLUSIONS Our findings demonstrate the rudimentary role business acumen has in practice viability and provides evidence to potentially re-shape the future of dietetic education in Australia. Private practice dietitians may benefit from tools and training that enable consistent collection of data about their services. Such data could enable benchmarking across the workforce and contribute to a broader understanding of dietetic impact on public health.
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Affiliation(s)
- Peter W Clark
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,Healthier You Pty Ltd, Port Macquarie, NSW, Australia
| | - Lauren T Williams
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Amy Kirkegaard
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Bryce Brickley
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Lauren Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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Evaluation of occupational therapy-led advanced practice hand therapy clinics for patients on surgical outpatient waiting lists at eight Australian public hospitals. J Hand Ther 2021; 33:320-328. [PMID: 30857889 DOI: 10.1016/j.jht.2019.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This is a prospective cohort study. INTRODUCTION Evidence is emerging that advanced practice hand therapy clinics improve patient outcomes. PURPOSE OF THE STUDY The aim of this study was to evaluate an advanced practice hand therapy model of care for patients with chronic hand conditions on surgical outpatient waiting lists at eight Australian public hospitals. METHODS Nonurgent and semiurgent patients were screened and treated, as required, by an advanced practice hand therapist and then discharged from the surgical outpatient waiting list as appropriate. Outcomes included patient safety, impact on the waiting list, patient satisfaction, and patients' perception of change as measured by Global Rating of Change (GROC). The GROC score was also compared across diagnoses. The relationship between the waiting time and need for surgical review during hand therapy treatment was also assessed. As appropriate, T-tests and analysis of variance were used for statistical analyses. RESULTS A total of 37.2% of patients who commenced hand therapy were removed or discharged from the surgical outpatient waiting lists. Of the subset of patients who completed hand therapy (n = 1116), 28.4% were discharged without requiring surgical follow-up. A further 7.53% requested return to the waiting list despite discharge being recommended. The model of care was safe, and patient satisfaction was above 90%. The mean GROC score was +2.09 (±3.58) but varied across diagnoses with trigger finger or trigger thumb showing the greatest improvement (+4.21 ± 2.92, P < .01). Patients who did not require surgical consultation during hand therapy had a shorter wait time for their initial hand therapy appointment (P < .001). CONCLUSIONS The advanced practice hand therapy model of care was safe and effective in reducing hospital surgical outpatient waiting lists. Patients reported high satisfaction.
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Moretto N, Stute M, Sam S, Bhagwat M, Raymer M, Buttrum P, Banks M, Comans TA. A uniform data set for determining outcomes in allied health primary contact services in Australia. Aust J Prim Health 2020; 26:58-69. [PMID: 31954431 DOI: 10.1071/py18104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/23/2019] [Indexed: 11/23/2022]
Abstract
The project aim was to develop and implement a set of metrics to capture and demonstrate the performance of newly established allied health primary contact services. Selection of the metrics and performance indicators was guided by an existing state-wide data collection system and from a review of the published literature. The metrics were refined after consultation with a working group of health service managers and clinicians. The data collection and reporting framework were developed for use in allied health primary contact services and implemented at public health facilities in Queensland, Australia. The set of metrics consists of 18 process and outcome measures. Patient-reported metrics include the global rating of change scale and patient satisfaction. Service metrics include wait times; referral source; triage category; diagnosis; occasions of service; referrals and investigations initiated; effects; care duration; discharge status; waitlist reinstatement reasons; treatment non-completion reasons; and expedited care. Safety, patient demographics and service improvement metrics were included. The metrics will enable analysis of the effectiveness of allied health primary contact services and will facilitate reporting, advocacy, service improvement, service continuity and research. The metrics are suitable for use by all providers of allied health primary contact services in hospital and primary care settings.
