Rural pharmacies and oral health in Tasmania

Ms Stephanie Dunbar1, Dr Ha Hoang1, Dr Tony  Barnett2, Mr Mark Kirschbaum2

1Centre for Rural Health, University Of Tasmania, Launceston, Australia, 2School of Health Sciences, University of Tasmania, Launceston , Australia

Introduction

People living in rural and remote areas of Australia have poorer oral health and less access to oral health services than those in metropolitan areas. In the absence of a resident dentist, rural dwellers often present to non-dental primary care providers (e.g. pharmacists) with oral health problems. This study aimed to investigate the views and experiences of rural pharmacists in providing oral health advice/treatment.

Methods

Semi-structured interviews were conducted 20 pharmacists and 1 assistant in rural Tasmania. Data was analysed in Nvivo 10 using thematic analysis.

Results

Pharmacists reported that they had 9 to 10 visits per week, for oral health problems. The oral health presentations to the pharmacists included toothache, abscesses, oral thrush, mouth ulcers and dry mouth.  Some respondents reported no confidence around providing oral health care while others were very confident. Barriers for patients to access dental services included cost of care, financial capacity, long waitlists, and distances to services, value of good dental health and fear of dentists.  Most pharmacies identified that they had a close relationship with at least one doctor in the area, but not with local dental services. The participants described their roles in oral health care in terms of health promotion, referring, and advice. Participants also commented on the key role of pharmacy assistants in oral health. Overall, responses suggested low coverage of oral health in pharmacy training.

Conclusions

There is a need to build collaborations between rural pharmacists and dentists in order to provide better oral health services for rural communities. Oral health training for rural pharmacists would be best if it were offered online and counted towards continuous professional development (CPD). Suggested strategies for overcoming patients’ barriers in oral health are: education to rural residents, free dental care, having a local dentist and increased access to public dental health.


Biography:

Stephanie Dunbar is an Allied Health Research Practitioner working with the Centre for Rural Health at the University of Tasmania. She is a registered psychologist, who also works in private practice. With a background in mixed methods research, Stephanie worked for the Queensland University of Technology for 6 years in research roles, before moving to Tasmania. She is passionate about improving mental and physical health through research.

Education in the digital age – first results from online nutrition training

Ms Caitlin Saunders1, Ms Juliet Bociulis2, Ms Caryn Batchelor2, Ms Kacey Rubie2

1Public Health Services DHHS, Hobart, Australia, 2Public Health Services DHHS, Launceston, Australia

The Commonwealth Home Support Programme (CHSP) is a federal government initiative which helps older people to stay living independently and in their homes for as long as possible. CHSP staff and volunteers have close, regular contact with older people. They are in a unique position to identify potential health issues as they arise, ensuring that older Tasmanians get support to maintain and improve their wellbeing sooner.

Many CHSP services (such as day respite centres, and in-home care services) find it hard to offer face-to-face professional development for their staff and volunteers. Part-time roles, shift-work, and client needs can make it hard to get everyone together for training, and an innovative approach is needed.

Dietitians at Public Health Services, DHHS developed a ‘nutrition for older people’ online training package, to make it easier for CHSP service staff and volunteers to undertake professional development in a flexible and convenient way.

The ‘nutrition for older people’ online training was launched in April 2017, and since then 83 participants have fully completed the training, with a further 86 in progress. Evaluation results indicate a high level of satisfaction with the online training (average 4.3/5), with most participants (89%) stating they would like to undertake further nutrition professional development online.

Online training also led to an intention to change practice, with 51/83 respondents (61%) describing things they will do differently as a result of training. Examples of intended practice changes included ‘being more proactive with malnutrition’, ‘keeping an eye out for nutrition changes in clients’, and ‘pushing for a nutrition review of every client we see’.

These results indicate that online professional development can be a useful adjunct to face-to-face training, and is an innovative way to upskill staff and volunteers to identify and help manage nutrition issues in older people who live at home.


Biography:

Caitlin has worked as a community dietitian for 7 years, with a focus on older adult nutrition since 2014. She is passionate about the role of nutrition in preventive health; and works with respite centres, day centres and delivered meal programs to support older adults to remain living independently at home. When she isn’t talking about food at work, she loves growing fruit and veggies in her back yard, and cooking for friends.

