Exploration of a transdisciplinary children service model delivered by rural generalists.

Ms Hannah Christensen1

1South West Hospital And Health Service, Roma, Australia

Abstract:

Background:This study evaluated the implementation of transdisciplinary child development service for a rural context delivered by rural generalists. The model included a centralised, coordinated intake and delivery of care process which was compared to the previous silo discipline approach.

Methods:This study was a comparison of outcomes on service efficiencies, economic analysis, family and staff perception of a transdisciplinary model for children 0 – 18 years presenting with questions surrounding their development. One month of clinical data for the different models of care were collected and compared including the families’ perception of whether the care delivered met their needs.

Results:The new model of care was measured against National Health Performance Framework indicators. This included; change in wait times, number of clients discharged from specialist (Paediatrician) wait list, changes in number of steps in patient journey and improved family satisfaction with care delivery.

Discussion and recommendations: A transdisciplinary model of care involving a centralised intake process will provide an efficient service which will be consistent with evidence based understanding of child development along the continuum of care.


Biography:

Hannah is a Physiotherapist who has worked in various project and leadership roles within Queensland Health across both metropolitan tertiary hospitals and rural settings. She has investigated models of care in which allied health clinicians work in an expanded scope of practice role to deliver services to communities in rural settings.

Allied Health Rural Generalist Trainee Positions (AHRGTP); a remote Torres Strait Islands / FNQ experience

Ms Marissa  Arnot1, Ms Jane Doepel1, Ms Kiah Petrie1, Ms Betty Mareko1

1Tores And Cape Hospital And Health Service, Thursday Island , Australia

Abstract:

AHPOQ (Allied Health Professional Office of Queensland) fund supernumerary positions for two years to assist rural and remote health services to expand and enhance their service delivery while developing rural generalist skills in early career allied health professionals. In 2017/18 the Torres and Cape Hospital and Health Service was successful in attracting this funding for two positions to expand the physiotherapy and dietetics services in the northern sector of the HHS which services Thursday Island, the outer islands of the Torres Strait and five mainland communities in the Northern Peninsula Area (NPA) of Cape York. Prior to this both services were delivered by sole rural generalist practitioners.

Challenges include:
• both the supervision of the AHRGTP and project management of service redevelopment project are provided by sole health practitioners (HP4) with large caseloads,
• large proportion of service delivered outside of hub site either by outreach or telehealth – both difficult mediums for early career professionals
• management of leave periods.
• high burden of chronic disease and predominately Indigenous population in this community provides challenges along side a rich learning environment to develop rural generalist skills.
Having two AHRGT positions at the same time has provided peer support for both trainees and supervisors alike which has been highlighted as a huge benefit by all involved.
Service delivery redesigns including expanded scope of practice ( skill sharing) and expansions of telehealth services are being undertaken alongside the workforce development of the early career professions and extended roles of senior supervisors.


Biography:

Marissa Arnot is the senior dietician for the Northern Torres and Cape Hospital and Health Service. Marissa has a Bachelor degree in Nutrition and Dietetics, a Graduate Certificate in Remote Health Practice and a Graduate Certificate in Diabetes Education. Marissa started as an early career professional in the Torres and Cape over 10 years ago and so has lived experience of becoming a rural generalist in a remote context. Marissa remains the sole permanent dietician for the Northern Torres and Cape HHS servicing 25 distinct communities

Allied Health Rural Generalist Training Positions- Changing healthcare in the country

Miss Jaclyn Muscio1

1South West Hospital And Health Service, Roma, Australia

Abstract:

Allied Health Rural Generalist Training Positions are an opportunity for rural and remote Hospital and Health Services to invest in the patient, practitioner and the future of health care, working towards better health outcomes. The position encourages an accelerated graduate experience requiring flexible and adaptable solution-driven treatment, with varied levels of supervision. Rural and remote service locations allow graduates to be ‘Generalists’ working within all facets of their scope. The Rural Generalist Training Program at James Cook University provides a platform of information for graduates to contribute to create positive changes in the workplace. Courses encourage graduates to become involved in project management and build leadership skills in multi-modal work-based assignments. The program encourages graduates to continue study and research to extend themselves within their full scope of practice. By investing in the position, the Health Service can build an adaptive and skillful workforce in rural and remote areas to potentially change how health care is delivered. Patients can benefit from increased accessibility to services and the implementation of service delivery strategies such as delegation and skill sharing with other health care professionals, encouraging multidisciplinary care for patients. With few positions available, it is competitive with graduate positions at major hospitals, encouraging graduates to become leaders in rural and remote health care. The Rural Generalist Training Position gives Hospital and Health Services an opportunity, to invest in improving health services, patient care and challenge the norm, making rural and remote hospital and health services the leaders in health care.