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Affiliation(s)
- Nicole Moretto
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital campus, Woolloongabba, Qld 4102, Australia; and Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia; and Corresponding author
| | - Michelle Stute
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Sonia Sam
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Marita Bhagwat
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Maree Raymer
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Peter Buttrum
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Merrilyn Banks
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Tracy A Comans
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital campus, Woolloongabba, Qld 4102, Australia; and Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
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Mutsekwa RN, Larkins V, Canavan R, Ball L, Angus RL. A dietitian-first gastroenterology clinic results in improved symptoms and quality of life in patients referred to a tertiary gastroenterology service. Clin Nutr ESPEN 2019; 33:188-194. [PMID: 31451260 DOI: 10.1016/j.clnesp.2019.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/01/2019] [Accepted: 05/23/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND The Dietitian First Gastroenterology Clinic (DFGC) is an initiative that has been established in response to increased gastroenterology clinical demand resulting in increased number of patients waiting outside clinically recommended timeframes for specialist care. In this clinic, a dietitian is the primary contact for eligible patients referred to tertiary gastroenterology services and provides assessment and management strategies for patients under the clinical governance of a gastroenterology consultant. This service has previously been shown to reduce patient wait-times and induce excellent patient satisfaction. Evaluation of models of care need to consider patient health outcomes as a key indicator for overall health service effectiveness. The aim of this study was to determine the impact of DFGC on patient related health outcomes. METHODS This study utilised a pretest-posttest design of patients seen in the DFGC who met the diagnostic criteria for irritable bowel syndrome using the Rome IV criteria Consenting participants completed the validated symptom-severity (IBS-SSS) and health-related quality of life (IBSQoL) assessments. Paired sample t-tests were used to analyse differences pre- and post-management in the DFGC. Univariate mixed effects analyses were conducted to examine associations between IBS-SSS, IBSQoL and patient demographics. RESULTS A total of 80 of 122 patients seen in the DFGC were recruited and completed baseline data, with 60 (75%) completing follow up assessments. The average participant age was 35.6 years (75% female), and IBS subtypes; IBS-C 15.0%, IBS-D 38.3%, IBS-M 26.7% and IBS-U 20.0%. Participants experienced significant reductions in symptom severity based on IBS-SSS (300.1 vs 151.7; p < 0.001) independent of IBS subtype, age or gender, with 88% (53/60) experiencing a clinically significant improvement. Quality of life significantly improved for all IBS subtypes (p < 0.001) across all subscales except food avoidance (p = 0.11). There was a moderate negative correlation between the changes in symptom severity and quality of life (R = 0.432, p = 0.001). CONCLUSIONS Management in the DFGC provided positive patient health outcomes demonstrated by improvements in symptom severity and QoL.
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Affiliation(s)
- Rumbidzai N Mutsekwa
- Gold Coast Hospital and Health Service, Nutrition and Food Service Department, 1 Hospital Boulevard Southport, Southport, Queensland, Australia.
| | - Vicki Larkins
- Gold Coast Hospital and Health Service, Nutrition and Food Service Department, 1 Hospital Boulevard Southport, Southport, Queensland, Australia
| | - Russell Canavan
- Gold Coast Hospital and Health Service, Gastroenterology Department, 1 Hospital Boulevard Southport, Southport, Queensland, 4215, Australia
| | - Lauren Ball
- School of Allied Health Sciences, Griffith University, Southport, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast 4222, Australia
| | - Rebecca L Angus
- Gold Coast Hospital and Health Service, Nutrition and Food Service Department, 1 Hospital Boulevard Southport, Southport, Queensland, Australia; School of Allied Health Sciences, Griffith University, Southport, Queensland, Australia
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Ward EC. Elizabeth Usher memorial lecture: Expanding scope of practice - inspiring practice change and raising new considerations. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:228-239. [PMID: 30898019 DOI: 10.1080/17549507.2019.1572224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/03/2018] [Accepted: 01/16/2019] [Indexed: 06/09/2023]
Abstract
As the speech-language pathology (SLP) profession matures and evolves, there will continue to be an ongoing need for practice change. Practice change has many drivers: consumer need; an advancing evidence base; clinical innovations; financial efficiency; local service needs; population change; government policy etc. If we are to continue to have a profession with a strong identity and the capacity to make meaningful contributions to the modern education and healthcare landscape, then practice change is a necessity. To achieve practice change we must step away from long-held traditional paradigms and service delivery models. We need a workforce that is ready, committed and willing to accept change. We need organisations that are willing and open to adopt new service models, and we must have the evidence base to support these new roles and responsibilities. Making change to ensure clinicians are working to full scope or considering extended scope models (when appropriate) is actively encouraged to help achieve a more client-centred, cost-effective health service. In this discussion paper, the benefits, issues and impacts of expanding scope of practice are discussed, and ways that individual clinicians, services, training institutions, and researchers can help support the future growth of our profession are highlighted.