Integration of a Podiatrist into an orthopaedic department: A cost-consequences analysis

Mr Tom Walsh1,2, Dr Linda Ferris1, Dr Nancy Cullen1, Dr Christopher Brown2, Ms Cathy Loughry3, Dr Nikki McCaffrey4

1The Queen Elizabeth Hospital, Woodville South, Australia, 2The Repatriation General Hospital, Daw Park, Australia, 3Central Adelaide Local Health Network, Adelaide, Australia, 4Deakin University, Burwood, Australia

Background

The aim of this study was to evaluate the cost-consequences of a podiatry-led triage clinic provided in an orthopaedic department relative to usual care for non-urgent foot and ankle complaints in an Australian tertiary care hospital.

 Methods

All new, non-urgent foot and ankle patients seen in an outpatient orthopaedic department were included in this study. The patients seen between 2014-2015 by Orthopaedic Surgeons were considered ‘usual care’, the patients seen between 2015-2016 by a Podiatrist were considered the ‘Podiatry Triage Clinic’. Data on the new : review patient ratio, the number of patients discharged; surgical conversion rate; staff time; and imaging use were collected. A cost-consequences analysis, undertaken from a healthcare provider perspective (hospital) estimated the incremental resource use, costs and effects of the Podiatry Triage Clinic relative to usual care over a 12-month period.

 Results

The Orthopaedic Surgeons and Podiatrist consulted with 72 and 212 new patients during the usual care and triage periods, respectively. The total integrated appointment cost for the 12-month usual care period was $32,744, which represented a cost of $454.78 / patient. The total appointment and imaging cost during the triage period was $19,999, representing $94.34 / patient. Further analysis, suggests that the projected annual saving of integrating a Podiatry Triage Clinic versus an orthopaedic clinic alone is $50,441.

 Conclusions

The integration of a Podiatrist into an orthopaedic department greatly increases the number of patients seen, is cost-effective, improves the surgical conversion rate and improves the utilisation of Orthopaedic Surgeons.


Biography:

Tom Walsh is a podiatrist and PhD candidate from Adelaide. He works in both the public and private sector. His research interests include the interaction of obesity and foot pain. His clinical practice predominately involves the management of musculoskeletal foot disorders.

“The steps to understanding”: Embedding trauma informed care into an inpatient mental health unit

Miss Deborah  Hewson1, Mrs Mary  Rayner1, Professor  Ken Walsh2

1Tasmanian Health Service, Hobart, Australia, 2University of Tasmania , Hobart , Australia

Background and rationale: Trauma informed care is an organisational structure and treatment framework aimed to understand, recognise, and respond to the effects of all types of trauma. It emphasises physical, psychological and emotional safety for both consumers and providers, helping consumers rebuild a sense of control and empowerment. Mistral place, a 10 bed sub-acute mental health unit in Hobart, where staff identified a need to develop more effective processes for working with trauma, undertook a project to bring a model of trauma informed care into practice.

Methods: An engagement plan was developed using the Building Effective Engagement Techniques (BEET) tool. Training in Trauma-Informed Care and Practice was rolled out to 90% of staff including domestic support, administration, allied health and nursing staff.  Low risk ethics was obtained and focus groups were organised to explore staff claims, concerns and issues regarding embedding the trauma informed care model into the unit. The Trauma-Informed Care and Practice Organisational Toolkit (TICPOT) was completed in collaboration with team members, external managers and consumer consultants to respond to its seven organisational domains and develop an action plan for implementing sustainable change.

Results: The application of the BEET tool, initial training and the claims, concerns and issues raised at focus groups facilitated in-depth understanding of the strengths of the service and challenges to overcome, and set the scene for embedding changes into more effective practice. The TICPOT highlighted specific areas of attention such as developing further policy and education, opening spaces for the introduction of more collaborative consumer and family work, and gave rise to strategies for improving direct client care.

Implications for practice: Changes are incremental but the process of engagement, exploration of strengths and challenges enabled work towards sustainable practice change across the service. Ongoing implementation of strategies and evaluation is planned over 2018.


Biography:

Debbie has been working as an Occupational therapist for more than a decade. She is a specialist in mental health, early psychosis and Occupational Therapy and has worked as an OT across the globe, in the UK, Canada, and Australia.

