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Raatz M, Ward EC, Moss P, Reilly C, Frederiksen N, Dickinson C, Clarke S, Beak K, Marshall J. Examining the Outcomes of Project ECHO ® as an Interprofessional Community of Practice for Pediatric Feeding Clinicians. Dysphagia 2024; 39:208-222. [PMID: 37454335 PMCID: PMC10957606 DOI: 10.1007/s00455-023-10603-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
Project ECHO® is a virtual, interprofessional, cased-based peer-learning model. To date, no studies have explored ECHO as a model for pediatric feeding education. This study examined the outcomes of establishing a pediatric feeding ECHO network. Using a prospective, mixed-methods design, two cohorts of allied health professionals were recruited. Each cohort participated in eight, 90-min videoconference sessions incorporating a didactic presentation and clinical case presentation. The case was presented by a participant, with questions and recommendations provided by the ECHO network. Participants completed: (1) a learning needs analysis before the ECHO series, (2) a self-reported confidence questionnaire pre, post, and 3-month post, (3) a satisfaction questionnaire after each session, and (4) an overall satisfaction questionnaire post-ECHO series. Time spent by hospital allied health clinicians providing impromptu phone/email feeding support to external clinicians was recorded for 8 weeks prior to and 8 weeks during the ECHO series. Forty-seven participants were included in the study, attending an average of 5.8 sessions. Significant improvements in self-reported confidence were observed across the three time points (p < 0.01) with less experienced participants demonstrating greater improvements. Participants reported high satisfaction with ECHO, with 93% (40/43) wanting continued access to ECHO in future. The multidisciplinary format, interactivity, structure, and case-based nature of ECHO were considered beneficial. A 75% reduction in requests for support from clinicians in the same catchment area was noted during the ECHO series. Results demonstrated that Project ECHO is a viable model for pediatric feeding education for clinicians working in the field. Further research is needed to investigate the long-term effects and impacts on clinical care.
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Affiliation(s)
- Madeline Raatz
- Queensland Children's Hospital, Children's Health Queensland, PO Box 3474, South Brisbane, QLD, 4101, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Elizabeth C Ward
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Perrin Moss
- Queensland Children's Hospital, Children's Health Queensland, PO Box 3474, South Brisbane, QLD, 4101, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Claire Reilly
- Queensland Children's Hospital, Children's Health Queensland, PO Box 3474, South Brisbane, QLD, 4101, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Nadine Frederiksen
- Queensland Children's Hospital, Children's Health Queensland, PO Box 3474, South Brisbane, QLD, 4101, Australia
| | - Corrine Dickinson
- Queensland Children's Hospital, Children's Health Queensland, PO Box 3474, South Brisbane, QLD, 4101, Australia
| | - Sally Clarke
- Queensland Children's Hospital, Children's Health Queensland, PO Box 3474, South Brisbane, QLD, 4101, Australia
| | - Kelly Beak
- Queensland Children's Hospital, Children's Health Queensland, PO Box 3474, South Brisbane, QLD, 4101, Australia
| | - Jeanne Marshall
- Queensland Children's Hospital, Children's Health Queensland, PO Box 3474, South Brisbane, QLD, 4101, Australia.
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
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Lal PB, Ward EC, Wishart LR, Schwarz M, Seabrook M, Coccetti A. Nature and timeliness of dysphagia management within an emergency setting. Int J Speech Lang Pathol 2024; 26:233-243. [PMID: 37306536 DOI: 10.1080/17549507.2023.2210266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE To examine referral pathways, clinical demographics, and timeliness of dysphagia management within an emergency department (ED) setting utilising both ED staff and speech-language pathology (SLP) initiated referral pathways. METHOD Six-month retrospective service review of patients who received dysphagia assessment by SLP within a major Australian ED. Data were collected on demographics, referral information, and SLP assessment and service outcomes. RESULT Three hundred and ninety-three patients were assessed by SLP staff in the ED, consisting of 200 stroke and 193 non-stroke referrals. In the stroke cohort, 57.5% of referrals were initiated by ED staff, while 42.5% were SLP initiated. ED staff initiated 91% of non-stroke referrals, with few (9%) proactively identified by SLP staff. SLP staff identified a higher proportion of non-stroke patients within 4 hr of presentation compared to ED staff. Stroke patients identified by SLP staff were more likely to have assessments completed within 8 hr compared to the ED referral pathway. Collectively, 51% of patients required ongoing dysphagia management following initial assessment. CONCLUSION Findings provide an overview of SLP services and referral pathways in an ED context. The SLP initiated referral pathway facilitated early assessment of stroke patients, and collaboration with ED staff was integral in referring other at risk populations. SLP/ED synergy is needed for appropriate and timely dysphagia management practices in an ED.
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Affiliation(s)
- Pranika B Lal
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Australia
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Brisbane, Australia
- Bayside Health Service, Metro South Hospital & Health Service, Brisbane, Australia; and
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Brisbane, Australia
| | - Laurelie R Wishart
- School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Brisbane, Australia
| | - Maria Schwarz
- Bayside Health Service, Metro South Hospital & Health Service, Brisbane, Australia; and
| | - Marnie Seabrook
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Brisbane, Australia
| | - Anne Coccetti
- Bayside Health Service, Metro South Hospital & Health Service, Brisbane, Australia; and
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Thomas EE, Taylor ML, Ward EC, Hwang R, Cook R, Ross JA, Webb C, Harris M, Hartley C, Carswell P, Burns CL, Caffery LJ. Beyond forced telehealth adoption: A framework to sustain telehealth among allied health services. J Telemed Telecare 2024; 30:559-569. [PMID: 35130099 DOI: 10.1177/1357633x221074499] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION As COVID-19 restrictions reduce globally, services will determine what components of care will continue via telehealth. We aimed to determine the clinician, service, and system level factors that influence sustained use of telehealth and develop a framework to enhance sustained use where appropriate. METHODS This study was conducted across 16 allied health departments over four health service facilities (Brisbane, Australia). It used a multi-method observational study design, involving telehealth service activity data from hospital administrative databases and qualitative interviews with allied health staff (n = 80). Data were integrated and analysed using Greenhalgh's Non-adoption, Abandonment, Scale-up, Spread, and Sustainability framework. RESULTS Increased telehealth use during the peak COVID period reverted to in-person activity as restrictions eased. Telehealth is unlikely to be sustained without a clear strategy including determination of roles and responsibilities across the organisation. Clinician resistance due to forced adoption remains a key issue. The main motivator for clinicians to use telehealth was improved consumer-centred care. Benefits beyond this are needed to sustain telehealth and improvements are required to make the telehealth experience seamless for providers and recipients. Data were synthesised into a comprehensive framework that can be used as a blueprint for system-wide improvements and service enhancement or redesign. DISCUSSION Sustainability of telehealth activity beyond the peak COVID period is unlikely without implementation strategies to address consumer, clinician, service, and system factors. The framework can inform how these strategies can be enacted. Whilst developed for allied health disciplines, it is likely applicable to other disciplines.
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Affiliation(s)
- Emma E Thomas
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Monica L Taylor
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Health, and, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane Australia
| | - Rita Hwang
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Allied Health, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Renee Cook
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health, and, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane Australia
- Allied Health, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Julie-Anne Ross
- Allied Health, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Clare Webb
- Allied Health, Queen Elizabeth II Jubilee Hospital, Metro South Health, Brisbane, Australia
| | - Michael Harris
- Allied Health, Bayside Health Service, Metro South Health, Brisbane, Australia
| | - Carina Hartley
- Allied Health, Logan Hospital, Metro South Health, Brisbane, Australia
| | - Phillip Carswell
- Consumer Advisor, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Clare L Burns
- Speech Pathology Department, Royal Brisbane & Women's Hospital, Metro North Hospital and Health Service, 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
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Poon FMM, Ward EC, Burns CL. Using concept mapping to guide dysphagia service enhancements in Singapore: Recommendations from the speech-language pathology workforce. Int J Speech Lang Pathol 2024:1-14. [PMID: 38439695 DOI: 10.1080/17549507.2023.2297653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
PURPOSE Optimising dysphagia service delivery is crucial to minimise personal and service impacts associated with dysphagia. However, limited data exist on how to achieve this in Singapore. This study aimed to develop prioritised enhancements that the speech-language pathology workforce perceived as needed to improve dysphagia services in Singapore. METHOD Using a concept mapping approach, 19 speech-language pathologists (SLPs) and 10 managers listed suggestions for dysphagia service optimisation. Within their groups, the collated suggestions were sorted based on similarity, and individually rated on a 5-point scale based on importance and changeability. Using cluster and bivariate analysis, clusters of similar suggestions and prioritised suggestions for service optimisation were identified. RESULT The SLPs and managers proposed 73 and 51 unique suggestions respectively. Six clusters were identified for each group, with similar themes suggesting agreement of service improvements. All clusters were rated as more important than changeable. The managers perceived services as easier to change. The SLPs and managers rated 37% (27/73) and 43% (22/51) of suggestions, respectively, as high priority, with similarities relating to workforce capacity and capability, support and services access, care transitions, and telehealth services. CONCLUSION Prioritised enhancements identified by SLPs and managers provide direction for dysphagia service optimisation in Singapore.
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Affiliation(s)
- Flora M M Poon
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Rehabilitation, Ng Teng Fong General Hospital and Jurong Community Hospital, National University Health System, Singapore, Singapore
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
| | - Clare L Burns
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Speech Pathology & Audiology Department, Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Australia
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Ryan M, Poke T, Ward EC, Carrington C, Snoswell CL. A systematic review of synchronous telepharmacy service models for adult outpatients with cancer. Res Social Adm Pharm 2024:S1551-7411(24)00081-0. [PMID: 38490859 DOI: 10.1016/j.sapharm.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/21/2024] [Accepted: 02/23/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Telephone and videoconsults are known synchronous telepharmacy modalities being used to respond to the demand for outpatient pharmacy services. However, little is known about the evidence for cancer telepharmacy service models. OBJECTIVES To review existing evidence regarding synchronous telepharmacy service models for adult outpatients with cancer, with a secondary focus on outcomes, enablers, and barriers. METHODS A PROSPERO registered systematic review was conducted using PubMed, CINAHL, and EMBASE in March 2023. Key search terms included pharmacy, telepharmacy, and outpatient. During article selection in Covidence, an extra inclusion criterion of synchronous cancer-focused services was applied; data extraction and narrative analysis were then performed. RESULTS From 2129 non-duplicate articles, 8 were eligible for inclusion, describing 7 unique patient populations. The service models included pre-treatment medication history taking, adherence monitoring, toxicity assessment, and discharge follow-up. Studies found synchronous telepharmacy services can improve timeliness of care, optimise workload management, and provide individualised and convenient efficacy monitoring and counselling. One study of 177 patients on immune checkpoint inhibitors found 38% of the 726 telephone consults involved at least one intervention. When videoconsults were compared directly with telephone consults for pre-treatment medication history, it was found scheduled videoconsults had a significantly higher success rate than unscheduled telephone consults, and that videoconsults also represented increased funding and equivalent time efficiency. When telephone follow-up was compared to no follow-up, improved treatment adherence was seen, and progression-free survival was significantly higher for the telephone group (6.1 months vs 3.7 months, p = 0.001). Reported enablers included physician buy-in, staff resources, and correct utilisation of technology, while identified barriers included time investment required and technical issues. CONCLUSION Both telephone and videoconsult modalities are being used to deliver synchronous telepharmacy services across a range of outpatient services. Although more evidence is needed, data to date supports positive service benefits and enhanced care.
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Affiliation(s)
- Marissa Ryan
- Pharmacy Department, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Brisbane, QLD, Australia; Centre for Online Health, The University of Queensland, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, 4102, Australia; Centre for Health Services Research, The University of Queensland, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, 4102, Australia.
| | - Tara Poke
- Pharmacy Department, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Brisbane, QLD, Australia.
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Suite 304, 3rd Floor, Buranda Village, Corner Cornwall Street and Ipswich Road, Buranda, Brisbane, QLD, 4102, Australia; School of Health and Rehabilitation Sciences, The University of Queensland, 84a Services Rd, St Lucia, Brisbane, QLD, 4067, Australia.
| | - Christine Carrington
- Pharmacy Department, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Brisbane, QLD, Australia; School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, Brisbane, QLD, 4102, Australia.
| | - Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, 4102, Australia; Centre for Health Services Research, The University of Queensland, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, 4102, Australia; School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, Brisbane, QLD, 4102, Australia.
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Stradling EJ, Barnhart MK, Robinson RA, Mogg PJ, Ward EC, Smee RI. Implementing flexible endoscopic evaluation of swallow screening within annual cancer surveillance appointments to monitor for late-stage radiation-induced dysphagia: A feasibility study. Head Neck 2024; 46:615-626. [PMID: 38151916 DOI: 10.1002/hed.27615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/14/2023] [Accepted: 12/12/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Late-stage progressive decline of swallowing function after radiotherapy for head and neck cancer (HNC) is often difficult to monitor. This study examined the feasibility and clinical outcomes of speech-language pathology implementing flexible endoscopic evaluation of swallow (FEES) screening during annual cancer surveillance visits to monitor late-stage swallowing function. METHODS Patients >2 years post treatment who attended routine oncological visits underwent FEES screening. Feasibility (service data, stakeholder survey) and swallowing outcomes (oral intake, secretions, internal lymphedema, penetration-aspiration, and residue) were collected. RESULTS Screening was completed with 70% (50/71) of eligible patients. Medical staff and speech-language pathologists indicated the protocol was worthwhile and achievable to incorporate into practice. Almost all patients were willing to complete the protocol annually. FEES outcomes identified 84% with dysphagia versus only 26% self-reported dysphagia. CONCLUSION Findings indicate FEES screening incorporated into annual oncological reviews is feasible and effective at monitoring late-stage swallowing function following HNC.
