1
|
Looi JCL. Australian specialised mental healthcare labour shortages: Potential interventions for consideration and further research. Australas Psychiatry 2024; 32:446-449. [PMID: 39110758 PMCID: PMC11440790 DOI: 10.1177/10398562241267138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2024]
Abstract
OBJECTIVE Specialised mental healthcare delivery is highly labour intensive, and the COVID-19 pandemic has exacerbated workforce shortfalls. We explore the information on the mental healthcare labour supply in Australia from a health policy viewpoint. Our purpose is to stimulate discussion, further research and development of interventions. CONCLUSIONS The mental healthcare labour market has a number of features that make it prone to shortages and other distortions. These include: the labour-intensive nature of healthcare work;, long-training periods; that traditional policy levers like pay are only partially effective; as well as other challenges in retaining and recruiting mental health nurses and psychiatrists, especially in public mental health services. Further research is needed to develop and evaluate effective interventions.
Collapse
Affiliation(s)
- Jeffrey CL Looi
- Jeffrey CL Looi, Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Building 4, Level 2, Canberra Hospital, PO Box 11, Garran, ACT 2605, Australia.
| |
Collapse
|
2
|
Winter S, Crocker S, Rolls T, Curtin D, Haratsis J, Szollosi I. Direct to psychology for sleep disorders: Innovating models of care in the hospital and health service. J Health Psychol 2024:13591053241267272. [PMID: 39104087 DOI: 10.1177/13591053241267272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024] Open
Abstract
A 'Direct to Psychology Insomnia' pathway was developed for implementation within a multidisciplinary sleep disorders service in a tertiary hospital in Brisbane, Australia. The project was informed by implementation science principles and methodology to re-design the model of care (MoC). A consensus group workshop using the Nominal Group Technique (NGT) with 12 multidisciplinary staff was undertaken to develop the new MoC. The workshop explored inclusion and exclusion criteria for a Direct to Psychology pathway including patient flow and enablers. The team endorsed a MoC that was acceptable to stakeholders and addressed service-level imperatives. The findings highlighted that patient inclusion or exclusion should be overseen by the Sleep Physician team and an Advanced Psychologist with behavioural sleep medicine expertise. Continuum of care for patients referred via primary care providers was considered. Barriers and risks to the MoC changes were identified which informed the refinement of the MoC.
Collapse
Affiliation(s)
- Sara Winter
- The Prince Charles Hospital, Australia
- University of Queensland, Australia
| | | | | | | | - Jessica Haratsis
- The Prince Charles Hospital, Australia
- Metro South Addiction and Mental Health Services, Australia
| | - Irene Szollosi
- The Prince Charles Hospital, Australia
- University of Queensland, Australia
| |
Collapse
|
3
|
Mutsekwa RN, Campbell KL, Canavan R, Angus RL, McBride LJ, Byrnes JM. Unlocking potential: a qualitative exploration guiding the implementation and evaluation of professional role substitution models in healthcare. Implement Sci Commun 2024; 5:73. [PMID: 38997750 PMCID: PMC11245812 DOI: 10.1186/s43058-024-00611-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 06/28/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND As role substitution models gain prominence in healthcare, understanding the factors shaping their effectiveness is paramount. This study aimed to investigate factors that impact the implementation and performance evaluation of professional role substitution models in healthcare, with a focus on understanding the variables that determine their success or failure in adoption, execution, continuity, and outcomes. METHODS The exploratory qualitative study used semi-structured interviews with key opinion leaders, decision makers, facilitators, recipients, and frontline implementers, who had influence and involvement in the implementation of professional role substitution models. Data analysis was guided by the Consolidated Framework for Implementation Research (CFIR). RESULTS Between November 2022 and April 2023, 39 stakeholders were interviewed. Factors influencing implementation and evaluation of allied health professional role substitution models of care aligned with the five core CFIR domains (innovation, outer setting, inner setting, individuals, implementation process) and outcome domain incorporating implementation and innovation outcomes. The six themes identified within these CFIR domains were, respectively; i) Examining the dynamics of innovation catalysts, evidence, advantages, and disadvantages; ii) Navigating the complex landscape of external factors that influence implementation and evaluation; iii) Impact of internal structural, political, and cultural contexts; iv) The roles and contributions of individuals in the process; v) Essential phases and strategies for effective implementation; and vi) The assessment of outcomes derived from allied health professional role substitution models. CONCLUSIONS The study highlights the complex interplay of contextual and individual factors that influence the implementation and performance evaluation of professional role substitution models. It emphasises the need for collaboration among diverse stakeholders to navigate the challenges and leverage the opportunities presented by expanded healthcare roles. Understanding these multifaceted factors can contribute to the development of an empowered workforce and a healthcare system that is more efficient, effective, safe, and sustainable, ultimately benefiting patients.