She currently works in Inpatient mental health with the Tasmanian Health Service.

Activities of daily living – health, hospital, home

Ms Christy Dorward1, Ms Jolene May1

1Tasmanian Health Service, Hobart, Australia

Background:  Activities of daily living (ADL’s) are essential to maintaining health and wellbeing and participating in a wide range of meaningful activities.

Aim: The aim of the review was to understand how ADL needs affect a person’s capacity to continue living at home and their likelihood of an acute hospital admission.

Method:  A systematic search and scoping review of the literature specific to activities of daily living, hospitalisation and readmission.

Results: The scoping review yielded evidence that the older person with ADL’s difficulties experienced poorer health, higher likelihood of presentation to hospital emergency departments, and hospital admissions.  Acute admissions, injury, and illness for the older person were associated with a decline in functional status which further increases their risk of admission and institutionalisation.  Evidence supports a multidisciplinary approach to addressing activities of daily living to enable the older person to remain living in their home and to prevent ADL related admissions.

Conclusion: Targeting ADL’s in the community and throughout the admission and discharge process will reduce the risk of functional decline, admissions and poor health outcomes.


Biography:

Christy Dorward is the Discipline Lead Occupational Therapy for Tasmanian Health Service, Southern Region.  She has a Master of Health Service Management and has worked in Australia, the United Kingdom and United States of America in community and hospital settings.

Jolene May is the Clinical Lead in Quality and Redesign for occupational therapy in the Tasmanian Health Service, Southern Region.  She has completed the Quality Improvement Lead Training Program through the ACHS Improvement Academy and is studying the Master of Health & Human.  She has worked in Australia and the United Kingdom including rehabilitation in community, public and private settings.

Elucidating obesity and eating disorders health literacy among key stakeholders: A focus groups study

Dr Jonathan Mond1, Ms Bianca Bullivant2

1Centre For Rural Health, University of Tasmania, Launceston, Australia, 2School of Medicine, University of Sydney, Sydney, Australia

In the past three decades, there has been a substantial increase in prevalence of both obesity and eating-disordered behaviour (EDB) and it is predicted that these issues will present public health challenges well into the future. Further, in view of the conspicuous links between these problems, it has been suggested that integrated health promotion programs are called for. Currently, however, little is known about key aspects of health literacy relating to obesity and EDB among key stakeholders, including health professionals. This is, in our view, a key barrier to the design and conduct of successful integrated programs. The goal of the current study was, therefore, to elucidate key aspects of health literacy relating to obesity and EDB among allied and other health professionals. Using a grounded theory framework, eight focus groups were conducted with a total of 55 participants (females: n = 41) aged 22 to 55 years including doctors, mental health professionals, dietitians, personal trainers, academics, teachers and consumer group representatives. Discussion of a broad range of issues relating to obesity and EDB was initiated through the use of a script comprising a series of semi-structured, open-ended questions. Six key themes were identified,  namely: awareness and understanding of eating disorders/behaviours and obesity; beliefs about the links between eating disorders and obesity related behaviours and experience; beliefs about the role of environmental factors; beliefs about government and industry regulation of/involvement in factors affecting EDB and obesity; beliefs about the feasibility of integrated obesity/EDB health promotion messages; and beliefs about appropriate target groups for prevention health promotion campaigns. Examples of statements within each theme will be given and the implications of the findings for the design and conduct of integrated obesity/EDB health promotion programs will be discussed, along with plans for the next, quantitative phase of the research.


Biography:

Dr Jon Mond is currently Senior Research Fellow in the Centre for Rural Health at the University of Tasmania. He has previously held Associate Professorships in Psychology, Sociology, Medicine and Health Sciences at various Australian Universities. Dr Mond has Honours and Master’s Degrees in Psychology and a PhD in Psychological Medicine, all from the University of Sydney, and a Master of Public Health from Harvard University. His research, which focuses on epidemiological and public health aspects of body weight, body image and eating-disordered behaviour, is widely cited (h index = 42, i10 index = 93, citations ≈ 5700).

Getting people moving after hip and knee replacement: The benefits of mobilising on the day of surgery

Mr David Jovic1, Ms Renee Wilson

1THS-north, West Launceston, Australia

Background

The LGH has seen a dramatic increase in the number of hip and knee arthroplasty surgeries since July 2016. Previously, the average length of stay (LOS) at LGH was 5.4 days. This was above the average LOS for similarly sized hospitals. Mobilisation of patients on the day of hip/knee arthroplasty had been described in the literature as a potential option in reducing length of stay in this population.