Biography:

Grew up in Regional Western Australia. Studied a Bachelor of Podiatry at University of Newcastle, New South Wales before moving to Roma Hospital in the South West Hospital and Health District working as a Podiatrist in a Graduate Allied Health Rural Generalist Training Position.

Establishment of speech pathology services in a remote Australian hospital

Ms Amanda O’keefe1, Ms Rebecca  Keeley1

1Top End Health Service, Darwin, Australia

Abstract:

The Allied Health Rural Generalist Pathway is a workforce development initiative that aims to support sustainable and accessible rural and remote allied health workforce models of service. An early career speech pathologist was employed utilising an Allied Health Rural Generalist Training Position to fill a service gap within our health service.
The aim of our project was to establish sustainable models of care for speech pathology services in a rural hospital three hours from a regional centre.
An early career speech pathologist was employed at a regional hospital to establish speech pathology services in the remote hospital 319km away. A range of service models were implemented including telehealth, delegation and education and upskilling of support staff. Activities such as dysphagia nurse screening, modified diet audits, service mapping and establishing speech pathology care pathways were also undertaken.
Established staff at the remote hospital were utilised including an allied health assistant, allied health professionals and nursing staff.
Since commencing the program referrals for speech pathology at the remote hospital have tripled. Pre and post education questionnaires indicated a significant improvement in the knowledge of local kitchen, nursing and allied health staff in the areas of dysphagia and communication.
The Allied Health Rural Generalist Training Position is a valuable resource enabling the establishment of speech pathology services in a remote Australian hospital. Despite the absence of an onsite speech pathologist, a variety of strategies ensured improved processes for managing communication and swallowing difficulties.


Biography:

Amanda is a speech pathologist and currently the Manager of Speech Pathology at Royal Darwin Hospital and the speech pathology profession lead for Top End Health Service (TEHS). Amanda has spent most of her 20 year career working in various rural health services delivering clinical services to adults. Rebecca Keeley is a speech pathologist currently employed in an allied health rural generalist training position with the TEHS. She is one of the founding group members for Speech Pathology Australia’s Early Career Reference Group, liaising with the organisation on graduate needs where she leads the rural and remote key issue group.

Implementing quality services in rural health: The workforce challenges of improving Physiotherapy in the Emergency Department at Mount Isa Hospital

Miss Bonnie Collins1

1North West Hospital And Health Service, Mount Isa, Australia

Abstract:

Background:In 2016 Mount Isa Hospital secured a subsidiary position for a new graduate HP3 under the Allied Health Professions Office of Queensland’s Rural Generalist Training Program (RGTP). As part of this program, the hospital is to use the additional FTE to implement an innovative service development initiative. The service initiative at Mount Isa Hospital is Physiotherapy services in emergency department, incorporating early and secondary contact models.

Aim:To improve access of physiotherapy services to Mount Isa Hospital’s Emergency Department.

Methods:To date there has been consultation with external health services about similar past projects, and ongoing consultation between internal stakeholders. The RGTP position holder has developed a presence in the ED. The RGTP position holder is set to develop skills in this area through work experience at a larger hospital.

Results: (so far..)
Increased referrals to physiotherapy from the ED.
Identification of gaps in the ED service at Mount Isa Hospital.
Identification of barriers to the physiotherapist’s role in the ED including service scope and experience, capacity and resources.
Identification of conflicting interests and scope of clinicians.

Discussion And Recommendations: Rural and remote health care in its nature is dynamic: Changing Lanscapes. It is important to remember that the end goal of quality improvement activities like this is to improve services for patients: Changing Lives.
During the planning and implementation of this project we have identified barriers, condensed the scope and now aim to implement a procedure for physiotherapy in the ED that will withstand the changing environment.


Biography:

Bonnie Collins graduated as a physiotherapist in 2016. During her study at the University of Newcastle, Bonnie completed a number of placements in regional and rural NSW, where she developed an appreciation for the generalist role of the rural health worker and the opportunities this field could provide. In 2017, Bonnie commenced a two-year Rural and Remote Allied Health Generalist position at Mount Isa Hospital in Queensland. This position includes provision for the implementation of a service development project, which in Mount Isa involves enhancing physiotherapy services in the ED. Bonnie has experienced, first hand, the challenges of being a new graduate physiotherapist in a transient workplace.

A retrospective audit of best possible medication histories (BPMH) and communication by pharmacist with patients from remote areas.

