Allied Health Practitioners Research Articles

Scoping review of Australian evaluations of healthcare delivery models: are we making the most of the evidence?

Objective Healthcare delivery models describe the organisation of healthcare practitioners and other resources to provide health care for a defined patient population. The organisation of health care has a predominant effect on the receipt of timely and appropriate health care. Efforts to improve healthcare delivery should be evidence informed, and large numbers of evaluations of healthcare delivery models have been undertaken. This paper presents a scoping review of Australian evaluations of new healthcare delivery models to inform a discussion of the appropriate use of such evidence to improve the efficiency and sustainability of the Australian health system. Methods A systematic scoping review was undertaken, following an a priori published protocol. PubMed, Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for primary comparative studies of healthcare delivery models undertaken in Australia and published between 2009 and 2018. Primary prevention studies, such as health promotion activities, were excluded. Results Of 14923 citations, 636 studies were included in the scoping review. Of these, 383 (60%) were randomised control trials. There were 18 clinical specialties in which over 10 evaluations were identified. Most models involved allied health practitioners or nurses. Conclusion Evaluations of healthcare delivery models provide important evidence that can be used to improve the use of the most important and costly assets of health systems, namely the healthcare practitioners who deliver health care. A nationally coordinated system is required to support local health services to assess the local value of alternative healthcare delivery models. What is known about the topic? The organisation and delivery of health care is continuously evolving in response to changes in the demand and supply of health care. New healthcare delivery models are often evaluated in specific locations, but it is not clear how such evidence informs the delivery of care in other locations. What does this paper add? This paper reports the findings of a scoping review of Australian evaluations of healthcare delivery models, highlighting the large and increasing number of such evaluations that have been published in the past 10 years. What are the implications for practitioners? Opportunities to improve health system efficiency are likely being lost due to the underuse of the available Australian evidence on new healthcare delivery models. Local health services need support to interpret such evidence in their local context, which could be provided through the development of a national framework for local evaluation.

Humanities and Health Programming: An Eighteenth-Century Approach to a Twenty-First Century Conundrum

Humanities and Health Programming:An Eighteenth-Century Approach to a Twenty-First Century Conundrum Katherine Gustafson (bio) Newspapers and magazines frequently represent the humanities as a discipline under attack.1 However, as a college professor, I experience disregard rather than vitriol. My students enjoy literature, but many major in so-called practical fields, thereby reflecting an assumption that humanities classes are nice but will not be useful once they graduate from college and begin their careers. What follows is my experience working with colleagues at three regional campuses within Indiana University—IU-South Bend, IU-Kokomo, and IU-Northwest—to create a multisite, two-track healthhumanities program that includes a medical humanities minor. This essay argues that collaboration between health and humanities departments may move the debate beyond a defense/attack binary by enabling humanists to ally with and demonstrate to nonhumanists that humanistic study is useful, especially for students pursuing health degrees.2 Moreover, it asserts that eighteenth-century study plays a unique role in this debate by testing medical students' empathy. It is no secret that many students major in fields like nursing, business, or engineering for what they assume are better employment opportunities, and do so despite reports that corporations increasingly value employees with humanities training.3 This disconnect, Scott Carlson argues, may be because [End Page 371] such reports do not "account for factors like class, institutional prestige, and student inputs."4 These factors matter, though, especially for students who attend community colleges, regional state universities, and other non-elite institutions in the U.S.5 IU-South Bend, IU-Kokomo, and IU-Northwest may offer insight into such campuses. IU-Northwest, for example, teaches a sizeable percentage of so-called nontraditional undergraduates. As of Fall 2017, 30 percent of IU-Northwest students were enrolled part time, and nearly 85 percent of all students attended school while working.6 For many of these students, the choice to attend college likely entails financial burden and risk, and thus a major with a direct employment pipeline may be preferable to one with an uncertain future. This information can help humanities faculty increase their enrollments by innovating around student needs. In 2016 IU-Northwest faculty from the Departments of Nursing, Public and Environmental Affairs, Health Information Management, English, and History collaborated to create interdisciplinary programming. The group eventually partnered with other IU campuses to develop the Health Studies Consortium, which consists of an Allied Health Practitioner Credentialing Program and a Medical Humanities Minor.7 The Medical Humanities Minor is a fifteen-credit-hour program in which students take required introductory and capstone courses, as well as elective health topics courses in science, social science, and humanities.8 These classes encourage students to think holistically about health and dovetail with the Consortium's goals of providing pathways into health studies, encouraging students' empathy, and offering a center for community health projects. Such collaboration parallels a report by the National Academies of Science, Engineering, and Medicine, which urges universities to create integrated STEM-Humanities programming even as it recognizes the administrative barriers that impede such efforts at many universities where course schedules and graduation requirements differ by discipline.9 Administrative divides, our team found, exist and require a shared commitment to problem solving. For example, we learned that nursing students might avoid the Medical Humanities Minor for fear of adding coursework to their jam-packed schedules. In response, we asked advisors to enroll pre-nursing students during their first two years of study when their schedules were more flexible. Equally important, our team found that methodological divides between the humanities and sciences can pose barriers to collaboration. Nonhumanists, for instance, were skeptical that humanities courses could enhance medical students' empathy and cultural knowledge. Our team approached such skepticism as an opportunity to explain the value of a humanistic perspective, articulate the program's goals in language that would appeal to STEM [End Page 372] partners, design a research protocol to test our claim, and study available data on humanities training in medical education. This research found that humanities coursework demonstrably develops medical students' observational abilities, empathy, and cultural competence, skills that directly impact patients' health outcomes.10 In addition, this research...