Collapse
Affiliation(s)
- Rumbidzai N Mutsekwa
- Gold Coast Hospital and Health Service, Nutrition and Food Services, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia.
- Gold Coast Hospital and Health Service, Allied Health Research Team, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia.
- Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, 1 Parklands Drive, Nathan, Queensland, 4111, Australia.
| | - Katrina L Campbell
- Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, 1 Parklands Drive, Nathan, Queensland, 4111, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, 1 Parklands Drive, Southport, Queensland, 4215, Australia
- Healthcare Excellence and Innovation, Metro North Hospital and Health Service, 153 Campbell Street, Bowen Hills, Queensland, 4029, Australia
| | - Russell Canavan
- Gastroenterology Department, Gold Coast Hospital and Health Service, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Rebecca L Angus
- Gold Coast Hospital and Health Service, Nutrition and Food Services, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, 1 Parklands Drive, Southport, Queensland, 4215, Australia
| | - Liza-Jane McBride
- Department of Health, Clinical Excellence, 15 Butterfield Street, Herston, Queensland, 4006, Australia
| | - Joshua M Byrnes
- Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, 1 Parklands Drive, Nathan, Queensland, 4111, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, 1 Parklands Drive, Southport, Queensland, 4215, Australia
| |
Collapse
|
4
|
Davis J, Ward EC, Seabrook M, Gundara J, Whitfield BCS. Outcomes of a first point of contact speech language therapy clinic for patients requiring vocal cord check pre and post thyroid/parathyroid surgery. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:963-975. [PMID: 37921245 DOI: 10.1111/1460-6984.12976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/13/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Speech Language Therapy First Point of Contact Clinic (SLT-FPOCC) models can assist assessment of low-risk patient populations referred to ear, nose and throat (ENT) services. To further improve ENT waitlist management and compliance with best-practice care, consideration of other low-risk populations that could be safely managed through this service model is needed. The aims of this paper are to evaluate the clinical and service outcomes of completing vocal cord check (VCC) assessments for patients' pre and post thyroid/parathyroid surgery within an SLT-FPOCC model and examine consumer perceptions. METHODS & PROCEDURES The service followed existing SLT-FPOCC procedures, with ENT triaging referrals, then SLT completing pre- and postoperative VCC assessment (interview, perceptual assessment, flexible nasendoscopy), with assessment data later reviewed by ENT to diagnose laryngeal pathology. Clinical and service outcomes were collected prospectively. Patients completed an anonymous post-service satisfaction survey. RESULTS Of the first 100 patients referred for preoperative VCCs, SLT assessment identified 42 with dysphonia and 30 reporting dysphagia, while ENT confirmed 9 with significant preoperative anatomical findings. Eighty-three underwent surgery, with 63 (95 nerves at surgical risk) returning for a postoperative VCC. Postoperative VCC identified three temporary neuropraxias (3.2%) and three unilateral vocal fold paresis (3.2%). Patients were highly satisfied with the service. All 163 pre-/postoperative VCCs were completed with no adverse events. CONCLUSION & IMPLICATIONS The current data support SLT-FPOCC service expansion to include pre and post thyroid/parathyroid surgery VCC checks, with positive consumer perception. The model supports delivery of best practice management (i.e., pre- and postoperative VCC) for patients receiving surgery for thyroid/parathyroid dysfunction, and associated efficiencies for ENT services. WHAT THIS PAPER ADDS What is already known Assessment of laryngeal function via flexible nasoendoscopy is recommended best practice for patients pre and postthyroid/parathyroid surgery, as recurrent laryngeal nerve injury is a low incidence (<10%), yet well-recognised risk of these surgeries. Traditionally, general surgeons refer presurgical patients to ear, nose and throat (ENT) for vocal cord check (VCC) assessment. However, with access to specialist outpatient services under increasing pressure, there is growing support for utilisation of other health professionals, such as speech-language therapists working in first point of contact (FPOCC) models, to assist with the administration of pre- and postsurgical assessments of such low-risk populations. What this study adds This work expands on the emerging body of evidence for speech language therapy (SLT) led FPOCC models within ENT outpatient services, providing clinical and service outcomes to support the safety of a new model designed to administer VCCs for patients pre and post thyroid/parathyroid surgery. Adopting a similar model to a prior published SLT-led FPOCC model, the trained SLT completes the pre- and postsurgical VCC including flexible nasoendoscopy and videostroboscopy, with images and clinical information then presented to ENT for diagnosis and management planning. This study also provides the first data on consumer perceptions of this type of service model. Clinical implications of this study Data on 100 consecutive presurgical patients revealed positive service findings, supporting the safety of this model. Nature and incidence of clinical findings pre and post surgery were consistent with previously published studies using traditional models of care (i.e., ENT completing the flexible nasendoscopy). Consumer perception was positive. This model enables delivery of pre-and postsurgical assessments for patients receiving thyroid/parathyroid surgery, consistent with best practice care, and reduces burden on ENT services. In total 163 ENT appointments were avoided with this model, with positive implications for ENT waitlist management.