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Affiliation(s)
- Emma J Stradling
- Department of Speech Pathology, Prince of Wales Hospital, South-Eastern Sydney Local Health District, Randwick, New South Wales, Australia
- Department of Radiation Oncology, Comprehensive Cancer Centre, POWH, Randwick, New South Wales, Australia
| | - Molly K Barnhart
- Department of Speech Pathology, Prince of Wales Hospital, South-Eastern Sydney Local Health District, Randwick, New South Wales, Australia
- Department of Radiation Oncology, Comprehensive Cancer Centre, POWH, Randwick, New South Wales, Australia
| | - Rachelle A Robinson
- Department of Speech Pathology, Prince of Wales Hospital, South-Eastern Sydney Local Health District, Randwick, New South Wales, Australia
| | - Penny J Mogg
- Department of Speech Pathology, Prince of Wales Hospital, South-Eastern Sydney Local Health District, Randwick, New South Wales, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Centre of Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Robert I Smee
- Department of Radiation Oncology, Comprehensive Cancer Centre, POWH, Randwick, New South Wales, Australia
- Department of Radiation Oncology, Tamworth Base Hospital, Tamworth, New South Wales, Australia
- The Clinical Teaching School, University New South Wales, Kensington, New South Wales, Australia
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Lal PB, Ward EC, Wishart LR, Foley J, Schwarz M, Seabrook M, O'Donnell C, Coccetti A. Dysphagia Management in the Emergency Department: Using Concept Mapping to Identify Actionable Change to Improve Services. Dysphagia 2024:10.1007/s00455-023-10651-5. [PMID: 38206345 DOI: 10.1007/s00455-023-10651-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/26/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Integrated speech-language pathology (SLP) services within the emergency department (ED) may facilitate timely dysphagia management. However, there are multiple patient and logistical factors specific to the ED that challenge the delivery of optimal dysphagia referral and management practices within this setting. The aim of the current study was to engage a stakeholder group to identify prioritised, actionable goals that could help enhance dysphagia management within the ED. METHODS AND PROCEDURES Applying concept mapping methodology, 16 ED stakeholders from SLP, medical, nursing, and leadership participated in semi-structured interviews to develop action statements which were sorted and ranked for importance and changeability. Multidimensional scaling and hierarchical cluster analysis were used to organise data in clusters with unifying themes before statements were ranked by importance and changeability. OUTCOMES AND RESULTS Stakeholders identified 53 unique statements, grouped into 8 clusters. Review of the 8 clusters identified 3 overarching aspects for change: (a) Improving processes related to identification and referral of patients as well as communication; (b) Teamwork and collaboration amongst the ED multidisciplinary team and SLP; and (c) Improving staffing and access to training resources for SLP and nursing teams. Seventeen statements were within the Go-zone rated highest for importance and changeability) with the highest rated statement being: Clear documentation by SLP re: recommendations. CONCLUSION The current data identified multiple aspects of service provision that require change to facilitate improved dysphagia referral and management services in the ED. Collaborative actions are required by both SLP and the ED multidisciplinary team to help optimise dysphagia services.
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Affiliation(s)
- Pranika B Lal
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia.
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Meadowbrook, QLD, Australia.
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Buranda, QLD, Australia
| | - Laurelie R Wishart
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Buranda, QLD, Australia
| | - Jasmine Foley
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | | | - Marnie Seabrook
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Meadowbrook, QLD, Australia
| | - Carolann O'Donnell
- Department of Emergency, Logan Hospital, Metro South Hospital & Health Service, Meadowbrook, QLD, Australia
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Kefford J, Marshall J, Packer RL, Ward EC. Feeding Characteristics in Children With Food Allergies: A Scoping Review. J Speech Lang Hear Res 2024; 67:132-148. [PMID: 38040005 DOI: 10.1044/2023_jslhr-23-00303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
BACKGROUND Food allergy (FA) affects approximately 8% of children and may be immunoglobulin E (IgE)-mediated or non-IgE-mediated. It is recognized clinically that children with both subtypes of FA may present with features of pediatric feeding disorder (PFD); however, there is currently a limited detail of presenting characteristics. OBJECTIVE The objective of this study was to synthesize the current evidence regarding the feeding characteristics of children with FA, with a focus on the feeding skills and psychosocial domains of PFD. METHOD This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Papers published between 2001 and 2022 describing feeding characteristics in the feeding skills and psychosocial domains in children with FA/history of FA were included. Papers that focused solely on characteristics from the medical or nutritional domains were excluded. Descriptive information regarding demographics, methodology, allergy profile and history, and the characteristics of PFD observed was extracted using a preconceived data extraction form. RESULTS Overall, 40 papers contained descriptions of feeding characteristics of children with non-IgE-mediated FA (n = 22) and IgE-mediated FA (n = 11), while four were nonspecific. In the psychosocial domain, food refusal/aversion, anxiety with eating, and poor intake were the most frequently reported, regardless of FA subtype. Less information was reported regarding feeding skills, although slowness in eating, immature diet, and delays in oral sensory-motor skills were described. CONCLUSIONS Children with FA/history of FA may present with a range of characteristics that map across the feeding skill and psychosocial domains of PFD. Systematic research is needed to fully describe the feeding characteristics of children with FA. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24562732.
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Affiliation(s)
- Jennifer Kefford
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Northern Sydney Local Health District, New South Wales Health, Sydney, Australia
| | - Jeanne Marshall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, Brisbane, Australia
| | - Rebecca L Packer
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, Brisbane, Queensland, Australia
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Clayton NA, Ward EC, Norman E, Ryan H, Kol MR. Speech pathology assessment of dysphagia post endotracheal extubation: A service-model evaluation. Aust Crit Care 2024; 37:144-150. [PMID: 37709658 DOI: 10.1016/j.aucc.2023.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 06/02/2023] [Accepted: 07/25/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND As postextubation dysphagia (PED) is correlated with pneumonia, feeding-tube placement, and in-hospital mortality, early identification is paramount. Endotracheal intubation duration of ≥48 h is independently predictive for PED. Therefore, a blanket intensive care unit (ICU) referral protocol was implemented to conduct PED assessment of patients intubated for ≥48 h. OBJECTIVES The objective of this study was to review outcomes of an established blanket referral model for PED assessment in patients intubated for ≥48 h. Outcomes of the model were examined over a 2-year period (June 2015-June 2017) for (i) numbers and clinical characteristics of patients meeting criteria and referred for speech pathology (SP) assessment; (ii) frequency identified with PED on clinical swallow examination; (iii) severity and duration of PED; and (iv) SP management within the ICU. RESULTS There was 96% adherence to the pathway with 108 participants (68% male) assessed. Median intubation duration was 142 h (mode = 61; interquartile range [IQR] = 131.75), and median ICU admission was 9 days (mode = 8; IQR = 6.75). SP referral occurred at a median of 19.5 h (mode = 4; IQR = 18.75) after extubation. Dysphagia assessment occurred at a median of 22 h (mode = 4; IQR = 19), with 34% assessed on the same day and 77% within 24 h of extubation. PED was observed in 89%, with 26% exhibiting profound PED. Dysphagia recovery occurred at a median of 7 days (mode = 2; IQR = 11). Dysphagia severity was associated with duration to swallow recovery (p = 0.001). A median of two occasions of service and 90 min clinical time was spent by the speech pathologist in the ICU. CONCLUSION The blanket referral model enabled timely triage and assessment of dysphagia in a patient cohort at high risk of PED in our facility.
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Affiliation(s)
- Nicola A Clayton
- Speech Pathology Department, Concord Repatriation General Hospital, NSW Australia; Intensive Care Unit, Concord Repatriation General Hospital, NSW Australia; School of Health and Rehabilitation Sciences, University of Queensland, QLD Australia; Faculty of Medical and Health Sciences, University of Sydney, NSW Australia.
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, University of Queensland, QLD Australia; Centre for Functioning and Health Research, Metro South Health, Queensland Health, QLD Australia
| | - Eva Norman
- Speech Pathology Department, Concord Repatriation General Hospital, NSW Australia; Intensive Care Unit, Concord Repatriation General Hospital, NSW Australia
| | - Helen Ryan
- Speech Pathology Department, Concord Repatriation General Hospital, NSW Australia
| | - Mark R Kol
- Intensive Care Unit, Concord Repatriation General Hospital, NSW Australia
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Cox R, Kyle G, Suzuki A, Wishart L, McCusker M, McConnell A, Ward EC, Ross L, Webb C. Patient and multidisciplinary health professional perceptions of an Australian geriatric evaluation and management and rehabilitation hospital in the home service. J Health Serv Res Policy 2024; 29:31-41. [PMID: 37897739 DOI: 10.1177/13558196231193863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2023]
Abstract
OBJECTIVES Hospital in the Home models are rapidly expanding in response to increasing bed pressures. This study examined patient and multidisciplinary health professional perceptions of a new geriatric evaluation and management and rehabilitation hospital in the home service in Australia. The service was unique, as adults of all ages with a variety of rehabilitation or geriatric evaluation and management needs were within scope. METHODS A qualitative descriptive approach was used with a consumer co-researcher and a consumer advisor being integral to decision-making. Patient feedback was collected via a paper-based patient satisfaction survey between August 2020 and February 2022. Additionally, interviews with current and past staff were conducted from July to November 2021. Reflexive thematic analysis was conducted for qualitative data and descriptive statistics used for quantitative data. RESULTS Patient surveys were analysed (n = 199, 42.2% response rate) with 60.8% of participants aged 75 years or over and 26.6% speaking a language other than English. High satisfaction was expressed. Feelings of comfort, familiarity, convenience, and reassurance were voiced. A person-centred approach enhanced involvement in care. Challenges included carer burden and clear communication. Sixteen staff (33% response rate) were interviewed. In general, staff said the service was inclusive and responsive, and the home environment beneficial, particularly for patients from culturally diverse backgrounds. A strong hospital partnership and comprehensive multidisciplinary approach were vital. Challenges included fragmentation due to part-time roles and combining with a pre-existing acute hospital in the home service. CONCLUSIONS This qualitative exploration of staff and patients' perceptions of a geriatrician-led, multidisciplinary geriatric evaluation and management and rehabilitation hospital in the home service demonstrated that it was person-centred and optimised patients' control and ownership of care. The inclusive service parameters ensured responsiveness to diverse needs whilst allowing earlier return home from hospital, both of which are vital for quality patient care.
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Affiliation(s)
- Ruth Cox
- Occupational Therapy Department, Queen Elizabeth II Jubilee Hospital, Brisbane, QLD, Australia
| | - Greg Kyle
- Centre for Functioning and Health Research, Metro South Health, Brisbane, QLD, Australia
| | - Anya Suzuki
- Occupational Therapy Department, Queen Elizabeth II Jubilee Hospital, Brisbane, QLD, Australia
| | - Laurelie Wishart
- Centre for Functioning and Health Research, Metro South Health, Brisbane, QLD, Australia
| | - Melissa McCusker
- Community and Oral Health, Metro South Health, Brisbane, QLD, Australia
| | - Alexander McConnell
- Consumer Partner, Queen Elizabeth II Jubilee Hospital, Brisbane, QLD, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Health, Brisbane, QLD, Australia
- School of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Leo Ross
- Division of Allied Health, Queen Elizabeth II Jubilee Hospital, Brisbane, QLD, Australia
| | - Clare Webb
- Occupational Therapy Department, Queen Elizabeth II Jubilee Hospital, Brisbane, QLD, Australia
- Division of Allied Health, Queen Elizabeth II Jubilee Hospital, Brisbane, QLD, Australia
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Wishart LR, Ward EC, Galloway G. Advances in and applications of imaging and radiomics in head and neck cancer survivorship. Curr Opin Otolaryngol Head Neck Surg 2023; 31:368-373. [PMID: 37548514 DOI: 10.1097/moo.0000000000000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
PURPOSE OF REVIEW Radiological imaging is an essential component of head/neck cancer (HNC) care. Advances in imaging modalities (including CT, PET, MRI and ultrasound) and analysis have enhanced our understanding of tumour characteristics and prognosis. However, the application of these methods to evaluate treatment-related toxicities and functional burden is still emerging. This review showcases recent literature applying advanced imaging and radiomics to the assessment and management of sequelae following chemoradiotherapy for HNC. RECENT FINDINGS Whilst primarily early-stage/exploratory studies, recent investigations have showcased the feasibility of using radiological imaging, particularly advanced/functional MRI (including diffusion-weighted and dynamic contrast-enhanced MRI), to quantify treatment-induced tissue change in the head/neck musculature, and the clinical manifestation of lymphoedema/fibrosis and dysphagia. Advanced feature analysis and radiomic studies have also begun to give specific focus to the prediction of functional endpoints, including dysphagia, trismus and fibrosis. SUMMARY There is demonstrated potential in the use of novel imaging techniques, to help better understand pathophysiology, and improve assessment and treatment of functional deficits following HNC treatment. As larger studies emerge, technologies continue to progress, and pathways to clinical translation are honed, the application of these methods offers an exciting opportunity to transform clinical practices and improve outcomes for HNC survivors.