 Methods

This is a prospective observational cohort study, assessing the impact of early mobilisation on length of stay after hip/knee replacement at the LGH. Patient selection was based on Physiotherapy staff capacity on the day of operation. Mobilisation was defined as weight bearing on the new joint with the Physiotherapist. The data captured represents all patients who underwent elective hip or knee arthroplasty between May 2016 and May 2017.

 Results

244 hip/knee replacements occurred at the LGH. 26% of patients were able to be mobilised on the day of operation, with the main barrier being Physiotherapy staffing constraints. 87% of patients were mobilised by the end of the first post-operative day. Univariate analysis indicates there was a difference in terms of patient age and length of procedure between the 2 groups (p<0.05). The rate of adverse events was not statistically different (1.5% in day 0 Vs 2.2% after day 0, p=0.46). The average LOS was reduced between patients mobilised on the day of the operation, as compared to those mobilised after day 0 (4.0 Vs 5.3 days, p<0.001). Rehabilitation needs were similar in patients who were mobilised on day 0.

 Conclusion

Further statistical analysis is required. However, this data demonstrates that mobilisation on the day of arthroplasty has the potential to safely reduce length of stay. This data will aid discussions related to Physiotherapy resource utilisation in hip and knee arthroplasty.

Factors associated with physical activity promotion by allied and other non-medical health professionals: A systematic review

Mr Paul Crisford1, Professor Tania Winzenberg1, Professor  Alison Venn1, Dr  Martin Schultz1, Dr Dawn Aitken1, Dr  Verity  Cleland1

1Menzies Institute For Medical Research, Hobart, Australia

Objectives

Health professionals are encouraged to promote physical activity (PA), but little is known about PA promotion behaviours outside general medical practice. This study aims to identify the factors associated with PA promotion behaviour amongst allied health and other non-medical health professionals.

Design

Systematic search, data extraction, narrative synthesis (thematic analysis) and quality assessment of each study.

Methods

Five electronic databases (PubMed, Embase, CINAHL, Psychinfo, Web of Science) and reference lists of included studies. Studies including practising health professionals (excluding medical doctors), a PA promotion behaviour measure, a test of association between potential influencing factors and PA promotion behaviour, and written in English.

Results

The search resulted in identification of 8169 studies of which 30 studies involving 7734 dental hygienists, dieticians, health care support workers, nurses, occupational therapists, physiotherapists, psychologists and practice assistants were included. Self-efficacy in PA promotion, positive beliefs in the benefits of PA, assessing patients’ PA, and PA promotion training were the main factors associated with PA promotion. Lack of remuneration was not associated with PA promotion behaviour. Common study limitations included a lack of information on non-responders, data collection by survey only and limited reliability or validity testing of measurements.

Conclusions

The factors identified may prove useful in guiding strategies to encourage greater PA promotion by the broader health professions. The absence of studies from some health professions and the lack of randomised control intervention trials highlights the need for further research.


Biography:

Associate Diploma in podiatry – Sydney Institute of Technology 1985

BSc in podiatric studies – 1st class Honors – Brighton University UK  1997

Current (part time) PhD candidate – Menzies Research Institute Tasmania since 2010. “Factors influencing podiatrists to engage in physical activity promotion”

Practicing podiatrist since 1985 both public and private

Sydney Technical College Podiatry Department part time teaching  1990-1994

University of Western Sydney part time lecturing  2002

NSW Podiatry Association State Board 1993-1995

SMA (Tasmania) State Board 2006-present

Vice President  2007-2008

President  2008-present

SMA National Board 2007-2011

AAPSM National Board 2009-2011

Both baseline and change in lower limb muscle strength in younger women are independent predictors of balance in middle-age: A 12-yr population-based prospective study

Dr Feitong Wu1, Dr Michele Callisaya1, Dr Karen Wills1, Dr Laura Laslett1, Professor Graeme Jones1, Professor Tania Winzenberg1

1Menzies Institute For Medical Research, University Of Tasmania, Hobart, Australia

Objectives: Poor balance is a risk factor for falls and fracture in older adults, but little is known about modifiable factors affecting balance in younger women. This study aimed to examine whether lower limb muscle strength (LMS) in young women and changes in LMS are independent predictors of balance in middle-age.