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Affiliation(s)
- Elizabeth C Ward
- a Centre for Functioning and Health Research, Metro South Hospital and Health Service , Brisbane , Australia
- b School of Health & Rehabilitation Sciences , The University of Queensland , Brisbane , Australia
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Fennelly O, Blake C, FitzGerald O, Breen R, O'Sullivan C, O'Mir M, Desmeules F, Cunningham C. Advanced musculoskeletal physiotherapy practice in Ireland: A National Survey. Musculoskeletal Care 2018; 16:425-432. [PMID: 29927063 DOI: 10.1002/msc.1351] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 04/30/2018] [Accepted: 04/30/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Since 2011, advanced practice physiotherapists (APPs) have triaged the care of patients awaiting orthopaedic and rheumatology consultant/specialist doctor appointments in Ireland. APP services have evolved across the major hospitals (n = 16) and, after 5 years, profiling and evaluation of APP services was warranted. The present study profiled the national musculoskeletal APP services, focusing on service, clinician and patient outcome factors. METHODS An online survey of physiotherapists in the allocated APP posts (n = 25) explored: service organization; clinician profile and experience of the advanced role; and patient wait times and outcome measures. Descriptive statistics were used to analyse hospital- and clinician-specific data, and a content analysis was performed to explore APP experiences. RESULTS A 68% (n = 17) response from 13 sites was achieved, whereby 20 whole-time APP posts existed in services led by 91 consultant doctors. Co-location of APP and consultant clinics at 11 sites facilitated joint medical-APP processes, with between-site differences in autonomy to screen referral letters, and arrange investigations, injections and surgery. Although 83% had postgraduate qualifications, APPs also availed themselves of informal role-specific training. Positive APP experiences related to learning opportunities and clinical support networks but experiences were consultant dependent, with further service developments and formal training required to manage workloads. APPs reported reduced wait times and most commonly chose to capture function/disability in future evaluations. CONCLUSIONS Variances existed in the organizational design and operating of APP services. Although highly experienced and qualified, APPs welcomed additional formal training and support, due to the complex, more medical nature of APP roles. Further formal evaluation, capturing patient outcomes, is proposed.
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Affiliation(s)
- Orna Fennelly
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Oliver FitzGerald
- Department of Rheumatology, St Vincent's University Hospital, Dublin, Ireland
| | | | - Cliona O'Sullivan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Marie O'Mir
- Physiotherapy Department, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Caitriona Cunningham
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Fennelly O, Blake C, Desmeules F, Stokes D, Cunningham C. Patient-reported outcome measures in advanced musculoskeletal physiotherapy practice: a systematic review. Musculoskeletal Care 2017; 16:188-208. [PMID: 28660673 DOI: 10.1002/msc.1200] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Advanced practice physiotherapists (APPs), also known as extended scope physiotherapists, provide a new model of service delivery for musculoskeletal (MSK) disorders. Research to date has largely focused on health service efficiencies, with less emphasis on patient outcomes. The present systematic review aimed to identify the patient-reported outcome measures (PROMs) being utilized by APPs. METHOD A wide search strategy was employed, including the PubMed, Embase, CINAHL, CENTRAL and PEDro databases, to identify studies relating to PROMs utilized by APPs in MSK healthcare settings. PROMs identified were classified into predetermined outcome domains, with additional contextual data extracted. RESULTS Of the initial 12,302 studies, 38 met the inclusion criteria. These involved APPs across different settings, utilizing 72 different PROMs and most commonly capturing: Patient Satisfaction, Quality of Life (QoL), Functional Status, and Pain; and, less frequently: Global Status (i.e. overall improvement), Psychological Well-Being, Work ability, and Healthcare Consumption and Costs. The quality of the PROMs varied greatly, with Satisfaction most commonly measured utilizing non-standardized locally-devised tools; the EuroQol five-dimensions questionnaire (EuroQoL-5D) and 36-Item Short-Form (SF-36) cited most frequently to capture QoL; and the Visual Analogue Scale (VAS) to capture Pain. No key measure was identified to capture Functional Status, with 15 different tools utilized. CONCLUSION APPs utilized a multiplicity of PROMs across a range of MSK disorders. The present review will act as an important resource, informing the selection of outcomes for MSK disorders, with a view to greater standardization of outcome measurement in MSK clinical practice, service evaluation and research.