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Affiliation(s)
- Laurelie R Wishart
- Centre for Functioning & Health Research, Metro South Hospital & Health Service
- School of Health and Rehabilitation Sciences, The University of Queensland
| | - Elizabeth C Ward
- Centre for Functioning & Health Research, Metro South Hospital & Health Service
- School of Health and Rehabilitation Sciences, The University of Queensland
| | - Graham Galloway
- Translational Research Institute
- Herston Imaging Research Facility, The University of Queensland, Brisbane, Australia
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Poon FMM, Ward EC, Burns CL. Identifying prioritised actions for improving dysphagia services in Singapore: Insights from concept mapping with patients and caregivers. Int J Lang Commun Disord 2023. [PMID: 37936543 DOI: 10.1111/1460-6984.12977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/13/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Person-centred services are inherently related to patients/caregivers' needs. However, the extent to which dysphagia services within Singapore meet consumer needs is largely unknown. Involving patients/caregivers in service evaluation/redesign deepens the understanding of consumer needs. This process also increases the success of implementing service enhancements through relevant and meaningful change. AIM This study aimed to identify aspects of dysphagia services, within acute and subacute settings in Singapore, perceived as highly important and easy to change by patients/caregivers. METHODS & PROCEDURES Using concept mapping methodology, 5 patients and 11 caregivers reflected on their experiences of receiving dysphagia care and proposed 59 unique suggestions to improve dysphagia services within Singapore. Then, each individual sorted the suggestions into groups based on similarity and rated each statement for its perceived importance and changeability for service enhancement. Data were analysed using multidimensional scaling, hierarchical cluster analysis, and bivariate analysis to generate clusters of conceptually similar suggestions and a prioritised list of suggestions for service enhancement. RESULTS Twelve clusters were identified, with most rated as more important than changeable for service improvement. Participants prioritised 23 (39%) of the suggestions as highly important and easy to change, and these focused on ensuring effective communication among consumers and healthcare team, enhancing patients and carers' access to support at home, increasing patients and carers' access to educational resources, and improving service quality and access through technology. CONCLUSION These findings provide future directions on how to develop and implement dysphagia services in Singapore to better meet the needs of patients/caregivers. WHAT THIS PAPER ADDS What is already known on this subject Little is known about patients and caregivers' experiences and expectations of receiving dysphagia services in Singapore. Consulting them in service review and improvement deepens understanding of their needs and increases the success of implementing meaningful service enhancements. What this study adds to existing knowledge This study shows that patients and caregivers in Singapore identified a wide range of dysphagia service issues and prioritised a list of suggestions for service improvement. They prioritised four key areas for service optimisation: ensuring effective communication among consumers and healthcare team, enhancing patients and carers' access to support at home, increasing patients and carers' access to educational resources, and improving service quality and access through technology. What are the clinical implications of this work? This research highlights the importance of considering the consumers' perspectives in service review and redesign. Patients and caregivers in Singapore identified four prioritised areas for service enhancements. These findings provide future directions on how to develop and implement dysphagia services in Singapore to better meet the needs of patients and caregivers.
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Affiliation(s)
- Flora M M Poon
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Rehabilitation, Ng Teng Fong General Hospital and Jurong Community Hospital, National University Health System, Singapore, Singapore
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
| | - Clare L Burns
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Speech Pathology & Audiology Department, Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Queensland, Australia
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14
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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. Int J Lang Commun Disord 2023. [PMID: 37921245 DOI: 10.1111/1460-6984.12976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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.
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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
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15
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Ward EC, Caird E, Khanal S, Kularatna S, Byrnes J, Penman A, Mcallister S, Baldac S, Cardell E, Davenport R, Davidson B, Hewat S, Howells S, Mccabe P, Purcell A, Walters J, Hill AE. A cost analysis of a 5-day simulation-based learning program for speech-language pathology student training. International Journal of Speech-Language Pathology 2023; 25:688-696. [PMID: 36062806 DOI: 10.1080/17549507.2022.2115138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Purpose: There is poor reporting of the cost of simulation and greater transparency is needed. The primary study aim was to conduct a financial analysis of the university/training institution costs associated with a 5-day simulation-based learning program for speech-language pathology students. The secondary aim was to consider the economic costs of the model.Method: Costs associated with the delivery of a 5-day simulation-based learning program for speech-language pathology students from six Australian universities were collected regarding: (a) pre-program training, (b) personnel, (c) room hire, (d) equipment, and (e) consumables. Both financial costs and economic costs (Australian dollar, at June 2017) were calculated per university site, and per student.Result: The simulation program was run 21 times involving 176 students. Average total financial cost per program ranged from $4717 to $11 425, with cost variation primarily attributed to local labour costs and various use of in-kind support. Average financial cost per student was $859 (range $683-$1087), however this was almost double ($1461 per student, range $857-$2019) in the economic cost calculation. Personnel was the largest contributing cost component accounting for 76.6% of financial costs. Personnel was also the highest contributing cost in the economic analysis, followed by room hire.Conclusion: This study provides clarity regarding financial and economic costing for a 5-day simulation-based learning program. These data can help universities consider potential up-front financial costs, and well as strategies for financial cost minimisation, when implementing simulation-based learning within the university context.
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Affiliation(s)
- Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
| | - Emma Caird
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Saval Khanal
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Sanjeewa Kularatna
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Adriana Penman
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Sue Mcallister
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | | | - Elizabeth Cardell
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Rachel Davenport
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Bronwyn Davidson
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Australia
| | - Sally Hewat
- School of Health Science, The University of Newcastle, Callaghan, Australia, and
| | - Simone Howells
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
| | - Patricia Mccabe
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Alison Purcell
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Joanne Walters
- School of Health Science, The University of Newcastle, Callaghan, Australia, and
| | - Anne E Hill
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Marshall J, Raatz M, Ward EC, Penman A, Beak K, Moore M, Hill AE. Development and Pilot Testing of Telesimulation for Pediatric Feeding: A Feasibility Study. Dysphagia 2023; 38:1308-1322. [PMID: 36692653 PMCID: PMC9872075 DOI: 10.1007/s00455-023-10556-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/10/2023] [Indexed: 01/25/2023]
Abstract
Simulation enables learners to practice new skills in a supportive environment. Largely driven by the COVID-19 pandemic, simulation via telepractice, i.e., telesimulation, has emerged. Viable delivery of telesimulation requires consideration of the adaptations needed to conduct simulation via telepractice. The aim of this study was to design and pilot test the feasibility of using telesimulation to provide training in infant feeding management. An iterative process was used across four phases: (1) simulation design, (2) telesimulation adaptations, (3) user testing, feedback, and modifications, and (4) user testing of modified simulation, feedback, and final modifications. During Phases 1 and 2, team members worked together to design and test telepractice adaptations for a simulation experience. During Phases 3 and 4, the telesimulation was pilot tested with a group of speech pathologists, with feedback sought via open-ended survey questions and/or an optional focus group. Manifest content analysis was used to interpret user feedback. In Phase 2, several adaptations were explored to optimize telesimulation delivery and engagement, including Zoom® functions (e.g., 'spotlighting,' digital backgrounds) and supplementary video/auditory files. There were 11 participants across Phases 3 and 4. Specific feedback centered around simulation preparation and structure, session practicalities, supports for realism, Zoom® functions, group dynamics, participants' experiences, and future enhancements. An overall list of recommendations for telesimulation was generated. Telesimulation for feeding management was considered feasible and participant feedback was favorable. Further research is required to investigate if the learner outcomes of telesimulation are comparable to in-person simulation for infant feeding management.
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Affiliation(s)
- Jeanne Marshall
- Speech Pathology Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Australia.
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Madeline Raatz
- Speech Pathology Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
- Speech Pathology Department, Logan Hospital, Metro South Hospital and Health Service, Brisbane, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, Brisbane, Australia
| | - Adriana Penman
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Kelly Beak
- Speech Pathology Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Madison Moore
- Speech Pathology Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Anne E Hill
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Schwarz M, Ward EC, Coccetti A, Simmons J, Burrett S, Juffs P, Perkins K. Exploring maturity of electronic medical record use among allied health professionals. HEALTH INF MANAG J 2023:18333583231198100. [PMID: 37702314 DOI: 10.1177/18333583231198100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND Electronic medical records (EMRs) have the potential to improve and streamline the quality and safety of patient care. Harnessing the full benefits of EMR implementation depends on the utilisation of advanced features, defined as "mature usage." At present, little is known about the maturity of EMR usage by allied health professionals (AHPs). OBJECTIVE To examine current maturity of EMR use by AHPs and explore perceived barriers to mature EMR utilisation and optimisation. METHOD AHPs were recruited from three health services. Participants completed a 27-question electronic questionnaire based on the EMR Adoption Framework, which measures clinician EMR utilisation (0 = paper chart, 5 = theoretical maximum) across 10 EMR feature categories. Interviews were conducted with both clinicians and managers to explore the nature of current EMR utilisation and perceived facilitators and barriers to mature usage. RESULTS Questionnaire responses were obtained from 192 AHPs. The majority of questions (74%) showed a mean score of <3, indicating a lack of mature EMR use. Pockets of mature usage were identified in the categories of health information, referrals and administration processes. Interviews with 18 clinicians and managers revealed barriers to optimisation across three themes: (1) limited understanding of EMR opportunities; (2) complexity of the EMR change process and (3) end-user and environmental factors. CONCLUSION Mature usage across EMR feature categories of the EMR Adoption Framework was low. However, questionnaire and qualitative interview data suggested pockets of mature utilisation. IMPLICATIONS Achieving mature allied health EMR use will require strategies implemented at the clinician, EMR support, and service levels.
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Affiliation(s)
| | - Elizabeth C Ward
- Queensland Health, Australia
- The University of Queensland, Brisbane Australia
| | | | | | - Sara Burrett
- Gold Coast Hospital and Health Service, Australia
| | - Philip Juffs
- West Moreton Hospital and Health Service, Australia
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Raatz M, Ward EC, Marshall J, Burns CL, Afoakwah C, Byrnes J. A time and cost analysis of speech pathology paediatric feeding services delivered in-person versus via telepractice. J Telemed Telecare 2023; 29:613-620. [PMID: 33966525 DOI: 10.1177/1357633x211012883] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Telepractice models of care have the potential to reduce the time and financial burdens that consumers may experience accessing healthcare services. The current study aimed to conduct a time and financial cost analysis of paediatric feeding appointments accessed via telepractice (using videoconferencing) compared to an in-person model. METHODS Parents of 44 children with paediatric feeding disorders (PFDs) residing in a metropolitan area completed three questionnaires relating to (a) demographics, (b) time and cost for in-person care and (c) time and cost for telepractice. Both cost questionnaires collected data required for direct and indirect costs comparisons (e.g. out-of-pocket costs associated with the appointment (direct), time away from usual duties (indirect)). Average number of services accessed by each participant, and PFD appointments conducted annually by the service, were collected from service statistics. Analysis involved cost minimisation and cost modelling from a societal perspective. RESULTS The telepractice appointment resulted in significant time (p = 0.007) and cost (AUD$95.09 per appointment, SD = AUD$64.47, p = < 0.0001) savings per family. The health service cost was equivalent for both models (AUD$58.25). Cost modelling identified cost savings of up to AUD$475.45 per family if 50% of appointments in a 10-session block were converted to telepractice. Potential cost savings of AUD$68,750.07 per annum to society could be realised if 50% of feeding appointments within the service were provided via telepractice. DISCUSSION The telepractice model offered both time and cost benefits. Future service re-design incorporating hybrid services (in-person and telepractice) will help optimise benefits and minimise burden for families accessing services for PFDs.
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Affiliation(s)
- Madeline Raatz
- Speech Pathology Department, Queensland Children's Hospital, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, Australia
| | - Jeanne Marshall
- Speech Pathology Department, Queensland Children's Hospital, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - Clare L Burns
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
- Speech Pathology and Audiology Department, Royal Brisbane and Women's Hospital, Australia
| | | | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, Australia
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Cook R, Haydon HM, Thomas EE, Ward EC, Ross JA, Webb C, Harris M, Hartley C, Burns CL, Vivanti AP, Carswell P, Caffery LJ. Digital divide or digital exclusion? Do allied health professionals' assumptions drive use of telehealth? J Telemed Telecare 2023:1357633X231189846. [PMID: 37543369 DOI: 10.1177/1357633x231189846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Telehealth use within allied health services currently lacks structure and consistency, ultimately affecting who can, and cannot, access services. This study aimed to investigate the factors influencing allied health professionals' (AHP) selection of consumers and appointments for telehealth. METHODS This study was conducted across 16 allied health departments from four Australian hospitals. Semi-structured focus groups were conducted with 58 AHPs. Analysis was underpinned by Qualitative Description methodology with inductive coding guided by Braun and Clarke's thematic analysis approach. RESULTS Six themes were identified that influenced AHPs' evaluation of telehealth suitability and selection of consumers. These included the following: (1) ease, efficiency and comfort of telehealth for clinicians; (2) clear benefits of telehealth for the consumer, yet the consumers were not always given the choice; (3) consumers' technology access and ability; (4) establishing and maintaining effective therapeutic relationships via telehealth; (5) delivering clinically appropriate and effective care via telehealth; and (6) external influences on telehealth service provision. A further theme of 'assumption versus reality' was noted to pervade all six themes. DISCUSSION Clinicians remain the key decision makers for whether telehealth is offered within allied health services. Ease and efficiency of use is a major driver in AHP's willingness to use telehealth. Assumptions and pre-conceived frames-of-reference often underpin decisions to not offer telehealth and present major barriers to telehealth adoption. The development of evidence-based, decision-support frameworks that engage the consumer and clinician in determining when telehealth is used is required. Services need to actively pursue joint decision-making between the clinician and consumer about service delivery preferences.
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Affiliation(s)
- Renee Cook
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research (CFAHR), Metro South Health, Brisbane, Australia
- Speech Pathology Department, Princess Alexandra Hospital, Metro South Health, 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
| | - Emma E Thomas
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research (CFAHR), Metro South Health, Brisbane, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Julie-Anne Ross
- Allied Health, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Clare Webb
- Allied Health, Queen Elizabeth II Jubilee Hospital, Metro South Health, Brisbane, Australia
| | - Michael Harris
- Allied Health, Bayside Health Service, Metro South Health, Brisbane, Australia
| | - Carina Hartley
- Allied Health, Logan Hospital, Metro South Health, Brisbane, Australia
| | - Clare L Burns
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Speech Pathology Department, Royal Brisbane & Women's Hospital, Metro North Health, Brisbane, Australia
| | - Angela P Vivanti
- Allied Health, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- School of Human Movement and Nutrition Studies, The University of Queensland, Brisbane, Australia
| | - Phillip Carswell
- Consumer Advisor, Princess Alexandra Hospital, Metro South Health, 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
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Lal PB, Wishart LR, Ward EC, Schwarz M, Seabrook M, Coccetti A. Understanding barriers and facilitators to speech-language pathology service delivery in the emergency department. Int J Speech Lang Pathol 2023; 25:509-522. [PMID: 35579003 DOI: 10.1080/17549507.2022.2071465] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Timely speech-language pathology (SLP) involvement with dysphagic patients in the Emergency Department (ED) may improve patient outcomes. This study utilised qualitative interviews to understand current models and explore factors which have influenced establishment and current dysphagia service provision in Australian EDs. METHOD Semi-structured interviews were conducted with representatives from 12 acute hospital facilities with a SLP ED service. Interview transcripts were analysed using plain content analysis to identify key themes. Sub-analysis using the Consolidated Framework for Implementation Research (CFIR) model was undertaken for facilities with more "expanded" models (n = 4). RESULT SLP ED service models ranged from referral-only services, to models with referral-only and proactive SLP-led screening procedures (classified as "expanded"). Patient-related factors, the ED setting, SLP service factors and perceptions of dysphagia management were key themes reported to impact service delivery. With expanded models, 14 CFIR constructs (innovation source, external policy and incentives, networks and communications, stakeholders and relative priority) were identified as facilitators, while four constructs (adaptability, cost, compatibility, available resources) were barriers to services. CONCLUSION There are service-specific issues with providing SLP care within the ED. Factors related to the unique ED environment must be considered by SLP departments when establishing/optimising dysphagia management within the ED.