Collapse
Affiliation(s)
- Jennifer Davis
- Speech Pathology Department, Logan Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
- Australian Catholic University, School of Allied Health, Brisbane, QLD, Australia
| | - Elizabeth C Ward
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia
- Centre of Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Marnie Seabrook
- Speech Pathology Department, Logan Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Justin Gundara
- Griffith University, School of Medicine and Dentistry, Gold Coast, QLD, Australia
- Department of Surgery, Logan Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
- Department of Surgery, Redland Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Bernard C S Whitfield
- Griffith University, School of Medicine and Dentistry, Gold Coast, QLD, Australia
- Department of Surgery, Logan Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| |
Collapse
|
5
|
Gosse G, Kumar S, Banwell H, Moran A. Exploring Allied Health Models of Care for Children with Developmental Health Concerns, Delays, and Disabilities in Rural and Remote Areas: A Systematic Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:507. [PMID: 38673418 PMCID: PMC11050593 DOI: 10.3390/ijerph21040507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Access to appropriate healthcare is essential for children's healthy development. This is lacking in rural and remote areas, impacting health outcomes. Despite efforts to improve access for these communities, to date, no review has systematically mapped the literature on allied health models of care for children with developmental needs. This scoping review seeks to address this knowledge gap. METHODS Adhering to the PRISMA-ScR and Joanna Briggs Institute guidelines, a systematic search was conducted. A total of 8 databases (from inception to May 2023) and 106 grey literature sources were searched. Two reviewers independently undertook a two-stage screening process. Data were extracted using customised tools and narratively synthesised utilising the Institute of Medicine's quality domains. This review is registered a priori via Open Science Framework. RESULTS Twenty-five citations were identified within the literature. Varied models of care were reported from five mostly Western countries. Models of care identified in these areas were classified as screening services, role substitution, consultative services, or online-based services. Positive impacts on quality of healthcare were reported across all quality domains (apart from safety) with the domain of effectiveness being the most commonly reported. CONCLUSIONS Multiple models of care are currently in operation for children with developmental needs in rural and remote areas and appear to improve the quality of care. Due to complexities within, and limitations of, the evidence base, it is unclear if one model of care is superior to another. This review provides a basis for further research to explore why some models may be more effective than others.
Collapse
Affiliation(s)
- Georgia Gosse
- Innovation Implementation and Clinical Translation, Allied Health and Human Performance Unit, University of South Australia, North Tce, Adelaide, SA 5001, Australia
| | - Saravana Kumar
- Innovation Implementation and Clinical Translation, Allied Health and Human Performance Unit, University of South Australia, North Tce, Adelaide, SA 5001, Australia
| | - Helen Banwell
- Innovation Implementation and Clinical Translation, Allied Health and Human Performance Unit, University of South Australia, North Tce, Adelaide, SA 5001, Australia
| | - Anna Moran
- Department of Rural Health, Melbourne Medical School, The University of Melbourne, Graham St Shepparton, Melbourne, VIC 3630, Australia
| |
Collapse
|
6
|
Brandenburg C, Ward EC, Schwarz M, Palmer M, Hartley C, Byrnes J, Coccetti A, Phillips R, Wishart LR. 'The big value of it is getting the patient seen by the right person at the right time': clinician perceptions of the value of allied health primary contact models of care. Int J Qual Health Care 2024; 36:mzae021. [PMID: 38442741 DOI: 10.1093/intqhc/mzae021] [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: 09/21/2023] [Revised: 01/18/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
Allied health primary contact clinic models of care have increasingly been used as a strategy to increase public health service capacity. A recent systematic review found little consistency or agreement on how primary contact clinics are evaluated. The concept of value of primary contact clinics, which has important implications for evaluation, has not yet been explored in-depth. To explore allied health clinicians' perceptions of the value of allied health primary contact clinics, with the goal of informing an evaluation framework, a descriptive qualitative approach utilizing semi-structured interviews was employed. Participants included allied health staff embedded in clinical lead roles within primary contact clinics across four acute care hospitals in a metropolitan health service located in South-East Queensland, Australia. Lead staff from 30 identified primary contact clinic models in the health service were approached to take part via email. All eligible participants who provided consent were included. An inductive thematic analysis approach was