Miss Phoebe Thompson1, Dr Alice Gilbert1, Ms Bhavini Patel1, Ms Jackie Crofton1, Ms Tristen Pogue1

1Royal Darwin Hospital Pharmacy, Tiwi, Australia

Abstract:

Aim: To determine patient demographics, BPMH and pharmacist communication practises to primary care providers for patients admitted from remote regions to a tertiary teaching hospital.

Methods: Hospital admission and medication management software were used to conduct a retrospective audit of patient demographics and BPMH conducted for patients admitted from 2/9/17 to 29/9/17. Patients admitted on the weekend and those without electronic medication charts were excluded. The Rural Generalist Pharmacist conducted semi-structured interviews with hospital pharmacists to gather current communication methods and information sources to complete a BPMH. The results were thematically interpreted.

Results: There were 3037 patients admitted over the period with 938 (31%) patients admitted from remote regions. There was little difference in the completion rates of BPMH for remote patients (35%) compared to the general population (32%).

The following themes were identified from the semi-structured interviews; many hospital pharmacists do not have a clear understanding of medication supply in remote areas; the two sources used for BPMH did not always include the patient; and there was large variation in processes used to collect information and communicate with primary care.

Discussion/ recommendations:

Additional work will be conducted to develop a streamlined approach for process of communication and prioritisation of remote patients which meet the needs of the primary health care providers. This audit identified the need for education to hospital pharmacists on the complexities of medicine management for remote patients.


Biography:

The First Rural Generalist Pharmacist at Royal Darwin Hospital.

Changing the approach to training rural Allied Health student supervisors: an innovative blend!

Ms Darlene Wyatt1, Ms Heather  Agnew2, Ms  Robyn  Gill3

1Country Health SA Local Health Network, Port Pirie, Australia, 2Country Health SA Local Health Network, Mount Gambier, Australia, 3Country Health SA Local Health Network, Adelaide, Australia

Abstract:

There are a range of generic skills required for student supervision across Allied Health Professionals (AHPs). A multi-disciplinary training workshop was developed and provided by Clinical Placement Educators for AHPs within Country Health SA Local Health Network (CHSALHN) for professional development around student supervision.

Due to the vast distances across rural South Australia, creative use of technology and facilitation were required to provide training to supervisors. Blended participation of face to face with videoconference (VC) attendees ensured both groups received quality training and opportunities for discussion and interaction.

Over 40 AHPs attended the training. Approximately half attended face to face and the other half joined the training via VC which linked 9 additional regional health sites. The model of training combined short presentations of information with time for interactive practice and development of skills in small groups. Sole participants linking in via VC liaised via this medium as a small group to practice skills.

Participants completed a survey to evaluate the training workshop. Feedback from all participants indicated that the blended approach to delivery of this workshop delivered excellent results allowing networking and discussion across rural SA and between disciplines.

The success of this training model has shown that there are opportunities to provide interactive, skills based multi-disciplinary training across vast geographical distances. Further evaluation data from participants will be presented. There are plans to develop this model and offer further blended, multi-disciplinary AHP student supervision workshops.


Biography:

With a career spanning almost 3 decades, Darlene has spent much of her social work career in regional and rural locations in South Australia. Darlene is a strong advocate for attracting students to rural and remote locations to experience the diverse work. The opportunity to work in a multi-disciplinary manner with other allied health professions to support staff with skills and knowledge that can assist them in feeling confident to support students was welcomed with open arms.
Darlene continues to work at growing the number of social work student placements across Country Health SA Local Health Network and looks forward to many more creative and dynamic opportunities in the future.

Chronic Condition Psychologist: implementing a new service in rural Queensland

Mrs Lisa Baker1, Ms Frances Lavis1

1Rural Allied & Community Health, Wide Bay HHS, Queensland Health, Gayndah, Australia

Abstract:

Background: The Wide Bay HHS in Queensland has the highest population aged over 65 years in Australia (21%) and recognizes high rates for all chronic conditions and related risk factors. A rural psychologist position was introduced to the allied health team in 2017 to address health needs across eight rural communities.

Methods: Workforce strategies to ensure the role met local needs included recruiting via a rural development pathway position and related training was included. Various professional supports were accessed to address the psychologist’s learning needs.

Results: The psychology service, focused on supporting clients with chronic conditions, has developed strategies to meet rural client and referrer needs along with the psychologist’s own learning needs. The position provides services via a mixed telehealth and face to face model of care across both inpatient and outpatient clinics. Adaptations to meet best practice guidelines and local service delivery practices were implemented to address distance, client and service needs.

Discussion: Barriers and enablers for rural service implementation will be discussed along with the benefits of including rural generalist training. Aspects specific to the consumer, psychologist and service will be covered within the discussion of this new rural service implementation.