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Affiliation(s)
- Orna Fennelly
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
| | - Catherine Blake
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Diarmuid Stokes
- Health Sciences Library, University College Dublin, Dublin, Ireland
| | - Caitriona Cunningham
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
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Barker RN, Sealey CJ, Polley ML, Mervin MC, Comans T. Impact of a person-centred community rehabilitation service on outcomes for individuals with a neurological condition. Disabil Rehabil 2016; 39:1136-1142. [DOI: 10.1080/09638288.2016.1185803] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Ruth N. Barker
- College of Healthcare Sciences, James Cook University, Townsville and Cairns, QLD, Australia
- Community Rehabilitation Northern Queensland, Northern Australia Primary Health Ltd., Townsville, QLD, Australia
| | - Cindy J. Sealey
- College of Healthcare Sciences, James Cook University, Townsville and Cairns, QLD, Australia
- Community Rehabilitation Northern Queensland, Northern Australia Primary Health Ltd., Townsville, QLD, Australia
| | - Michelle L. Polley
- Community Rehabilitation Northern Queensland, Northern Australia Primary Health Ltd., Townsville, QLD, Australia
| | - Merehau C. Mervin
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Tracy Comans
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
- Metro North Hospital and Health Service District, Brisbane, QLD, Australia
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Pighills AC, Bradford M, Bell K, Flynn LJ, Williams G, Hornsby D, Torgerson DJ, Kaltner M. Skill-sharing between allied health professionals in a community setting: A randomised controlled trial. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2015. [DOI: 10.12968/ijtr.2015.22.11.524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alison C Pighills
- Associate professor, Mackay Hospital and Health Service, Queensland, Australia, and James Cook University, Queensland, Australia
| | - Michelle Bradford
- Team Leader, Mobile Allied Health Team, Mackay Hospital and Health Service, Queensland, Australia
| | - Kirsty Bell
- Director of Occupational Therapy, Mackay Hospital and Health Service, Queensland, Australia
| | - Laura J Flynn
- Senior physiotherapist, Mackay Hospital and Health Service, Queensland, Australia
| | - Gary Williams
- Occupational therapist and Lecturer in biostatistics, James Cook University, Queensland, Australia
| | - Danielle Hornsby
- Executive director of Allied Health, Mackay Hospital and Health Service, Queensland, Australia
| | | | - Melissa Kaltner
- Principal research officer, Department of Family and Community Services, New South Wales, Australia, and Senior lecturer, University of New England, New South Wales, Australia
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Is More Intensive Better? Client and Service Provider Outcomes for Intensive Versus Standard Therapy Schedules for Functional Voice Disorders. J Voice 2014; 28:652.e31-652.e43. [DOI: 10.1016/j.jvoice.2014.02.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 02/14/2014] [Indexed: 12/22/2022]
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Wenke R, Lawrie M, Hobson T, Comben W, Romano M, Ward E, Cardell E. Feasibility and cost analysis of implementing high intensity aphasia clinics within a sub-acute setting. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 16:250-259. [PMID: 24597463 DOI: 10.3109/17549507.2014.887777] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The current study explored the clinical feasibility and costs of embedding three different intensive service delivery models for aphasia treatment (computer, group therapy, and therapy with a speech pathology therapy assistant) within three sub-acute facilities. The study employed a two cohort comparison design, with the first cohort (n = 22) receiving the standard service of treatment currently offered. This treatment was delivered by a speech-language pathologist and involved on average 3 hours of treatment/week over 8 weeks. Participants in the second cohort (n = 31) received one of the three intensive treatment models providing up to 9 hours of therapy/week for 11 weeks. Organizational data was collected throughout treatment, with participant, caregiver, and clinician satisfaction with the intensive models also being measured. Participants completed the spoken language production sub-tests and the Disability Questionnaire of the Comprehensive Aphasia Test (CAT) pre- and post-treatment. All intensive models yielded high participant attendance, satisfaction, and significant improvements to the CAT sub-tests. The pro-rata cost of providing treatment per hour per client for the computer and group therapy models was found to be ˜ 30% cheaper compared to the standard service. The outcomes support the potential feasibility of embedding the different models into sub-acute facilities to enhance client access to intensive treatment for aphasia.