used. A total of 23 clinicians (n = 23) representing 22 diverse models of primary contact clinics participated. Most participants were physiotherapists, dietitians, or occupational therapists, although speech pathology, audiology, and podiatry were also represented. Participant perceptions of the 'value' of PCCs were a highly complex phenomenon, comprising five intersecting domains: (i) patient satisfaction; (ii) clinical outcomes; (iii) care pathway and resource use; (iv) health service performance; and (v) staff satisfaction and professional standing. These five core value domains were positively or negatively influenced by 12 perceived benefits and 8 perceived drawbacks, respectively. Value domains were also highly interrelated and impacted upon each other. The concept of 'value' relating to primary contact clinics involves multiple intersecting domains encompassing different perspectives. This study highlighted potential benefits and drawbacks of primary contact clinics that have not yet been measured or explored in the literature, and as such may be useful for healthcare administrators to consider. The findings of this study will inform an evaluation framework including health economics calculator for primary contact clinics.
Collapse
Affiliation(s)
- Caitlin Brandenburg
- Centre for Functioning and Health Research, Metro South Health, 199 Ipswich Road, Brisbane, Queensland 4102, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Health, 199 Ipswich Road, Brisbane, Queensland 4102, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Fred Schonell Drive, Brisbane, Queensland 4072 Australia
| | - Maria Schwarz
- Allied Health, Metro South Health, Cnr Armstrong and Loganlea Roads Brisbane, Queensland 4131 Australia
| | - Michelle Palmer
- Nutrition and Dietetics, Logan Hospital, Metro South Health, Cnr Armstrong and Loganlea Roads, Brisbane, Queensland 4131, Australia
| | - Carina Hartley
- Occupational Therapy, Logan Hospital, Metro South Health, Cnr Armstrong and Loganlea Roads, Brisbane, Queensland 4131, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, 1 Parklands Dr, Gold Coast, Queensland 4215, Australia
| | - Anne Coccetti
- Metro South Health, QEII Jubilee Hospital, Cnr Kessels and Troughton Roads, Brisbane, Queensland 4108, Australia
| | - Rachel Phillips
- Metro South Health, Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Queensland 4102, Australia
| | - Laurelie R Wishart
- Centre for Functioning and Health Research, Metro South Health, 199 Ipswich Road, Brisbane, Queensland 4102, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Fred Schonell Drive, Brisbane, Queensland 4072 Australia
| |
Collapse
|
7
|
Mutsekwa RN, Campbell KL, Canavan R, Angus RL, McBride LJ, Byrnes JM. Measuring performance in allied health professional role substitution models of care: a clinician survey. BMC Health Serv Res 2024; 24:79. [PMID: 38229130 DOI: 10.1186/s12913-024-10556-5] [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: 02/13/2023] [Accepted: 01/03/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Professional role substitution models of care have emerged as a key strategy to address increasing healthcare demand. Gaining insights from those actively engaged in the process of these models' implementation and evaluation is pivotal to ensuring sustainability and further successful implementation. The purpose of this study was to describe allied-health clinicians' perceptions, practice, and experiences of healthcare performance evaluation in professional role substitution models of care. METHODS Data were collected via an online platform between 22 June - 22 July 2022 using a combination of convenience and network-based sampling of allied-health clinicians involved or interested in the implementation and evaluation of professional role substitution models of care. Clinicians answered 25 questions which consisted of demographic and targeted questions regarding performance evaluation across six domains of healthcare quality (effectiveness, safety, appropriateness, access & equity, continuity of care, and cost, efficiency, productivity & sustainability). RESULTS A total of 102 clinicians accessed the survey, with 72 providing complete survey data. Eleven allied-health professions were represented, working across twelve specialities in thirteen hospital and health services. Whilst most allied-health clinicians (93-100%) supported measuring performance in each of the six healthcare quality domains, only 26-58% were measuring these domains in practice. Allied-health leadership support (62.5%), clinician drive (62.5%), consumer engagement (50%) and medical support (46%) were enablers whilst a lack of resources (human, time, financial (47%)), healthcare performance frameworks and/or policies (40%) were identified as barriers. Given the opportunity, clinicians would invest the most financial resources in digital solutions as a core strategy to improve performance evaluation. CONCLUSIONS Allied-health professionals expressed strong support for principles of performance evaluation, however in practice, performance evaluation is still in its infancy in professional role substitution models of care. Organisations can implement strategies that maximise the enablers whilst addressing barriers identified to improve performance evaluation in these models of care.