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Affiliation(s)
- Pranika B Lal
- School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Queensland, Australia, and
| | - Laurelie R Wishart
- School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Queensland, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital & Health Service, Queensland, Australia
| | - Maria Schwarz
- Bayside Health Service, Metro South Hospital & Health Service, Queensland, Australia
| | - Marnie Seabrook
- Speech Pathology Department, Logan Hospital, Metro South Hospital & Health Service, Queensland, Australia, and
| | - Anne Coccetti
- Bayside Health Service, Metro South Hospital & Health Service, Queensland, Australia
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Foley J, Wishart LR, Ward EC, Burns CL, Packer RL, Philpot S, Kenny LM, Stevens M. Exploring the impact of remoteness on people with head and neck cancer: Utilisation of a state-wide dataset. Aust J Rural Health 2023. [PMID: 37280733 DOI: 10.1111/ajr.13005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 04/18/2023] [Accepted: 05/18/2023] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE Living in regional/rural areas can impact outcomes for people with head and neck cancer (HNC). Using a comprehensive state-wide dataset, the impact of remoteness on key service parameters and outcomes for people with HNC was examined. METHODS Retrospective quantitative analysis of routinely collected data held within the Queensland Oncology Repository. DESIGN Quantitative methods (descriptive statistics, multivariable logistic regression and geospatial analysis). SETTING All people diagnosed with HNC in Queensland, Australia. PARTICIPANTS The impact of remoteness was examined in 1991 people (1171 metropolitan, 485 inner-regional, 335 rural) with HNC cancer diagnosed between 2013 and 2015. MAIN OUTCOME MEASURES This paper reports key demographics and tumour characteristics (age, gender, socioeconomic status, First Nations status, co-morbidities, primary tumour site and staging), service use/uptake (treatment rates, attendance at multidisciplinary team review and timing to treatment) and post-acute outcomes (readmission rates, causes of readmission and 2-year survival). In addition to this, the distribution of people with HNC across QLD, distances travelled and patterns of readmission were also analysed. RESULTS Regression analysis revealed remoteness significantly (p < 0.001) impacted access to MDT review, receiving treatment, and time to treatment commencement, but not readmission or 2-year survival. Reasons for readmission did not differ by remoteness, with dysphagia, nutritional inadequacies, gastrointestinal disorders and fluid imbalance indicated in the majority of readmissions. Rural people were significantly (p < 0.0001) more likely to travel to care and to readmit to a different facility than provided primary treatment. CONCLUSIONS This study provides new insights into the health care disparities for people with HNC residing in regional/rural areas.
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Affiliation(s)
- Jasmine Foley
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Laurelie R Wishart
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Centre of Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
- Division of Cancer Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, QLD Health, Brisbane, Queensland, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Centre of Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Clare L Burns
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
- The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia
| | - Rebecca L Packer
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Shoni Philpot
- Cancer Alliance Queensland, Metro South Hospital and Health Service, QLD Health, Brisbane, Queensland, Australia
| | - Lizbeth M Kenny
- The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia
- The University of Queensland, School of Medicine, St Lucia, Queensland, Australia
| | - Maurice Stevens
- The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia
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Ward EC, Hancock K, Boxall J, Burns CL, Spurgin AL, Lehn B, Hoey J, Robinson R, Coleman A. Post-laryngectomy pulmonary and related symptom changes following adoption of an optimal day-and-night heat and moisture exchanger (HME) regimen. Head Neck 2023; 45:939-951. [PMID: 36808179 DOI: 10.1002/hed.27323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 01/03/2023] [Accepted: 01/20/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND This study examined post-laryngectomy pulmonary and related symptom changes following establishment of an optimal day/night regimen (all day/night wear of devices with improved humidification) using a new generation range of heat and moisture exchanger (HME) devices. METHODS In Phase 1 (6 weeks), 42 post-laryngectomy HME users transitioned from their usual HME regime to equivalent new device/s (i.e., "like-for-like"). In Phase 2 (6 weeks) participants used the full range of HMEs to achieve an optimal day/night regimen. Pulmonary symptoms, device use, sleep, skin integrity, quality of life and satisfaction were examined at baseline, and weeks 2 and 6 of each Phase. RESULTS From baseline to end of Phase 2, cough symptoms and impact significantly improved, as did sputum symptoms, sputum impact, duration and types of HMEs used, reasons for HME replacement, involuntary coughs, and sleep. CONCLUSION The new HME range supported improved HME use, with pulmonary and related symptom benefits.
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Affiliation(s)
- Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Kelli Hancock
- Speech Pathology, Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia
| | - Jenni Boxall
- Speech Pathology, Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia
| | - Clare L Burns
- Speech Pathology, Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Queensland, Australia
| | - Ann-Louise Spurgin
- Speech Pathology, Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Queensland, Australia
| | - Belinda Lehn
- Speech Pathology, Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Queensland, Australia
| | - Juliet Hoey
- Speech Pathology, Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Queensland, Australia
| | - Rachelle Robinson
- Speech Pathology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Adele Coleman
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
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Foley J, Ward EC, Burns CL, Nund RL, Wishart LR, Graham N, Patterson C, Ashley A, Fink J, Tiavaasue E, Comben W. Enhancing speech-language pathology head and neck cancer service provision in rural Australia: Using a plan, do, study, act approach. Int J Speech Lang Pathol 2023; 25:292-305. [PMID: 35532005 DOI: 10.1080/17549507.2022.2050300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE People with head and neck cancer (HNC) require ongoing speech-language pathology (SLP) services into the post-acute recovery phase of care. However, there are recognised service inequities/barriers for people from rural areas who are unable to access SLP services locally, necessitating travel to metropolitan centres. This study implemented strategies to assist rural speech-language pathologists to work to full scope of practice and support post-acute rehabilitation services for people with HNC. METHOD The study involved five SLP departments within a rural health referral network (one tertiary cancer centre, four rural sites). It involved a Plan-Do-Study-Act (PDSA) method, across two six month cycles, to achieve implementation of a model to support local SLP delivery of HNC care. Data collected included service activity, consumer feedback from people accessing local care, staff perceptions of the model and changes to local SLP service capabilities. RESULT Staff identified four objectives for change across the two PDSA cycles including resource development, upskilling/training and improving communication, and handover processes. In cycle 1, multiple resources were developed such as an eLearning program for training and skill development. In cycle 2, a pilot trial of a shared-care model was implemented, which successfully supported a transfer of care to local services for eight people with HNC. The majority of consumers accessing HNC care locally were satisfied with the service and would recommend future people with HNC receive similar care. CONCLUSION The PDSA process supported development and implementation of a model enabling local speech-language pathologists to offer post-acute care for people with HNC. This model helps rural people with HNC to access care closer to home by supporting rural clinicians to work to full scope of practice.
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Affiliation(s)
- Jasmine Foley
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre of Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Australia
| | - Clare L Burns
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Department of Speech Pathology, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Rebecca L Nund
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Laurelie R Wishart
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre of Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Australia
- Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, Australia
| | - Nicky Graham
- Department of Speech Pathology, Children's Health Queensland Hospital and Health Service, Wondai Hospital, Australia
| | - Corey Patterson
- Department of Speech Pathology, The Townsville University Hospital, The Townsville Hospital and Health Service, Townsville, Australia
| | - Amy Ashley
- Department of Speech Pathology, The Townsville University Hospital, The Townsville Hospital and Health Service, Townsville, Australia
| | - Julie Fink
- Department of Speech Pathology, The Townsville University Hospital, The Townsville Hospital and Health Service, Townsville, Australia
| | - Emily Tiavaasue
- Department of Speech Pathology, The Mount Isa Hospital, North West Hospital and Health service, Mount Isa, Australia
| | - Wendy Comben
- Department of Speech Pathology, The Townsville University Hospital, The Townsville Hospital and Health Service, Townsville, Australia
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Raatz M, Marshall J, Ward EC, Dickinson C, Frederiksen N, Reilly C, Fernando S. Understanding Training Needs in Pediatric Feeding for Allied Health Professionals: An Australian Perspective. Am J Speech Lang Pathol 2023; 32:452-468. [PMID: 36692930 DOI: 10.1044/2022_ajslp-22-00232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Clinician experience and confidence can negatively impact pediatric feeding service availability, but limited research has investigated what training allied health professionals (AHPs) need to increase these factors. This study developed and distributed a survey investigating Australian AHPs' self-reported confidence and anxiousness, training needs, factors impacting training access, and training preferences. METHOD This study was conducted over two phases. Phase 1 involved development and refinement of the survey, and Phase 2 involved distribution to Australian AHPs. Questions pertained to general demographics, feeding experience, feeding confidence and skills perception, and training needs. The questions were composed of multiple-choice, Likert scale, and short-response options. RESULTS Overall, 198 complete responses were received. Participants reported significantly lower confidence and higher anxiousness working with infants compared to older children (p < .01). Increased frequency of service provision predicted higher self-reported confidence and lower anxiousness (p < .01). Practical training opportunities including case discussion, videos, and clinical feedback were preferred. Access facilitators were online, on-demand training; however, respondents reported preferring hands-on training opportunities. Common barriers included cost, time, competing professional development priorities, and distance/travel. CONCLUSIONS Findings have highlighted that recency and frequency of practice impact self-reported confidence and anxiousness, and that AHPs self-report lowest confidence and highest anxiety working with infants compared to older age groups. Overall, the findings highlight the need for flexible, practical, and remotely accessible training opportunities, as well as the need for access to regular clinical supervision and a pediatric feeding caseload.
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Affiliation(s)
- Madeline Raatz
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Jeanne Marshall
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Corrine Dickinson
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia
| | - Nadine Frederiksen
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia
| | - Claire Reilly
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia
| | - Shenali Fernando
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia
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Schwarz M, Ward EC, Coccetti A, Simmons J, Burrett S, Juffs P, Perkins K, Foley J. Identifying opportunities to optimise the electronic medical record for allied health professionals: a concept mapping study. AUST HEALTH REV 2023:AH22288. [PMID: 36857797 DOI: 10.1071/ah22288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/10/2023] [Indexed: 03/03/2023]
Abstract
ObjectiveTo utilise a concept mapping process to identify key opportunities for electronic medical record (EMR) optimisation for allied health professionals (AHPs).MethodsA total of 26 participants (allied health managers, clinicians and healthcare consumers) completed the concept mapping process, which included generating statements, and then subsequently sorting all statements into groups, and also ranking each statement for importance and changeability (0 = not important/changeable, 4 extremely important/changeable). Multivariate analysis and multidimensional scaling were then used to identify core priorities for digital optimisation.ResultsParticipants generated 98 discrete statements that were grouped into 13 conceptual clusters. Of these, 36 statements were subsequently determined to fall within the 'green zone' on the Go-Zone plot of importance and changeability (changeability ≥2.44, importance ≥2.79), and formed the set of key optimisation priorities. Clusters with the most items in the Go-Zone plot were 'training and business rules' and 'service statistics.'ConclusionConcept mapping facilitated identification of 36 key optimisation priorities considered both changeable and important to assist EMR optimisation for AHPs. Addressing these priorities requires action related to end-user skills and training, EMR system capacity, and streamlining of governance and collaboration for the optimisation process.
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Zahir MZ, Miles A, Hand L, Ward EC. Designing equitable speech-language pathology services in the Maldives to achieve Sustainable Development Goals 10 and 4. Int J Speech Lang Pathol 2023; 25:52-57. [PMID: 36511713 DOI: 10.1080/17549507.2022.2150308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE The United Nations adopted 17 Sustainable Development Goals (SDGs) in 2015 as a universal plan to address challenges experienced around the globe. SDG 4 focuses on inclusive and equitable education while SDG 10 aims to reduce inequality within and among countries. To achieve these goals for children with communication disabilities living in underserved communities, equitable access to services is required. Service delivery should be tailored to the unique characteristics of specific communities to best cater to the needs of the population. This commentary presents the Context-specific Service Delivery Framework (CSDF) that can be used to explore contexts systematically and identify suitable speech-language pathology service delivery approaches. CSDF focuses on the three dimensions of sustainability that are emphasised in the SDGs: environmental, social and economic. RESULT We present how CSDF was developed in the case of one Majority world country, the Maldives. Five studies were conducted to complete CSDF and the findings were used to derive recommendations for service delivery approaches that could help achieve SDG 4 and SDG 10. These included, building capacity by using asset-based approaches, collaborating with service providers and the community, using population-based methods to focus on prevention of communication disabilities and using available technology to provide support. CONCLUSION Other underserved communities could also benefit from using CSDF to design equitable services for children with communication disabilities in their countries. This commentary paper focuses on SDG 4 and SDG 10.