Biography:

Lisa Baker is the Rural Allied and Community Health team leader with the Wide Bay Hospital and Health Service, based at Gayndah within Queensland’s Wide Bay region. Lisa is a speech pathologist and holds a Masters of Remote Health Management and has been actively involved in rural speech pathology and allied health service provision since 2002.

Frances Lavis is the rural development pathway psychologist with the Rural Allied & Community Health team in Wide Bay Hospital and Health Service. Frances is a clinical psychologist working with clients to support chronic condition management.

Staying Steady in the Straits: Using the Calderdale Framework to develop a skill sharing service model to address balance and falls in remote communities of the Torres Strait

Ms Jane Doepel1, Ms Catherine  Clarke1, Ms Betty  Mareko1, Ms Corina Billingham

1Tores And Cape Hospital And Health Service, Thursday Island , Australia

Abstract:

The Torres Strait and Northern Peninsula Area stretches from the tip of Cape York to within 4km of PNG. There are 23 island communities spread across 48,000 square kilometres. The  population of 10,886  ( 81% indigenous ) 1 receive  very limited outreach  allied health services from the hub on Thursday Island

The sequelae of diabetes, high incidence of osteoarthritic knees and high set housing are some of the factors influencing balance and falls in this population

If older Torres Strait Islander people are unable to age at home or are hospitalised they are forced to be hundreds of kilometres over the ocean away from home and family

The team used the Calderdale Framework to establish skill sharing between the physiotherapy , occupational therapy and Podiatry services to address the issues of providing timely  assessment and interventions for balance and falls prevention in the older population.

  1. http://www.censusdata.abs.gov.au/census_services/getproduct/census/2016/quickstat/SSC30135?opendocument

Learnings

  • Using the Calderdale framework helped focus the project and gave rigour and  clear direction
  • Clinical tasks shared included a balance of assessment and interventions
  • Training each other takes time. Competing priorities and travelling on outreach meant time was difficult to quarantine.
  • Staff turnover was identified early as a high risk and proved to be so. Managing to implement the training phase and sustain the changes required engagement from all levels and ongoing commitment.

Take Home Message

Skill share is a valuable service delivery model in remote contexts


Biography:

Jane graduated 1985 with a BApp Sc (Physiotherapy) in Sydney and has a Master Public Health and Tropical Medicine form JCU (1997 ). She began her career working as a generalist in rural & remote communities. She has worked in NSW, WA and Qld and also in Timor Leste helping to develop the Community Based Rehabilitation Facilitator program. She has always worked in teams and understands the unique perspectives & skills that each profession contributes
Working for a some years in Early Childhood Intervention and being part of the change of service model to a key worker model helped Jane develop greater understanding of how we can blur boundaries and share skills to improve outcomes for patients . Jane has brought that understanding to helping develop a skill share model in the Torres Strait where she has been working for the past 4 years

Enhancing the Pathway to Allied Health – Make the change early in your career

Miss Hilary Byrth1

1Podiatry Department, Country Health Connect, Mount Gambier, Mount Gambier, Australia

Abstract:

Background: ‘Achieving attitudinal and practice change is one of the greatest challenges in health care.’ Historically there is a lack of awareness amongst early career professionals in nursing and medicine of the scope, impact and value of Allied Health professions (AHP) on patient care.

Objective: Does the introduction of AH colleagues and scope of practice materially change the referral practices of early career Nurses and Doctors?

Method: Country Health SA Transition to Professional Practice (TPPP), ‘is a broad program covering theoretical and clinical aspects of the nurse/midwife and medical roles‘. TPPP is run annually in Mount Gambier. An additional presentation by and about AHPs will be included in the 2018. Each AHP will have 10 minutes to provide information on scope of practise, clinical priority tool and referral criteria with supporting written information.
A baseline perception survey will be completed prior to the presentation. This survey will be repeated at 3 and 6 month intervals and the data analysed.
AHP referrals will be audited 1 month prior to the presentation and at 3 and 6 month intervals using a predetermined set of ‘value’ criteria (eg appropriate use of priority tool, timeliness of referral, increase in referrals).

Results:It is hoped that it will demonstrate that the introduction of information regarding the scope and impact of AHP delivered in person as part of a structured learning program has a long-term effect on the referring and interprofessional attitudes of early career Doctors and Nurses.


Biography:

Hilary is a Podiatrist that has been based in the Mount Gambier, South Australia since graduating from a Bachelor of Podiatry in 2016.
Due to experiences in her studies, Hilary was drawn to providing care in rural and remote settings and moved to the Mount Gambier as a new graduate. Now as a clinical Podiatrist with 2 years experience she is providing care in outreach communities, has a passion for interprofessional management of country living clients and involved in the introduction multi disciplinary high risk foot management clinics.

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