Collapse
Affiliation(s)
- Rumbidzai N Mutsekwa
- Gold Coast Hospital and Health Service, Nutrition and Food Services, 1 Hospital Boulevard Southport, Southport, Queensland, 4215, Australia.
- Gold Coast Hospital and Health Service, Allied Health Research Team, 1 Hospital Boulevard Southport, Southport, Queensland, 4215, Australia.
- Centre for Applied Health Economics, School of Medicine, Sir Samuel Griffith Centre, Griffith University, Nathan, Queensland, 4111, Australia.
| | - Katrina L Campbell
- Centre for Applied Health Economics, School of Medicine, Sir Samuel Griffith Centre, Griffith University, Nathan, Queensland, 4111, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Queensland, 4215, Australia
- Metro North Hospital and Health Service, Healthcare Excellence and Innovation, 153 Campbell Street, Bowen Hills, Queensland, 4029, Australia
| | - Russell Canavan
- Gastroenterology Department, Gold Coast Hospital and Health Service, 1 Hospital Boulevard Southport, Southport, Queensland, 4215, Australia
| | - Rebecca L Angus
- Gold Coast Hospital and Health Service, Nutrition and Food Services, 1 Hospital Boulevard Southport, Southport, Queensland, 4215, Australia
- Gold Coast Hospital and Health Service, Allied Health Research Team, 1 Hospital Boulevard Southport, Southport, Queensland, 4215, Australia
- School of Allied-health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, Queensland, 4215, Australia
| | - Liza-Jane McBride
- Department of Health, Clinical Excellence 15 Butterfield Street, Herston, Queensland, 4006, Australia
| | - Joshua M Byrnes
- Centre for Applied Health Economics, School of Medicine, Sir Samuel Griffith Centre, Griffith University, Nathan, Queensland, 4111, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Queensland, 4215, Australia
| |
Collapse
|
8
|
Mutsekwa RN, Campbell KL, Canavan R, Mulhern B, Angus RL, Byrnes JM. Patient Preferences for Attributes that Characterise Alternative Models of Care in Gastroenterology: A Discrete Choice Experiment. THE PATIENT 2023; 16:165-177. [PMID: 36637751 DOI: 10.1007/s40271-022-00609-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Increased demand for gastroenterology services has resulted in growing waitlists, with patients at risk of exceeding clinically recommended wait-times. Given limited healthcare resources, expanded scope models of care are an option to help address this demand, but little is known about patient preferences for these models of care. METHODS Low-risk gastroenterology patients (n = 1198) referred to an outpatient tertiary service in Australia over a 2-year period were invited to participate in an unlabelled discrete choice experiment with seven attributes: primary healthcare professional, wait-time, continuity of care, consultation length, manner and communication skills, reassurance, and cost. These were developed using qualitative research, literature review, and stakeholders' experiences. A d-efficient fractional design was used to construct four blocks of 12 choice sets, with two alternatives. A 13th choice set was included as a data and quality check. Latent class and mixed logit regression were used for analysis. The resulting preference parameters for individual attributes were then used to calculate willingness to pay and willingness to wait. RESULTS Overall, the model based on the 347 respondents suggested no strong preference for professional background. All other attributes were statistically significant predictors of preference (p < 0.001), with respondents willing to make significant trade-offs (time and cost) before accepting deterioration in attributes. There was strong emphasis on manner and communication skills, with a clinician who listens and provides good explanations overwhelmingly the most important attribute. Latent class analysis identified two patient segments who differed in their preference for the primary treating healthcare professional (doctor or dietitian) based on exposure to either traditional medical or non-medical professional role substitution model. CONCLUSIONS Patients have strong but varied preferences for gastroenterology services based on whether they have been exposed to expanded scope models of care. Design and implementation of new models of care need to consider strategies to overcome any perceived loss in utility or deterioration in healthcare quality for those unfamiliar with professional role substitution.