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Affiliation(s)
- Rachel Wenke
- Gold Coast Hospital and Health Service , Gold Coast , Australia
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Dettman RH, Rohrer J, Anderson CL. Impact of Cardiac Ultrasound Screening on Body Mass Index in Community Health Centers. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2014. [DOI: 10.1177/8756479313517295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Body mass index is an important indicator in primary care as a measure of a specific health care outcome. As such, it can provide a quantitative basis for clinicians to achieve improvement in care and the process by which patient care is delivered. The potential impact of cardiac sonographic screening on body mass index in disadvantaged primary care patients is unknown. Changes in body mass index (BMI), blood pressure, and low density lipoprotein cholesterol (LDL-C) levels in patients who had cardiac sonographic screening were compared to changes in a control group of similar patients treated in a clinic where cardiac sonographic screening was not available. Control patients gained weight (BMI 27.8 at baseline vs. 28.3 at follow-up), while cardiac screening patients maintained weight (BMI 27.9 at baseline vs. 27.8 at follow-up, P < .05). In overweight patients those who had cardiac screening experienced better outcomes in the quality indicator BMI than control patients, yielding a statistically significant result for some subgroups of patients. Additional effort should be directed toward refining the motivational impact of cardiac sonographic screening. It appears in this particular study that cardiac screening in a community health center was associated with better control of BMI. Such screening may have a significant impact on motivating patients to take a greater interest in personal health maintenance.
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Affiliation(s)
- Richard H. Dettman
- School of Health Sciences Cardiovascular Technology Program, Milwaukee Area Technical College, Milwaukee, WI, USA
| | - Jim Rohrer
- College of Health Sciences, Walden University, Minneapolis, MN, USA
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Homeming LJ, Kuipers P, Nihal A. Orthopaedic podiatry triage: process outcomes of a skill mix initiative. AUST HEALTH REV 2012; 36:457-60. [DOI: 10.1071/ah11102] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 03/05/2012] [Indexed: 11/23/2022]
Abstract
Background. The Orthopaedic Podiatry Triage Clinic (OPodTC) is a ‘skill mix’ model of care developed in Queensland Health to address the problem of lengthy waiting times for orthopaedic surgery on foot and ankle pathologies. It is based on the recognition that many orthopaedic surgery referrals can be identified early and treated conservatively with podiatry, averting the need for more costly and invasive surgical interventions. The model is collaborative and relies on screening and triage by the podiatrist, rather than delegation by the orthopaedic surgeon. Methods. Screening and triage through OPodTC was trialled at three Queensland Health hospital facilities during 2009 and 2010 to improve service timeliness. Patients identified by the OPodTC podiatrist as suitable for conservative management were provided with non-surgical podiatry interventions and discharged if appropriate. Those identified as still requiring surgical intervention after the benefit of interim conservative treatment provided by the podiatrist (or who chose to remain on the list) were returned to their previous place on the orthopaedic waiting list. This paper presents a summary and description of waiting list changes in association with this trial. Results. The OPodTC intervention resulted in a reduction in the non-urgent category of the waiting list across the three hospitals of between 23.3% and 49.7%. Indications from wait-list service data demonstrated increased timeliness and improved patient flow, which are core goals of these skill mix initiatives. Conclusions. This study highlights the potential of screening and triage functions in the skill mix debate. In this example, conservative treatment options were considered first, suitable patients did not have to wait long periods to receive timely and appropriate interventions, and those for whom surgery was indicated, were provided with a more targeted service. What is known about the topic? Shifting and delegation of tasks is a key issue in current global debate on models of care. Discussion regarding the mix and shifting of tasks in podiatry and orthopaedic surgery has been limited in Australia, and the appropriate measurement of outcomes and processes is a point for discussion. What does this paper add? This paper describes such an initiative in podiatry and orthopaedic surgery. It describes a skill mix initiative based on triage and screening rather than delegation. It reflects benefits of including waiting lists as a process measure. What are the implications for practitioners? Support for triage-oriented skill mix collaboration in Podiatry and Orthopaedic Surgery.
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