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Affiliation(s)
| | - Anna Miles
- The University of Auckland, Auckland, New Zealand
| | - Linda Hand
- The University of Auckland, Auckland, New Zealand
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia and
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
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Ryan M, Ward EC, Burns CL, Carrington C, Cuff K, Mackinnon M, Snoswell CL. An evaluation of telephone versus videoconference consults for pre-treatment medication history taking by cancer pharmacists. J Telemed Telecare 2022; 28:750-756. [DOI: 10.1177/1357633x221122140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction The primary aim was to compare the successful completion rates of pre-treatment medication history consults conducted by pharmacists with patients either via an unscheduled telephone consult (current standard care) or a scheduled videoconference consult model. Secondary aims were to examine pharmacist perceptions of the telephone and videoconference consults and explore patient (+/− support person) perceptions of videoconference consults. Method Completion data were collected and compared for the two modalities. In addition, pharmacists commented on any positive/negative factors impacting all consults. For the final 35 participants completing a videoconference consult, patients, support people, and pharmacists involved, completed a survey exploring perceptions and satisfaction. Results A significantly higher completion rate ( p < 0.0001) was found for the videoconferencing model, with 94% (76 of 81) completed successfully compared to 72% (76 of 105) of the unscheduled telephone consults. Pharmacists reported multiple factors impacting the success of the telephone consults including scheduling issues and patient factors. Survey responses revealed that 100% of patients/support people and 82% of pharmacists reported satisfaction with videoconference consults. Surveyed participants noted some technical issues, however, the ‘ability to show/view medication containers and/or labels’ and ‘convenience of scheduled time’ were benefits of the videoconference model. Discussion Results indicate that pre-treatment medication history consults should be offered via videoconference to maximise success.
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Affiliation(s)
- Marissa Ryan
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Online Health, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Clare L Burns
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Speech Pathology Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Christine Carrington
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Katharine Cuff
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Mhairi Mackinnon
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Centaine L Snoswell
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Australia
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Schwarz M, Ward EC, Seabrook M, Coccetti A, Dunn K, Whitfield BCS, Bond C, Suliman E, Winckel C. Speech pathology prescribing in the outpatient setting: A review of requirements, considerations and barriers. Int J Lang Commun Disord 2022; 57:1194-1206. [PMID: 35793383 DOI: 10.1111/1460-6984.12756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND As health systems face increasing demands, non-medical prescribing is a workforce redesign strategy adopted within some services. Despite successful implementation in other professional groups, non-medical prescribing within speech pathology (SP) has not yet been described. AIMS To provide a descriptive account of the development and planned implementation of two SP prescribing models. METHODS & PROCEDURES The evolution of two SP-led prescribing models, including relevant training and credentialing, for use of (1) nystatin oral drops (100,000 units/mL); and (2) lidocaine (lignocaine) and phenylephrine nasal spray (5 mg/500 μg/spray), in the outpatient setting is detailed. Challenges to implementation are outlined. MAIN CONTRIBUTION The development of relevant governance structures, a research evidenced-based project evaluation framework, and an overview of training pathways and credentialing was successfully completed. However, implementation of the models was unable to be achieved. A thorough review of the requirements and a discussion of contextual considerations that had a negative influence on the implementation of SP-led prescribing within this specific service context is provided. CONCLUSIONS & IMPLICATIONS The successful implementation of SP-led prescribing is complex and highly context dependent. This work offers a discussion and review of the complexities of introducing a non-medical prescribing model in an outpatient hospital setting. WHAT THIS PAPER ADDS What is already known on the subject Allied Health prescribing is an emerging practice area aiming to reduce current pressures on health services. SP-led prescribing has not been thoroughly investigated in the Australian context. What this study adds to existing knowledge This study describes the development of a SP-led prescribing process in the outpatient setting, and a thorough review and discussion of the drivers and barriers to the model's implementation. What are the potential or actual clinical implications of this work? The successful implementation of SP-led prescribing was identified to be complex from a legislative and operational perspective, as well as being highly context dependent. This study further highlights the importance of a thorough context evaluation and workflow mapping prior to full-scale implementation of SP prescribing trials.
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Affiliation(s)
- Maria Schwarz
- Speech Pathology and Audiology Department, Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Queensland, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland Health, Queensland, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Marnie Seabrook
- Speech Pathology and Audiology Department, Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Queensland, Australia
| | - Anne Coccetti
- Allied Health, Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Queensland, Australia
| | - Katrina Dunn
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Speech Pathology Department, West Moreton Hospital and Health Service, Queensland Health, Queensland, Australia
| | - Bernard C S Whitfield
- Integrated Specialist Ear Nose and Throat Service, Department of Otolaryngology Head and Neck Surgery, Division of Surgery, Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Queensland, Australia
- Griffith University (Associate Professor), Brisbane, Queensland, Australia
| | - Craig Bond
- Ear Nose and Throat Service, Ipswich Hospital, West Moreton Hospital and Health Service, Queensland Health, Queensland, Australia
| | - Erin Suliman
- Speech Pathology Department, West Moreton Hospital and Health Service, Queensland Health, Queensland, Australia
| | - Cal Winckel
- Pharmacy Department, Ipswich Hospital, West Moreton Hospital and Health Service, Queensland Health, Queensland, Australia
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Taubert ST, Burns CL, Ward EC, Bassett L. Evaluation of the implementation of a speech and language therapist-led referring model for VFSS using the Consolidated Framework for Implementation Research (CFIR). Int J Lang Commun Disord 2022; 57:977-989. [PMID: 35582771 DOI: 10.1111/1460-6984.12733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Speech and language therapists (SLTs) use videofluoroscopic swallow study (VFSS) results to manage dysphagia. Yet, in some services only doctors can directly request a VFSS, potentially creating workflow inefficiencies and delaying patient access to VFSS. An alternative model, where SLTs directly refer patients for VFSS, is used in many services in the UK and Australia. However, processes for implementing and sustaining this model have not been reported. AIMS To evaluate the implementation of an SLT-led inpatient VFSS referring model using the Consolidated Framework for Implementation Research (CFIR) to ascertain implementation barriers, facilitators and critical sustainability factors. METHODS & PROCEDURES This implementation evaluation examined stakeholder perceptions of implementing the SLT-led VFSS referring model via interviews of (1) SLTs who treat and refer inpatients for VFSS; (2) doctors who manage and refer inpatients for VFSS; (3) radiologists; and (4) trained VFSS referring SLTs. The CFIR was used to prospectively guide implementation planning, evaluation and outcome reporting, regarding barriers, facilitators and sustainability factors. OUTCOMES & RESULTS Implementation facilitators were (1) the advantage of SLT-led VFSS referring over the standard model (doctors referring), in promoting high-quality VFSS referrals; (2) compatibility of the model with the SLT skill set; (3) supportive communication networks between staff groups; and (4) engaging stakeholders throughout implementation. Adequate availability of trained VFSS referring SLTs was both a barrier and a facilitator of implementation. It was also a critical sustainability factor, along with ongoing staff education and outcome monitoring. CONCLUSIONS & IMPLICATIONS The CFIR supported systematic evaluation of implementation facilitators and barriers, and adjustment of factors critical for implementing and sustaining the new model. Findings may assist other organizations to establish the SLT-led VFSS referring model. WHAT THIS PAPER ADDS What is already known on the subject Models where SLTs directly refer patients for VFSS have been described in the literature, with evidence of appropriate referrals and adherence to radiation safety standards. However, the process for establishing and sustaining this referring model has not been published. What this paper adds to existing knowledge This study describes the process and outcomes of implementing an SLT-led VFSS referring model, using the CFIR. A key advantage of the new model that facilitated implementation was the improved quality of VFSS referrals compared with the standard referring model. Important facilitating factors in the environment were the compatibility of the model with SLTs' skillset and supportive communication network between doctors and SLTs. Initially, an implementation barrier was the inadequate availability of trained SLT referrers. Using proactive implementation strategies, more referrers were trained (which was a facilitating factor for implementing and sustaining the model). What are the potential or actual clinical implications of this work? This study highlights that successful implementation requires more than just an effective model. Features of the environment require consideration to minimize barriers and optimize facilitating factors, supported by proactive implementation strategies. Planning and evaluating implementation processes and outcomes using a standardized implementation framework such as CFIR aided understanding of barriers and facilitators for introducing the SLT-led VFSS referring model. This process may assist other services to implement the model.
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Affiliation(s)
- Shana T Taubert
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, QLD, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Clare L Burns
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, QLD, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Research Excellence in Telehealth, The University of Queensland, Brisbane, QLD, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Research Excellence in Telehealth, The University of Queensland, Brisbane, QLD, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Lynell Bassett
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, QLD, Australia
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Brandenburg C, Ward EC. One career, many pathways, no direction: the challenge facing Allied Health clinician researchers. AUST HEALTH REV 2022; 46:639-641. [PMID: 36002147 DOI: 10.1071/ah22102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022]
Abstract
Career pathways for Allied Health clinician researchers in Australia are currently underdeveloped. As these pathways are limited in structure, there are a wide variety of pathways that are 'cobbled together' by Allied Health professionals to combine clinical and research careers. This perspective piece summarises some of these pathways and discusses recommended improvements to create more streamlined career pathways, vital to Australia's research and patient care excellence.
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Affiliation(s)
- Caitlin Brandenburg
- Centre for Functioning and Health Research, Metro South Health, Queensland Health, Buranda, Brisbane, Qld 4102, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Health, Queensland Health, Buranda, Brisbane, Qld 4102, Australia; and School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia
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Hutchison A, Nund RL, Brown B, Ward EC, Wishart L. Using dosimetric information to guide dysphagia management in patients with head and neck cancer: Clinicians' knowledge and experiences. Int J Speech Lang Pathol 2022; 24:417-426. [PMID: 34651538 DOI: 10.1080/17549507.2021.1984578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose: The use of dosimetric information to guide the management of dysphagia related to head and neck cancer (HNC) treatment is an emerging area of practice. In order to better meet the needs of people with dysphagia in HNC, it is important to explore how clinicians use this information to guide practice and also to identify factors that influence/discourage the use of dosimetric information.Method: A descriptive qualitative method was chosen and purposeful sampling with additional snowball sampling were used to recruit clinicians working within Australian cancer centres. To facilitate participation, clinicians were offered either a focus group or individual interview as a means to collect their perspectives. A total of 20 clinicians with varying years of clinical experience (range 2.5 - 29 years) were recruited. Eight participants took part in a focus group and 12 elected to participate in an individual interview. Content analysis was used to analyse transcripts.Result: Three main themes emerged from the transcripts: (1) clinician factors such as experience, confidence and knowledge and (2) clinical service factors such as staffing levels, clinical management pathways and system access influence use of dosimetric information; (3) patient factors such as demographics, surgical history and education needs influence dysphagia management plans.Conclusion: Speech-language pathologists' (SLPs') use of dosimetric information within HNC settings to direct patient management is emerging and varies between clinicians and workplaces. Given that dosimetric information potentially enables specialised dysphagia management planning for patients during their radiotherapy treatment, further education and training for speech-language pathologists in this area should be prioritised.
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Affiliation(s)
- Alana Hutchison
- Centre for Functioning and Health Research, Queensland Health, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Rebecca Louise Nund
- Centre for Functioning and Health Research, Queensland Health, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Bena Brown
- Centre for Functioning and Health Research, Queensland Health, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Speech Pathology Department Princess Alexandra Hospital, Queensland Health, Brisbane, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Queensland Health, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Laurelie Wishart
- Centre for Functioning and Health Research, Queensland Health, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Stone DB, Rebbeck T, Ward EC, Elliott JE. Features and impact of dysphagia, dysphonia and laryngeal hypersensitivity in whiplash associated disorder - a qualitative study. Disabil Rehabil 2022:1-12. [PMID: 35867954 DOI: 10.1080/09638288.2022.2098395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Investigation into dysphagia, dysphonia and laryngeal hypersensitivity after whiplash is limited, offering minimal insight into specific features and impact. This study aimed to explore these symptoms. MATERIALS AND METHODS A qualitative interpretive description design was used. Eleven participants with chronic Whiplash Associated Disorder and self-reported swallowing, voice and/or throat-related problems completed baseline symptom questionnaires and were offered a videofluroscopic swallow study to investigate baseline swallowing biomechanics. Semi-structured interviews were conducted to explore features of swallowing, voice and laryngeal sensory complaints and analysed using thematic analysis. RESULTS There were high baseline levels of self-reported neck, pain- and throat-related disability and psychological distress. There was no evidence of baseline deficits in swallow biomechanics. Thematic analysis revealed 5 themes: (1) A range of features of dysphagia and dysphonia exist after whiplash with varied clinical course; (2) Activity and participation in swallow and voice activities have changed; (3) There are psychological and emotional impacts; (4) Features of laryngeal hypersensitivity co-exist and (5) There are barriers to management. CONCLUSIONS Swallow, voice and laryngeal sensory problems after whiplash were described, with impacts on quality of life and barriers to management. These insights broaden understanding of post-whiplash sequalae, indicating the need for better detection.Implications for rehabilitationDysphagia, dysphonia and laryngeal hypersensitivity are under-recognised consequences of whiplash.Individuals presenting with dysphagia, dysphonia and laryngeal sensory symptoms after whiplash experience significant implications to wellbeing, activity and participation.Improved understanding of these symptoms may facilitate better detection and subsequent referral to speech-language pathology.Greater understanding into the functional and psychosocial implications of these symptoms may guide more effective post-whiplash assessments and informed rehabilitation.