Collapse
Affiliation(s)
- Rumbidzai N Mutsekwa
- Gold Coast Hospital and Health Service, Nutrition and Food Services, 1 Hospital Boulevard Southport, Southport, QLD, 4215, Australia. .,Gold Coast Hospital and Health Service, Allied Health Research Team, Southport, QLD, Australia. .,Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, Nathan, QLD, Australia.
| | - Katrina L Campbell
- Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, Nathan, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Russell Canavan
- Gastroenterology Department, Gold Coast Hospital and Health Service, 1 Hospital Boulevard Southport, Southport, QLD, Australia
| | - Brendan Mulhern
- Centre for Health Economics Research, University of Technology Sydney, Sydney, NSW, Australia
| | - Rebecca L Angus
- Gold Coast Hospital and Health Service, Nutrition and Food Services, 1 Hospital Boulevard Southport, Southport, QLD, 4215, Australia.,School of Allied-health Sciences and Social Work, Griffith University, Southport, QLD, Australia
| | - Joshua M Byrnes
- Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, Nathan, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| |
Collapse
|
9
|
Mutsekwa RN, Byrnes JM, Larkins V, Canavan R, Angus RL, Campbell KL. Role substitution of specialist medical doctors with allied-health professionals: A qualitative exploration of patients' experiences and perceptions of healthcare quality. J Eval Clin Pract 2022; 28:1096-1105. [PMID: 35470945 DOI: 10.1111/jep.13691] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/26/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The need to improve patient access, offer increased choice and improve patient outcomes whilst maintaining safe care is driving the healthcare workforce to evolve. Extending allied-health scope of practice by integrating models of care that traverse traditional professional boundaries has been one such strategy. This study explored patients' acceptance and experiences of four allied-health extended scope of practice models of care. The study aimed to identify dimensions of quality healthcare that matter to patients and describe the extent to which they perceived these to be delivered in allied-health professional role substitution models of care. METHODS Qualitative methodology using semistructured interviews were conducted with 29 participants who had received treatment from an allied-health professional role substitution model. This was a purposeful sample with recruitment across genders, ages and social backgrounds. Interviews were audio recorded, transcribed and independently analysed by two researchers using a thematic approach. RESULTS Six major themes were identified which revealed dimensions of healthcare quality that were important to participants: Balancing expectations and overall satisfaction; Timely access and convenience; Continuity, integration and coordination of care; Clinician expert skills, professional manner and interpersonal attributes; Financial considerations when receiving care; and Perceptions of treatment outcomes. CONCLUSIONS This study highlights participants' views and experiences of allied-health extended scope of practice models of care. Service delivery models were an acceptable alternative to traditional specialist medical care with the perception that extended scope of practice models of care delivered many aspects of quality care that mattered to patients.
Collapse
Affiliation(s)
- Rumbidzai N Mutsekwa
- Nutrition and Food Service Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.,School of Medicine, Centre for Applied Health Economics, Sir Samuel Griffith Centre, Griffith University, Nathan, Queensland, Australia
| | - Joshua M Byrnes
- School of Medicine, Centre for Applied Health Economics, Sir Samuel Griffith Centre, Griffith University, Nathan, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Vicki Larkins
- Nutrition and Food Service Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Russell Canavan
- Gastroenterology Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Rebecca L Angus
- Nutrition and Food Service Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.,School of Allied Health Sciences, Griffith University, Southport, Queensland, Australia
| | - Katrina L Campbell
- School of Medicine, Centre for Applied Health Economics, Sir Samuel Griffith Centre, Griffith University, Nathan, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia.,Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| |
Collapse
|
10
|
Osborne B, Thoirs K, Dizon J, Parange N, Milanese S. Patient satisfaction and incidence of adverse events during a trial of sonographer administered musculoskeletal injections. SONOGRAPHY 2022. [DOI: 10.1002/sono.12306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Brooke Osborne
- Allied Health and Human Performance University of South Australia Adelaide South Australia Australia
| | - Kerry Thoirs
- Allied Health and Human Performance University of South Australia Adelaide South Australia Australia
| | - Janine Dizon
- International Centre for Allied Health Evidence University of South Australia Adelaide South Australia Australia
| | - Nayana Parange
- Allied Health and Human Performance University of South Australia Adelaide South Australia Australia
| | - Steve Milanese
- Allied Health and Human Performance University of South Australia Adelaide South Australia Australia
- International Centre for Allied Health Evidence University of South Australia Adelaide South Australia Australia
| |
Collapse
|