Methods: This was an observational 10-yr follow-up of 470 women aged 25-44 years at baseline who had previously participated in a 2-yr population-based randomised controlled trial of osteoporosis education interventions. Linear regression was used to examine the association between baseline LMS (by dynamometer) and change in LMS over 12 years with balance at 12 years (timed up and go test (TUG), step test (ST), functional reach test (FRT) and lateral reach test (LRT)).

Results: LMS declined by a mean of 17.3 kg over 12 years. After adjustment for potential confounders, baseline and change in LMS were independently beneficially associated with TUG (β=-0.008sec/kg, 95%confidence interval (CI):-0.01 to -0.006 and -0.006sec/kg:-0.009 to -0.003 for baseline and change respectively), FRT (β=0.057cm/kg, 95%CI: 0.030 to 0.084 and 0.071cm/kg: 0.042 to 0.101) and LRT (β=0.030cm/kg, 95%CI: 0.012 to 0.049 and 0.022cm/kg:0.002 to 0.043)12 years later. There was an association between baseline LMS and ST (β=0.044steps/kg, 95%CI: 0.022 to 0.067) but not between change in LMS and ST.

Conclusions: Among young women, greater LMS at baseline and slower decline over time are both associated with better balance in midlife. Analogous to the contributions of peak bone mass and bone loss to fracture risk in older adults, this suggests that both improvement of muscle strength in younger age and prevention of age-related loss of muscle strength could be potentially useful strategies to improve balance and reduce falls in later life.


Biography:

Prof Winzenberg is a Senior Research Fellow-General Practice at Menzies Institute for Medical Research, University of Tasmaina. She is a member of the Australian and New Zealand Bone and Mineral Society (ANZBMS), the ASBMR and the Australian Association of Academic Primary Care and is a fellow of the RACGP. She is an invited member of the Therapeutics, the Professional Affairs and the Research Committees of the ANZBMS. Her work focuses on chronic disease prevention and management, particularly for musculoskeletal conditions and cardiovascular disease, with a particular interest in aspects of this relevant to primary care.

Introduction of consistent neglect outcome measurement for patients admitted with acute stroke to Launceston General Hospital, and findings for local incidence and patient outcomes across acute and sub-acute services

Mrs Helen Titmuss1, Mrs Rebecca Cannell1

1THS-North Occupational Therapy, Launceston, Australia

Neglect is a common perceptual disorder post-stroke, where spatial and/or sensory inattention significantly disrupts independence and occupational performance.  Clients experiencing neglect have poorer functional outcomes, increased length of stay, and require more assistance upon discharge to return to community living. A staff survey identified neglect as an area of low confidence and best practice knowledge for Occupational Therapists and Physiotherapists, and wide variations in practice were noted.

A review of best practice measures for assessment and evidence-based interventions for neglect was completed by the Clinical Lead of Occupational Therapy at Launceston General Hospital (LGH) and an interdisciplinary working group in 2015.  This enabled increased understanding of the evidence, and knowledge translation gaps within the Occupational and Physiotherapy departments.

An education package was developed, with in-house training for clinicians, with the aim of consistent local terminology and classification, screening, outcome measurement and a selection of interventions for  improving  practice for this population.  Guidelines to support these processes were developed. The primary outcome measure now used across THS-North for neglect, The Catherine Bergego Scale (CBS), has been positively received by therapists, and found to be feasible for use in our setting.

A database was created and maintained for 12 months to collect incidence rates, severity levels and gains made between changes in episodes of care.  We will report local incidence and sub-types of neglect in comparison to the literature, and examine impairment and activity restrictions, outcomes, and length of stay data for neglect patients in THS-North. We will also report on our learning’s for knowledge translation activities, including ongoing education for clinicians, to sustain best practice.


Biography:

Helen Titmuss is a Clinical Lead Occupational Therapist at THS-North, with an interest in best practice for cognitive and perceptual neurological rehabilitation.

Rebecca Cannell is Senior Occupational Therapist on The Launceston General Hospital Stroke Unit, and has extensive experience across rehabilitation services.

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