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Affiliation(s)
- Danielle B Stone
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney,Australia.,Speech Pathology Department, Royal North Shore Hospital, St. Leonards, Australia.,Neuromuscular Imaging Research Laboratory, Kolling Institute at the Northern Sydney Local Health District, Sydney, Australia
| | - Trudy Rebbeck
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney,Australia.,Neuromuscular Imaging Research Laboratory, Kolling Institute at the Northern Sydney Local Health District, Sydney, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland and Centre for Functioning and Health Research (CFAHR) Metro South Hospital and Health Services, Brisbane, Australia
| | - James E Elliott
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney,Australia.,Neuromuscular Imaging Research Laboratory, Kolling Institute at the Northern Sydney Local Health District, Sydney, Australia.,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Schwarz M, Ward EC, Coccetti A, Burton K, Seabrook M, Newnham S, McCamley J, Hartley C. Digital dashboards: a speech pathology case study. AUST HEALTH REV 2022; 46:501-508. [PMID: 35831027 DOI: 10.1071/ah22011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/23/2022] [Indexed: 11/23/2022]
Abstract
The introduction of electronic medical records has created vast opportunities in relation to data storage, visibility and extraction. In Allied Health the collection, storage, display and reporting of service statistics is a key opportunity to utilise the capabilities of the electronic medical record to reduce clinician time completing data entry, improve accuracy and visibility of available data and maximise opportunities to view and utilise service statistic information in clinical and operational decision making. This case study describes service statistic capture and extraction for a speech pathology department, pre- and post- the introduction of a digital dashboard. A new Allied Health digital dashboard was created via clinicians and informaticians working collaboratively to define service delivery elements for data extraction and design dashboard functionality. Descriptive comparison of data capture pre- and post- dashboard implementation was undertaken. The integration of service statistic information into a digital dashboard was found to support service statistic reporting, improve ease of access, and provide greater visibility and timeliness of service information.
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Affiliation(s)
- Maria Schwarz
- Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Qld, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, University of Queensland, Qld, Australia; and Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland Health, Qld, Australia
| | - Anne Coccetti
- Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Qld, Australia
| | - Kate Burton
- Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Qld, Australia
| | - Marnie Seabrook
- Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Qld, Australia
| | - Siobhan Newnham
- Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Qld, Australia
| | - Jordan McCamley
- Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Qld, Australia
| | - Carina Hartley
- Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Qld, Australia
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Foley J, Burns CL, Ward EC, Nund RL, Wishart LR, Kenny LM, Stevens M. Post-acute health care needs of people with head and neck cancer: Mapping health care services, experiences, and the impact of rurality. Head Neck 2022; 44:1377-1392. [PMID: 35319137 PMCID: PMC9313784 DOI: 10.1002/hed.27037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/26/2022] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with head and neck cancer (HNC) have complex health care needs; however, limited evidence exists regarding the nature or patterns of service access and use. This study explored the post-discharge health care needs and experiences of individuals with HNC from metropolitan and rural areas. METHODS Health care appointments and services accessed by people with HNC were collated for 6-month post-treatment. Data analysis of the whole cohort examined patterns of access while journey mapping integrated participants' experiences of recovery. RESULTS The 6-month service access journey was mapped for 11 people. Rural participants attended a significantly greater number of appointments (p = 0.012), higher canceled/missed appointments (p = 0.013), and saw more professionals (p = 0.007). Rural participants reported higher stress and burden due to service access barriers and unmet needs. CONCLUSIONS Multiple challenges and inequities exist for rural people with HNC. Findings inform opportunities to enhance the post-treatment recovery of people with HNC in rural areas.
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Affiliation(s)
- Jasmine Foley
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland
| | - Clare L Burns
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland.,The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland.,Centre of Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Rebecca L Nund
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland
| | - Laurelie R Wishart
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland.,Centre of Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia.,Division of Cancer Services, Princess Alexandra Hospital, Metro South Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia
| | - Lizbeth M Kenny
- The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Maurice Stevens
- The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia
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Hall AE, Brandenburg C, Ward EC, Pokorny MA, Trafford K, Seabrook M, Whitfield BCS. Evaluation of health service outcomes for an audiology first point of contact retrocochlear clinic: a 6-year retrospective cohort study. Int J Audiol 2022:1-9. [DOI: 10.1080/14992027.2022.2073477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Amber E. Hall
- Speech Pathology and Audiology Department, Logan Hospital, Meadowbrook, Australia
| | - Caitlin Brandenburg
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
| | - Elizabeth C. Ward
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Michelle A. Pokorny
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Katye Trafford
- Speech Pathology and Audiology Department, Logan Hospital, Meadowbrook, Australia
| | - Marnie Seabrook
- Speech Pathology and Audiology Department, Logan Hospital, Meadowbrook, Australia
| | - Bernard C. S. Whitfield
- Integrated Specialist ENT Service, Department of Otolaryngology Head and Neck Surgery, Logan Hospital, Meadowbrook, Australia
- School of Medicine, Griffith University, Southport, Australia
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Taubert ST, Burns CL, Ward EC, Bassett L. Implementation of a speech and language therapy-led referring model for videofluoroscopic swallow studies: An evaluation of service outcomes. Int J Lang Commun Disord 2022; 57:512-523. [PMID: 35141997 DOI: 10.1111/1460-6984.12700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 11/11/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Videofluoroscopic swallow studies (VFSS) are integral to diagnosing and supporting dysphagia management. However, in many countries, only doctors are authorized to complete medical imaging request forms, in accordance with radiation safety regulations. This can impact workflow and timely access to VFSS. Enhanced scope of practice (ESP) models of care exist, where speech and language therapists (SLTs) are authorized to complete VFSS request forms. However, formal evaluations of these ESP models are currently lacking. AIMS The primary aim of this study was to examine service outcomes regarding the safety and efficiency of SLTs completing VFSS request forms compared with the medical referring model (standard care). The secondary aim was to ascertain the impacts on SLTs' daily workflow and the utility of training for SLTs to complete VFSS requests. METHODS & PROCEDURES The study involved a mixed-method design. First, referrals completed using standard care versus those completed under the new SLT-led VFSS referring model were compared for efficiency (days to request completion, number of contacts between staff to complete requests and delay to VFSS appointments) and safety (compliance with radiation safety standards for requests, adverse events and change to dysphagia management to justify radiation exposure). Semi-structured interviews were then conducted with SLT referrers (n = 7) exploring the impacts of the model on daily workflow and the utility of training. OUTCOMES & RESULTS VFSS inpatient requests were examined across a 3-month period (n = 61 requests) using the standard model, and for 6 months (n = 109 requests) following the introduction of SLT-led VFSS referring. Regarding efficiency, there was no significant difference between the two models, with most request forms taking less than or equal to 1 day to be completed. Adherence to radiation safety requirements was significantly greater in the SLT-led VFSS referring model compared with the standard model (p < 0.001) in relation to the overall requisite clinical information being documented on the request forms. No adverse events occurred and 100% of VFSSs led to changed dysphagia management. Interviews of VFSS referring SLTs revealed that completing requests was not complex or onerous, and that the training equipped them well to undertake the role. CONCLUSIONS & IMPLICATIONS The SLT-led VFSS referring model was feasible for SLTs and resulted in satisfactory efficiency and greater adherence to radiation safety requirements for VFSS request forms than the standard model. Improved information on VFSS request forms provides clearer justification for the radiation procedure and helps optimize the diagnostic yield of VFSS. The evidence supports further widespread adoption of this model. WHAT THIS PAPER ADDS What is already known on the subject Models of care permitting selected allied health professionals to refer patients for diagnostic radiology procedures have been established to achieve healthcare efficiencies. Evidence supports the safety and efficiency of physiotherapists referring to radiology. However, limited published outcome data exist regarding models of SLTs referring for radiology procedures, such as VFSS. What this paper adds to existing knowledge This study describes the implementation of a SLT-led VFSS inpatient referring model in a quaternary hospital and examines service outcomes. The findings reveal that VFSS request forms completed in the SLT-led referring model had greater adherence to radiation safety standards compared with the standard referring model. Efficiency was similar across both models and there were no adverse events. Completing VFSS requests did not disrupt daily workflow for SLTs and training was effective preparation for the role. What are the potential or actual clinical implications of this work? Results demonstrate that the SLT-led VFSS referral model can be safely and appropriately implemented in the inpatient setting. Improved quality of information documented on request forms by SLTs increases adherence with radiation safety standards, providing clearer justification for radiation assessments and potentially eliciting more targeted diagnostic information to inform dysphagia treatment planning. These findings may support other hospital services to establish this type of referring model.
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Affiliation(s)
- Shana T Taubert
- Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Herston, QLD, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Clare L Burns
- Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Herston, QLD, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Research Excellence in Telehealth, The University of Queensland, Brisbane, QLD, Australia
| | - Elizabeth C Ward
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Centre for Research Excellence in Telehealth, The University of Queensland, Brisbane, QLD, Australia
- Metro South Hospital and Health Service, Centre for Functioning and Health Research, Brisbane, QLD, Australia
| | - Lynell Bassett
- Metro North Hospital and Health Service, Royal Brisbane & Women's Hospital, Herston, QLD, Australia
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Schwarz M, Ward EC, Seabrook M, Davis J, Whitfield BCS. Outcomes from an extended scope of practice speech-language pathology service for low risk ENT outpatients: A 5-year service review. Int J Speech Lang Pathol 2022; 24:3-11. [PMID: 34075843 DOI: 10.1080/17549507.2021.1916592] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose: Early evidence supports the safety and efficiency of extended scope speech-language pathology (SLP) clinics designed to manage low risk ear nose and throat (ENT) outpatient referrals, however long-term data is lacking. The aim of this study was to complete a 5-year audit of clinical outcomes, including rates of re-referral, for a SLP Allied Health Practitioner (SLP AHP) led dysphagia and dysphonia service within an Integrated Specialist ENT Service.Method: A retrospective audit was undertaken of all patients referred with non-urgent dysphonia and/or dysphagia symptoms over a 5-year period since establishment of the SLP AHP service. Clinical outcomes, rates and reasons for re-referral to the specialist ENT waiting list were investigated.Result: Of 616 patient referrals, 462 patients were seen by the SLP AHP service. Most (72%, n = 333) received all required management through the clinical model, with only 28% (n = 129) requiring additional ENT intervention, consistent with previously published data. Only 36 of the 616 (6%) were re-referred/re-presented within 12 months of first presentation, of which only 12 were referred for same condition as initial referral. No adverse outcomes were recorded on the clinical database during this 5-year period.Conclusion: Results provide further evidence that the SLP AHP service is a safe and efficient method for managing low risk ENT outpatient referrals.
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Affiliation(s)
- Maria Schwarz
- Speech Pathology and Audiology Department, Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Queensland, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland Health, Queensland, Australia
| | - Marnie Seabrook
- Speech Pathology and Audiology Department, Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Queensland, Australia
| | - Jennifer Davis
- Speech Pathology and Audiology Department, Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Queensland, Australia
| | - Bernard C S Whitfield
- Department of Otolaryngology Head and Neck Surgery, Division of Surgery, Integrated Specialist Ear Nose and Throat Service, Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Queensland, Australia
- School of Medicine, Griffith Medical School, Griffith University, Brisbane, Australia
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Foley J, Nund RL, Ward EC, Burns CL, Wishart LR, Graham N, Patterson C, Ashley A, Fink J, Tiavaasue E, Comben W. Clinician and consumer perceptions of head and neck cancer services in rural areas: Implications for speech pathology service delivery. Aust J Rural Health 2022; 30:175-187. [DOI: 10.1111/ajr.12829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/31/2021] [Accepted: 11/05/2021] [Indexed: 02/02/2023] Open
Affiliation(s)
- Jasmine Foley
- School of Health and Rehabilitation Sciences The University of Queensland Brisbane QLD Australia
| | - Rebecca L. Nund
- School of Health and Rehabilitation Sciences The University of Queensland Brisbane QLD Australia
| | - Elizabeth C. Ward
- School of Health and Rehabilitation Sciences The University of Queensland Brisbane QLD Australia
- Centre of Functioning and Health Research Metro South Hospital and Health Service Brisbane OLD Australia
| | - Clare L. Burns
- School of Health and Rehabilitation Sciences The University of Queensland Brisbane QLD Australia
- Speech Pathology Department The Royal Brisbane and Women's HospitalQueensland Health Brisbane QLD Australia
| | - Laurelie R. Wishart
- School of Health and Rehabilitation Sciences The University of Queensland Brisbane QLD Australia
- Centre of Functioning and Health Research Metro South Hospital and Health Service Brisbane OLD Australia
- Princess Alexandra Hospital Metro South Hospital and Health Service Brisbane QLD Australia
| | - Nicky Graham
- Speech Pathology Department Children’s Health Queensland Hospital andHealth Service, Wondai Hospital Wondai QLD Australia
| | - Corey Patterson
- Speech Pathology Department The Townsville University Hospital The Townsville Hospital and Health Service Townsville QLD Australia
| | - Amy Ashley
- Speech Pathology Department The Townsville University Hospital The Townsville Hospital and Health Service Townsville QLD Australia
| | - Julie Fink
- Speech Pathology Department The Townsville University Hospital The Townsville Hospital and Health Service Townsville QLD Australia
| | - Emily Tiavaasue
- Speech Pathology Department The Mount Isa HospitalNorth West Hospital and Health Service Mount Isa QLD Australia
| | - Wendy Comben
- Speech Pathology Department The Townsville University Hospital The Townsville Hospital and Health Service Townsville QLD Australia
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Brandenburg C, Ward EC. "There hasn't been a career structure to step into": a qualitative study on perceptions of allied health clinician researcher careers. Health Res Policy Syst 2022; 20:6. [PMID: 35000610 PMCID: PMC8743061 DOI: 10.1186/s12961-021-00801-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022] Open
Abstract
Background There are many demonstrated benefits for health service organizations engaging in research. As a result, growing numbers of clinicians are being encouraged to pursue research as part of their clinical roles, including in allied health (AH). However, while the benefits of having clinician researchers embedded in AH services have been well established, the career needs of those engaged in these dual roles are poorly understood. The aim of this study was to examine perspectives of the career pathway for AH clinicians engaged in “clinician researcher” roles within Australian health services. Methods A qualitative descriptive study was conducted, utilizing semi-structured interviews. Purposive sampling was used to ensure selection of varied locations, professions and role types. Results were analysed using thematic analysis. Trustworthiness was established using regular peer debriefing during theme development, and respondent validation of final themes. Results Fifty-seven AH clinician researchers, including those who did and did not have research as a formal component of their current role, participated in semi-structured interviews. Key themes were as follows: (1) clinician researchers prefer roles which are embedded in health services; (2) current opportunities for clinician researcher roles in health are insufficient; (3) there are deficiencies in the pathway for clinician researcher careers; (4) clinician researchers are not always valued or incentivized by health services; (5) the current career challenges impair the viability of clinician researcher careers; and (6) the clinician researcher career path has been improving, and there is hope it will continue to improve. Conclusion This study outlines a number of weaknesses in the current career structure and opportunities for AH clinician researchers in Australian health services. In particular, while there are strong intrinsic drivers to pursue this dual career, extrinsic drivers are poorly developed, including a lack of job opportunities, an unstable career pathway and a lack of valuing or incentivizing this career choice within health services. This often means that clinician researchers feel compelled to choose between a research or clinical career, leading to loss of this valuable combined skill set. The findings of this research may assist health services in developing and supporting improved clinician researcher career pathways. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-021-00801-2.
