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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.
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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
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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.
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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
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Jolliffe L, Williams CM, Bozyk N, Collyer TA, Caspers K, Snowdon DA. Consumer perspectives of allied health involvement in a public hospital setting: cross-sectional survey and electronic health record review. AUST HEALTH REV 2024; 48:191-200. [PMID: 38373740 DOI: 10.1071/ah23225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/26/2024] [Indexed: 02/21/2024]
Abstract
Objective Consumer-centred care is fundamental to high-quality health care, with allied health professionals playing a pivotal role in hospital settings. Allied health typically operates within standard weekday working-hours. Consumer preferences for receiving allied health services are largely unexplored but could inform whether weekend and/or out-of-hours services are required. This study aims to understand consumer preferences for hospital-based inpatient and outpatient allied health services. Methods Using a cross-sectional survey and convenience sampling approach, consumers of a public health service in Melbourne, Australia were surveyed about preferences for allied health service delivery. Electronic health record reviews compared the accuracy of self-reported service delivery times. Descriptive statistics, concordance and predictive values were calculated. Responses to free-text survey items were analysed using content analysis. Results Of 120 participants (79% response rate), most (69%) received allied health services, however, almost half of inpatient responders (44%) were unsure of the specific allied health professional involved. Audit results found moderate-high concordance overall (range, 77-96%) between self-reported and audit-identified allied health services by profession. Most inpatient responders had no strong day of week preference, equally selecting weekdays and weekend days, with most preferring services between 8 am and 4 pm. Outpatient responders (81%) preferred a weekday appointment between 8 am and 12 pm or before 8 am (29%) to complete scheduled activities early in the day. Conclusion While provision of allied health services during standard working-hours was preferred by most consumers, some inpatient and outpatient consumers are receptive to receiving weekend and out-of-hours services, respectively. Decisions about offering these services should consider operational capacity and research evidence.
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Affiliation(s)
- Laura Jolliffe
- Allied Health, Peninsula Health, Melbourne, Vic., Australia; and School of Primary and Allied Health Care, Department of Occupational Therapy, Monash University, Melbourne, Vic., Australia; and National Centre for Healthy Ageing, Melbourne, Vic., Australia
| | - Cylie M Williams
- School of Primary and Allied Health Care, Department of Podiatry, Monash University, Melbourne, Vic., Australia
| | - Natalie Bozyk
- Allied Health, Peninsula Health, Melbourne, Vic., Australia
| | - Taya A Collyer
- National Centre for Healthy Ageing, Melbourne, Vic., Australia
| | | | - David A Snowdon
- Allied Health, Peninsula Health, Melbourne, Vic., Australia; and National Centre for Healthy Ageing, Melbourne, Vic., Australia
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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.
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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
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Gallegos-Rejas VM, Kelly JT, Snoswell CL, Haydon HM, Banbury A, Thomas EE, Major T, Caffery LJ, Smith AC, de Camargo Catapan S. Does the requirement for an interpreter impact experience with telehealth modalities, acceptability and trust in telehealth? Results from a national survey including people requiring interpreter services. J Telemed Telecare 2023; 29:24S-29S. [PMID: 38007697 DOI: 10.1177/1357633x231197945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
We aimed to assess if experience with telehealth modalities, acceptability and levels of trust in telehealth vary with the need for an interpreter using a cross-sectional survey of telehealth consumers in Australia. Non-parametric tests were used to compare the means and percentages between those who required an interpreter and those who did not. A total of N = 1,116 completed the survey; 5% (n = 56) represented people needing an interpreter for telehealth services. Of those needing interpreters, 14.29% had experienced only phone consultations whereas 63.21% of those who did not need interpreters had experienced only phone consultations. Trust in telehealth with allied health professionals was significantly higher among people needing interpreters (mean 4.12 ± 1.02) than those with no interpreter required (mean 3.70 ± 1.30), p = 0.03. People requiring interpreters had non-significantly higher acceptability towards video consultation than those who did not (mean 3.60 ± 0.61 vs mean 3.51 ± 0.80, p = 0.42), similar to telephone consultations (mean 3.71 ± 0.95 vs mean 3.48 ± 0.79, p = 0.38). The need for interpreters does not appear to impact acceptability or trust in telehealth with doctors. However, experience with telehealth modalities and trust in telehealth with allied health varied significantly among groups. Increasing exposure to telehealth modalities, trust and acceptability is crucial to promote equitable access to telehealth.
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Affiliation(s)
- Victor M Gallegos-Rejas
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Jaimon T Kelly
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Helen M Haydon
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Annie Banbury
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Emma E Thomas
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Taylor Major
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Innovative Medical Technology, University of Southern Denmark, Odense, Denmark
| | - Soraia de Camargo Catapan
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
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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.
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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
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