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Affiliation(s)
- Caitlin Brandenburg
- Centre for Functioning and Health Research, Metro South Health, Queensland Health, Brisbane, Australia.
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Health, Queensland Health, Brisbane, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Ward EC, Raatz M, Marshall J, Wishart LR, Burns CL. Telepractice and Dysphagia Management: The Era of COVID-19 and Beyond. Dysphagia 2022; 37:1386-1399. [PMID: 35428923 PMCID: PMC9012247 DOI: 10.1007/s00455-022-10444-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/28/2022] [Indexed: 12/16/2022]
Abstract
The COVID-19 pandemic drove rapid and widespread uptake of telepractice across all aspects of healthcare. The delivery of dysphagia care was no exception, with telepractice recognized as a service modality that could support social distancing/infection control, overcome service delivery challenges created by lockdowns/service closures, and address consumer concerns about attending in-person appointments. Now, almost two years since most services first rapidly deployed telepractice, it is time to reflect on the big picture, and consider how telepractice will continue as a service option that is sustained and integrated into mainstream dysphagia care. It is also timely to consider the research agenda needed to support this goal. To this end, in this paper we present 4 discussion topics, which raise key considerations for the current and future use of telepractice within adult and pediatric dysphagia services. These are (1) Dysphagia services must meet consumer and service needs; (2) Aspects of dysphagia services can be safely and reliably provided via telepractice; (3) Telepractice can be used in flexible ways to support the delivery of dysphagia services; and (4) Providing quality dysphagia services via telepractice requires planned implementation and evaluation. Then directions for future research are discussed. These considerations are presented to help shift perspectives away from viewing telepractice as simply a COVID-19 "interim-care solution". Rather, we encourage clinicians, services, and researchers to embrace a future of "integrated care", where traditional dysphagia services are combined with telepractice models, to enhance the quality of care provided to our clients.
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Affiliation(s)
- Elizabeth C. Ward
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, PO Box 6053, Buranda, QLD 4102 Australia ,School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia
| | - Madeline Raatz
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia ,Speech Pathology Department, Queensland Children’s Hospital, Brisbane, QLD Australia
| | - Jeanne Marshall
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia ,Speech Pathology Department, Queensland Children’s Hospital, Brisbane, QLD Australia
| | - Laurelie R. Wishart
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, PO Box 6053, Buranda, QLD 4102 Australia ,School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia
| | - Clare L. Burns
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia ,Speech Pathology Department, Royal Brisbane & Women’s Hospital, Metro North Hospital and Health Service, Brisbane, QLD Australia
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Zahir MZ, Miles A, Hand L, Ward EC. Opportunities to Enhance Children's Communication Development at School in Underserved Communities. Lang Speech Hear Serv Sch 2021; 53:104-121. [PMID: 34793257 DOI: 10.1044/2021_lshss-20-00148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Alternative service delivery approaches are required to provide support for children with communication difficulties in underserved communities. Schools have a unique set of assets that can be utilized to provide this support. This study explored what the education sector and classrooms in the early years of schooling offer as support for children with communication difficulties in an underserved Majority World country, the Maldives. The objective was to identify opportunities to enhance support provided for these children. METHOD A qualitative multimethod approach was used involving (a) 520 min of classroom observational data from four remote schools, (b) interviews with four special education needs teachers, and (c) an interview with a Ministry of Education official. Classroom observational data were analyzed using the Communication Supporting Classroom Observation Tool. Deductive content analysis was used to analyze the interview data. RESULTS The support system aimed to reflect the Inclusive Education Policy of the Maldives. The Ministry of Education official and teachers raised concerns regarding lack of allied health services such as speech-language therapy in schools. Teachers frequently used certain communication supporting interactions such as imitation in classrooms. Missed opportunities to enhance communication were observed, including limited use of some interaction features such as modeling language, limited planned opportunities for children to interact in class, and limited resources in the environment to develop communication in Grade 1 and 2 compared to preschool. CONCLUSION Findings suggest building capacity among teachers and training teachers on identified classroom communication support areas to enhance support for children with communication difficulties. Supplemental Material https://doi.org/10.23641/asha.17003980.
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Affiliation(s)
| | | | | | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
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Ward EC, Burns CL, Gray A, Baker L, Cowie B, Winter N, Rusch R, Saxon R, Barnes S, Turvey J. Establishing Clinical Swallowing Assessment Services via Telepractice: A Multisite Implementation Evaluation. Am J Speech Lang Pathol 2021; 30:2456-2464. [PMID: 34432993 DOI: 10.1044/2021_ajslp-21-00109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose While research has confirmed the feasibility and validity of delivering clinical swallowing evaluations (CSEs) via telepractice, challenges exist for clinical implementation. Using an implementation framework, strategies that supported implementation of CSE services via telepractice within 18 regional/rural sites across five health services were examined. Method A coordinated implementation strategy involving remote training and support was provided to 18 sites across five health services (five hub and spoke services) that had identified a need to implement CSEs via telepractice. Experiences of all 10 speech-language pathologists involved at the hub sites were examined via interviews 1 year post implementation. Interview content was coded using the Consolidated Framework for Implementation Research (CFIR) and constructs were rated for strength and direction of influence, using published CFIR coding conventions. Results Services were established and are ongoing at all sites. Although there were site-specific differences, 10 CFIR constructs were positive influencing factors at all five sites. The telepractice model was perceived to provide clear advantages for the service, and clinicians were motivated by positive patient response. Strategies used to support implementation, including having a well-organized implementation resource and an external facilitator who worked closely with the local champions, were highly valued. Two CFIR constructs, Structural Characteristics and Available Resources, were challenges for all sites. Conclusions A complex interplay of factors influenced service implementation at each site. A strong local commitment to improving patient care, and the assistance of targeted strategies to support local implementation were viewed as central to enabling implementation.
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Affiliation(s)
- Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Australia
- Centre for Research in Telerehabilitation, The University of Queensland, Australia
| | - Clare L Burns
- School of Health & Rehabilitation Sciences, The University of Queensland, Australia
- Centre for Research in Telerehabilitation, The University of Queensland, Australia
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Queensland, Australia
| | - Amy Gray
- Gayndah Community Health, Wide Bay Hospital and Health Service, Queensland, Australia
| | - Lisa Baker
- Wide Bay Rural Allied Health & Community Health Service, Wide Bay Hospital and Health Service, Queensland, Australia
| | - Brooke Cowie
- Caboolture Hospital, Metro North Hospital and Health Service, Queensland, Australia
| | - Natalie Winter
- Cairns Hospital, Cairns and Hinterland Hospital and Health Service, Queensland, Australia
| | - Rukmani Rusch
- Cairns Hospital, Cairns and Hinterland Hospital and Health Service, Queensland, Australia
| | - Robyn Saxon
- Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Queensland, Australia
| | - Sarah Barnes
- Charleville Hospital, South West Hospital and Health Service, Queensland, Australia
| | - Jodie Turvey
- Charleville Hospital, South West Hospital and Health Service, Queensland, Australia
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Ryan M, Carrington C, Ward EC, Burns CL, Cuff K, Mackinnon M, Snoswell CL. Changing from telephone to videoconference for pre-treatment pharmacist consults in cancer services: Impacts to funding and time efficiency. J Telemed Telecare 2021; 27:680-684. [PMID: 34726996 DOI: 10.1177/1357633x211048393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: This study examined the reimbursement opportunity and the time efficiency of a standard care model of unscheduled telephone consults compared to scheduled videoconference consults for obtaining pre-treatment medication histories for patients with cancer. Methods: Data related to (a) the available and the claimed activity-based funding for both models and (b) the number of contacts and the duration of each contact to complete the patient's medication history via either unscheduled telephone or scheduled videoconference consults were collected and compared. Results: Data was collected for 86 telephone and 56 videoconference consults. The actual activity-based funding claimed for telephone consults was $0, even though $86 of activity-based funding was available for each consult. This represented a $0 reimbursement for the staff time spent conducting the telephone consults, and a missed opportunity to claim $86 per consult. Activity-based funding was claimed for all but one videoconference consult with an average of $205 received per consult, when $221 per consult was available. Videoconference consults were an average of 2.3 min shorter than telephone consults. Discussion: When compared to unscheduled telephone consults, the scheduled videoconference consults represented increased reimbursement and equivalent time efficiency for the cancer pharmacist completing pre-treatment medication histories.
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Affiliation(s)
- Marissa Ryan
- Pharmacy Department, 1966Princess Alexandra Hospital, Brisbane, Australia.,Centre for Online Health, 1974The University of Queensland, Brisbane, Australia.,Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia
| | - Christine Carrington
- Pharmacy Department, 1966Princess Alexandra Hospital, Brisbane, Australia.,School of Pharmacy, 1974The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, 157829Metro South Hospital and Health Service, Brisbane, Australia.,School of Health and Rehabilitation Sciences, 1974The University of Queensland, Brisbane, Australia
| | - Clare L Burns
- School of Health and Rehabilitation Sciences, 1974The University of Queensland, Brisbane, Australia.,Speech Pathology Department, 3883Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Katharine Cuff
- Division of Cancer Services, 1966Princess Alexandra Hospital, Brisbane, Australia
| | - Mhairi Mackinnon
- Division of Cancer Services, 1966Princess Alexandra Hospital, Brisbane, Australia
| | - Centaine L Snoswell
- Pharmacy Department, 1966Princess Alexandra Hospital, Brisbane, Australia.,Centre for Online Health, 1974The University of Queensland, Brisbane, Australia.,Centre for Health Services Research, 1974The University of Queensland, Brisbane, Australia.,School of Pharmacy, 1974The University of Queensland, Brisbane, Australia
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Wishart LR, Harris GB, Cassim N, Alimin S, Liao T, Brown B, Ward EC, Nund RL. Association Between Objective Ratings of Swallowing and Dysphagia-Specific Quality of Life in Patients Receiving (Chemo)radiotherapy for Oropharyngeal Cancer. Dysphagia 2021; 37:1014-1021. [PMID: 34625841 DOI: 10.1007/s00455-021-10364-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 08/30/2021] [Indexed: 11/26/2022]
Abstract
The pervasive nature of dysphagia in the head/neck cancer (HNC) population necessitates a comprehensive evaluation approach, including both objective assessment of dysphagia, and subjective patient-reported functional measures. However, the congruence between clinician-rated and patient-perceived function is still not well understood. The current study investigated the association between objective clinician-rated swallow physiology (using the MBSImP) and patient-reported measures of swallowing-related quality of life (using the MDADI) in a secondary analysis of patients with oropharyngeal HNC treated with (chemo)radiotherapy. Seventy-nine patients with oropharyngeal HNC receiving (chemo)radiotherapy completed a standardised videofluoroscopic swallow study (VFSS) rated using the MBSImP, and the MDADI, at pre-treatment (baseline), 6 weeks and 3 months post-treatment as per a previous prospective RCT. Data on n = 67 participants were analysed as part of the secondary analysis. Association between MBSImP oral and pharyngeal composite scores versus MDADI Global and subscale scores was examined using ordinary least squares regression and mixed-effects general linear modelling (GLM). Univariable analyses demonstrated significant associations between MBSImP oral composite scores and each of the MDADI subscales, as well as the MBSImP pharyngeal composite scores and all MDADI subscales. GLM analysis revealed significant associations were maintained between MBSImP pharyngeal scores and the MDADI global and emotional subscale scores at the multivariable level, with the physical subscale trending towards significance. No significant association was observed between the MBSImP oral composite scores and any of the MDADI subscales at the multivariable level. This study found significant associations between objective measures of pharyngeal swallow physiology and patient-perceived swallowing-related quality of life. These findings suggest a higher degree of concordance between clinician-rated and patient-reported measures up to 3 months post-(C)RT than previously reported.
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Affiliation(s)
- Laurelie R Wishart
- Centre for Functioning & Health Research, Metro South Hospital & Health Service, Brisbane, Australia.
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia.
- Centre for Functioning & Health Research, PO Box 6053, Buranda, Brisbane, QLD, 4102, Australia.
| | - Grace B Harris
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Nabeela Cassim
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Stephanie Alimin
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Ting Liao
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Bena Brown
- Centre for Functioning & Health Research, Metro South Hospital & Health Service, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Speech Pathology Department, Princess Alexandra Hospital, Brisbane, Australia
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Brisbane, Australia
| | - Elizabeth C Ward
- Centre for Functioning & Health Research, Metro South Hospital & Health Service, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Rebecca L Nund
- Centre for Functioning & Health Research, Metro South Hospital & Health Service, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Fong R, Rumbach AF, Ward EC, Doeltgen SH, Sun N, Tsang R. Videofluoroscopic and manometric outcomes of cricopharyngeus balloon dilation for treatment of pharyngo-esophageal dysphagia associated with nasopharyngeal cancer: A case series. Laryngoscope Investig Otolaryngol 2021; 6:1077-1087. [PMID: 34667851 PMCID: PMC8513417 DOI: 10.1002/lio2.641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/17/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Problems with pharyngo-esophageal bolus flow have been reported following nasopharyngeal cancer (NPC) treatment. While studies using videofluoroscopic assessment have shown balloon dilation can help address this impairment, the impact of dilation on pressure and bolus flow characteristics incorporating high-resolution pharyngeal manometry (HRPM) has not been reported. METHODS Five cases with pharyngo-esophageal dysphagia post NPC underwent balloon dilation. Videofluoroscopic swallowing study (VFSS) and HRPM were completed before and 1 month post dilation. Oral intake and dysphagia related quality of life were reported to 3 months. RESULTS VFSS, manometry and functional outcomes revealed positive benefits from dilation in two cases. In the other three cases, two showed improvements on VFSS only. These three failed to make functional swallowing gains. CONCLUSIONS Where there was functional gain, both fluoroscopy and HRPM recorded improvement to UES function. Across the cases, response to dilation was variable and further work is needed to determine which patients would receive most benefit. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Raymond Fong
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of MedicineThe Chinese University of Hong KongHong Kong
- The University of Queensland, School of Health and Rehabilitation SciencesBrisbaneQueenslandAustralia
| | - Anna F. Rumbach
- The University of Queensland, School of Health and Rehabilitation SciencesBrisbaneQueenslandAustralia
| | - Elizabeth C. Ward
- The University of Queensland, School of Health and Rehabilitation SciencesBrisbaneQueenslandAustralia
- Centre of Functioning and Health Research, Metro South Hospital and Health ServiceBrisbaneQueenslandAustralia
| | - Sebastian H. Doeltgen
- Speech PathologyCaring Futures Institute, College of Nursing and Health Sciences, Flinders UniversityAdelaideSouth AustraliaAustralia
| | - Nikie Sun
- Department of Ear, Nose & ThroatQueen Mary HospitalHong Kong
| | - Raymond Tsang
- Department of Ear, Nose & ThroatQueen Mary HospitalHong Kong
- Division of Otorhinolaryngology, Department of Surgery, Li Ka Shing Faculty of MedicineUniversity of Hong KongHong Kong
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Foley J, Ward EC, Burns CL, Nund RL, Wishart L, Graham N, Patterson C, Ashley A, Fink J, Tiavaasue E, Comben W. Speech pathology service enhancement for people with head and neck cancer living in rural areas: Using a concept mapping approach to inform service change. Head Neck 2021; 43:3504-3521. [PMID: 34477267 DOI: 10.1002/hed.26850] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/17/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Speech pathology (SP) services provide swallowing and communication intervention to people with head and neck cancer (HNC) across the continuum of care. However, difficulties exist with access and delivery of services in rural areas. The study aim was to identify actionable goals for SP change, utilizing a concept mapping approach. METHODS Eleven SP staff from two regional/remote services completed the concept mapping process. Multivariate analysis and multidimensional scaling were used to develop a final set of prioritized goals for change. RESULTS Between the two participating health services, 30 actionable goals were identified within the "green-zone" on the go-zone graph of importance and changeability. Among the most highly rated areas for change was the need to deliver and receive more support for training, mentoring, and supervision to consolidate skills. CONCLUSIONS This methodology enabled identification of prioritized, actionable changes to improve SP services for people with HNC living in regional/remote areas.
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Affiliation(s)
- Jasmine Foley
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
| | - Elizabeth C Ward
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia.,Speech Pathology Department, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Clare L Burns
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia.,Speech Pathology Department, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Rebecca L Nund
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
| | - Laurelie Wishart
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia.,Centre of Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia.,Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Nicky Graham
- Speech Pathology Department, Children's Health Queensland Hospital and Health Service, Wondai Hospital, Wondai, Queensland, Australia
| | - Corey Patterson
- Speech Pathology Department, The Townsville University Hospital, The Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Amy Ashley
- Speech Pathology Department, The Townsville University Hospital, The Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Julie Fink
- Speech Pathology Department, The Townsville University Hospital, The Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Emily Tiavaasue
- Speech Pathology Department, The Mount Isa Hospital, North West Hospital and Health Service, Mount Isa, Queensland, Australia
| | - Wendy Comben
- Speech Pathology Department, The Townsville University Hospital, The Townsville Hospital and Health Service, Townsville, Queensland, Australia
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Zahir MZ, Miles A, Hand L, Ward EC. Optimising existing speech-language therapy resources in an underserved community: A study of the Maldives. J Commun Disord 2021; 93:106136. [PMID: 34325224 DOI: 10.1016/j.jcomdis.2021.106136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 05/23/2021] [Accepted: 05/31/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND People living in Majority world countries face complex challenges regarding speech-language therapy services. As traditional individualised service delivery approaches may not suit the needs of the population, customised solutions are needed. AIM This study explored speech-language therapy and related resources available in the Maldives, a Majority world country, as seen by local government representatives and service providers. The goal was to identify service delivery approaches for children with communication difficulties that could yield the most out of existing resources. METHOD Semi-structured interviews were conducted with six service providers (three speech-language therapists (SLTs), three representatives from Non-Governmental Organisations (NGOs) related to disabilities) and six local government representatives (atoll councillors) of the Maldives. Interview questions related to services available for children with communication difficulties. The data were analysed via deductive content analysis. RESULTS SLTs predominantly delivered traditional individualised and rehabilitative therapy. Services were unevenly distributed across the Maldives with some atolls receiving no services. Support was available from community groups and atoll councillors in some atolls, for instance to access aids provided by the government. Some NGOs were trialling alternative service delivery approaches by conducting programs for parents and teachers in atolls. Participants suggested several possible measures including increasing awareness of speech-language therapy and communication difficulties amongst communities, engaging active community groups to support interventions and allowing less qualified professionals to provide services. The costs related to access and provide services were noted as a challenge. CONCLUSION While this study discovered limitations, the existing resources that were identified can be better directed to reach more children who require services in the Maldives. The following potential alternative service delivery approaches were derived from the results: focusing on prevention, using public health approaches to train families and teachers, creating awareness, building capacity within the community, and adopting cost-effective approaches to provide services.
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Affiliation(s)
| | - Anna Miles
- The University of Auckland, Auckland, New Zealand
| | - Linda Hand
- The University of Auckland, Auckland, New Zealand
| | - Elizabeth C Ward
- The University of Queensland, School of Health and Rehabilitation Sciences, Queensland, Australia; Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland, Australia.
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Abstract
Purpose This study aimed to investigate the interrater reliability of pediatric feeding assessments conducted via synchronous (real-time) telepractice. Secondary aims were to investigate parent and clinician satisfaction. Method The eating and/or cup drinking skills of 40 children (aged 4 months to 7 years) were simultaneously assessed by one speech-language pathologist (SLP) leading the appointment via telepractice and a second SLP present in the family home. A purpose-designed assessment form was used to assess (a) positioning, (b) development, (c) oral sensorimotor function, (d) prefeeding respiratory status, (e) observation of eating and drinking, (f) parent-child interaction, (g) overall feeding skills, and (h) feeding recommendations. The telepractice SLP completed a postappointment satisfaction questionnaire, and parents completed five questionnaires specifically investigating perceptions of and satisfaction with the telepractice feeding appointment. Results Agreement for all assessment components except intraoral examination (palate integrity and tonsils) was > 85%. All appointments were able to be conducted via telepractice, and for 90% of these (n = 36), clinicians agreed that telepractice was an effective service delivery method. Parents reported high levels of satisfaction with telepractice, with 76% reporting that the telepractice appointment was similar to a traditional in-person appointment. Conclusion Study results demonstrated that synchronous pediatric feeding assessments conducted in family homes via telepractice were feasible, reliable, and acceptable to both clinicians and parents. Supplemental Material https://doi.org/10.23641/asha.14700228.
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Affiliation(s)
- Madeline Raatz
- Speech Pathology Department, Queensland Children's Hospital, South Brisbane, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Jeanne Marshall
- Speech Pathology Department, Queensland Children's Hospital, South Brisbane, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Clare L Burns
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Speech Pathology and Audiology Department, Royal Brisbane and Women's Hospital, Queensland, Australia
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Finch E, Ward EC, Brown B, Cornwell P, Hill AE, Hill A, Hobson T, Rose T, Scarinci N, Marshall J, Cameron A, Shrubsole K. Setting a prioritized agenda to drive speech-language therapy research in health. Int J Lang Commun Disord 2021; 56:768-783. [PMID: 34048119 DOI: 10.1111/1460-6984.12626] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Prioritized research agendas are viewed internationally as an important method for ensuring that health research meets actual areas of clinical need. There is growing evidence for speech-language therapy-prioritized research agendas, particularly in disorder-specific areas. However, there are few general research priority agendas to guide speech-language therapy research. AIMS To collaboratively develop a prioritized research agenda for an Australian public health context with clinical speech-language therapists (SLTs), academic SLTs and consumers of speech-language therapy services. METHODS & PROCEDURES An initial stimulus list of potential research areas for prioritization was collected from SLTs via an online survey. Two categories (service delivery and expanded scope of practice) were selected from this list for prioritization due to their relevance across multiple health services. The Nominal Group Technique (NGT) was used to develop a prioritized research agenda for each of the two categories. One NGT session was conducted with each of the three participant groups (clinical SLTs, academic SLTs, consumers) for each category (total NGT sessions = six). The prioritization data for each group within each category were summed to give a single, ranked prioritized research agenda for each category. OUTCOMES & RESULTS Two prioritized research agendas were developed. Within each agenda, SLTs and consumers prioritized a need for more research in areas related to specific practice areas (e.g., Alternative and Augmentative Communication, Communication Partner Training), as well as broader professional issues (e.g., telehealth, working with culturally and linguistically diverse families). CONCLUSIONS & IMPLICATIONS The current findings support the need for funding proposals and targeted projects that address these identified areas of need. WHAT THIS PAPER ADDS What is already known on this subject Evidence-based practice is a critical component of SLT practice. There is often a disconnect between the research evidence generated and areas of clinical need, and in some areas a lack of evidence. Prioritized research agendas can help drive research in areas of clinical need. What this paper adds to existing knowledge A collaborative, prioritized SLT research agenda was developed using the NGT according to the views of clinical SLTs, academic SLTs and consumers of speech-language therapy services in a conglomerate of public health services. SLTs and consumers identified a need for further research in specific areas of SLT practice as well as broader emerging professional issues What are the potential or actual clinical implications of this work? Targeted research projects funded on a large scale are required to address these identified areas of need. Other health services around the world could replicate this prioritization process to drive research in areas of clinical need.
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Affiliation(s)
- Emma Finch
- Princess Alexandra Hospital, Brisbane, QLD, Australia
- The University of Queensland, Saint Lucia, QLD, Australia
- Centre for Functioning and Health Research, Brisbane, QLD, Australia
| | - Elizabeth C Ward
- The University of Queensland, Saint Lucia, QLD, Australia
- Centre for Functioning and Health Research, Brisbane, QLD, Australia
| | - Bena Brown
- Princess Alexandra Hospital, Brisbane, QLD, Australia
- The University of Queensland, Saint Lucia, QLD, Australia
| | | | - Anne E Hill
- The University of Queensland, Saint Lucia, QLD, Australia
| | - Annie Hill
- The University of Queensland, Saint Lucia, QLD, Australia
| | - Tania Hobson
- Children's Health Queensland, Brisbane, QLD, Australia
| | - Tanya Rose
- The University of Queensland, Saint Lucia, QLD, Australia
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Wishart LR, Brown B, Nund RL, Fotinos E, Hutchison AR, Ward EC, Porceddu SV. A prospective study monitoring carer distress during (chemo)radiotherapy for head and neck cancer via an electronic platform. J Med Radiat Sci 2021; 68:139-148. [PMID: 33169922 PMCID: PMC8168069 DOI: 10.1002/jmrs.448] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/14/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Research has shown that electronic platforms can assist data capture of patient-reported outcome measures (PROMs) to guide clinical care. In comparison, routine collection of carer-reported outcome measures (CROMs) to support the patient-carer dyad during cancer treatment has had limited attention. The current study utilised a novel electronic CROM (eCROM) system, ScreenIT Carer, to monitor the prevalence and nature of distress in carers of patients undergoing (chemo)radiotherapy ((C)RT) for head/neck cancer (HNC), and explore factors associated with carer distress. METHODS Carers completed ScreenIT Carer weekly when attending patients' (C)RT treatment sessions from planning to 2 weeks post-treatment. ScreenIT Carer included the Distress Thermometer (DT) and Problem List, and a purpose-built Mealtime-Specific DT and Problem list. Data were first examined descriptively, then associations between demographic/treatment-related factors and distress severity were analysed using mixed-effects general linear modelling. RESULTS 135 carers provided 434 ScreenIT Carer entries during the study period (mean entries = three/carer; yielding average adherence rate of 41% (range 11-100%)). A high prevalence of general (59%) and mealtime-specific distress (46%) was reported by carers. Nature of distress was multifactorial, with emotional problems and the patients' physical condition/symptoms common contributing factors. Based on multivariate analysis, tumour site, geographical location of residence and time during (C)RT when ScreenIT Carer was completed were significant predictors of carer distress severity. CONCLUSIONS Carer distress is prevalent and multifactorial during (C)RT. This study highlights the feasibility of utilising eCROM platforms such as ScreenIT Carer, to monitor carer wellbeing and guide supportive care services as part of a holistic care pathway.
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Affiliation(s)
- Laurelie R. Wishart
- Centre of Functioning & Health ResearchMetro South HealthBrisbaneQueenslandAustralia
- Division of Speech PathologySchool of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneQueenslandAustralia
| | - Bena Brown
- Centre of Functioning & Health ResearchMetro South HealthBrisbaneQueenslandAustralia
- Division of Speech PathologySchool of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneQueenslandAustralia
- Speech Pathology DepartmentPrincess Alexandra HospitalBrisbaneQueenslandAustralia
| | - Rebecca L. Nund
- Centre of Functioning & Health ResearchMetro South HealthBrisbaneQueenslandAustralia
- Division of Speech PathologySchool of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneQueenslandAustralia
| | - Elena Fotinos
- Centre of Functioning & Health ResearchMetro South HealthBrisbaneQueenslandAustralia
| | - Alana R. Hutchison
- Centre of Functioning & Health ResearchMetro South HealthBrisbaneQueenslandAustralia
| | - Elizabeth C. Ward
- Centre of Functioning & Health ResearchMetro South HealthBrisbaneQueenslandAustralia
- Division of Speech PathologySchool of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneQueenslandAustralia
| | - Sandro V. Porceddu
- Radiation Oncology DepartmentPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- School of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
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