Fall prevention in primary care using chronic disease management plans: A process evaluation of provider and consumer perspectives.

Falls are an important issue in primary care. General practitioners (GPs) are in a key position to identify older people at risk of falls on their caseload and put preventative plans into action. Chronic Disease Management (CDM) plans allow GPs to refer to allied health practitioners (AHPs) for evidence-based falls interventions. A previous pilot study reduced falls risk factors using CDM pans with older people at risk of falls. This study aimed to conduct a process evaluation of how the intervention worked in the pilot study for providers and consumers. This process evaluation used qualitative descriptive methods by interviewing the GPs, AHPs and older people involved in the intervention study. An independent researcher conducted interviews. These were audiotaped, transcribed and analysed using thematic analysis. Data were also collected about the implementation of the programme. Two GPs, three occupational therapists, three physiotherapists and eight older people were interviewed. Key themes emerged from the perspectives of providers and consumers. The programme was implemented as intended, adherence to the exercise diaries was variable and the falls calendars were fully completed for three months of follow-up. The programme was implemented as intended. The pilot CDM falls prevention programme did not identify common barriers attributed to GPs. Older people were amenable to the programme and participated freely. Private AHPs needed to make the CDM items work for their business model. This approach can be rolled out in a larger study and integrated pathways are needed to identify and intervene with older people at risk of falls in primary care.

Cough in lung cancer: A survey of current practice among Australian health professionals

BackgroundSystematic reviews and guidelines are available to guide management of cough in lung cancer, but evidence for intervention efficacy is limited, and little research has yet described current practice. AimTo canvass the experiences and perspectives of Australian health professionals with regard to the clinical importance and current management of cough in people with lung cancer. MethodsAn open, online, cross-sectional survey was conducted in 2018. Health professionals of all disciplines were eligible, and recruitment was by direct approach to lung cancer multidisciplinary teams, professional listservs and conferences. FindingsFifty-eight people completed the survey, of whom 26 (45%) were medical practitioners, 21 (36%) registered nurses, and 10 (17%) allied health practitioners. Nearly all (>90%) considered cough to be of clinical concern and welcomed efforts to improve management. In most services, ≤25% of patients with clinically concerning cough receive management. Opiates were perceived to be the most consistently effective pharmacological strategy, with ≥50% participants indicating minimal or variable effectiveness for all others. The few participants who had experience of non-pharmacological strategies perceived these to be only somewhat or variably effective. DiscussionResults from this study identified variability in the management of cough associated with lung cancer, and suggest this problem may be under-treated in most services. Unmet needs identified by this study are likely under-estimated due to the volunteer effect associated with open surveys. ConclusionFurther efforts are needed to raise awareness about the importance of managing cough and provide evidence-based strategies for this population.

Competencies and skill development in maternity care services in Victoria - A qualitative study

In healthcare, continuing professional development is provided to ensure professional standards are maintained and for clinicians to remain fit to practice. The purpose of the study was to identify potential gaps or issues with continuing professional development in maternity services through consultations with key stakeholders and, in addition, to generate possible solutions or recommendations towards the development of a state wide continuing professional development program. The data was collected through semi-structured interviews of a purposive sample between June and August 2018. A thematic analysis was undertaken. Participants included a practicing midwife, allied health practitioner (physiotherapist), manager, healthcare educator, and an outlier service worker (maternal and child health nurse). Following the thematic analysis, four main themes (education, practitioner standards, programme monitoring and resources) were identified along with nine sub-themes. The results suggest organisations need to offer explicit support for staff to access to continuing professional development. In addition, the qualifications of facilitators of continuing professional development and/or consumer education are recommended to go beyond education levels required for registration. In this respect, some organisations credentialed their educators locally in a ‘train the trainer’ manner however, most participants supported professional preparation for the role of educator.

Editorial introductions

Editorial introductions

How Do General Practitioners (GPs) Engage in Falls Prevention With Older People? A Pilot Survey of GPs in NHS England Suggests a Gap in Routine Practice to Address Falls Prevention.

Falls are highly prevalent amongst older people and have substantial financial and social costs for health services and the community. Prevention of falls is the key to managing this threat to older people. General practitioners can identify older people at risk of falls on their caseloads. Once identified, actions can be taken to reduce the risk of falls by referring to appropriate services available in the community, such as allied health practitioners. However, the level of engagement in evidence based falls prevention by GPs is unknown. This study aimed to explore how British general practitioners (GPs) address falls prevention with older people, and to determine if there are any gaps in practice. As a pilot study, another aim was to test the feasibility of methods to survey GPs, if a larger survey was warranted from the findings. An on-line cross-sectional survey was distributed by email to all the Clinical Commissioning Groups in NHS England (n = 213) and individual general practices listed on the NHS Choices website, supplemented by invitations distributed to CCGs through Twitter and LinkedIn sites. Thirty-seven responses were received. Most GPs were unfamiliar with the 2013 NICE guidelines on assessment and prevention of falls in older people (51.4%, n = 19), and only 29.7% (n = 11) asked older people if they had fallen during consultations. If falls risk was identified, 81.1% (n = 30) frequently made referrals to physiotherapy (PT) and 56.8% (n = 21) to occupational therapy (OT). Most GPs did not identify older people on their caseloads as being at risk of falls unless they presented with a fall, and referral rates to relevant AHPs or falls prevention programs were low. Barriers to implementation of falls prevention best practice were identified. Alternative methods are needed to capture the falls prevention practice of a wider sample of GPs.

Developing strategic priorities in osteoarthritis research: Proceedings and recommendations arising from the 2017 Australian Osteoarthritis Summit

BackgroundThere is a pressing need to enhance osteoarthritis (OA) research to find ways of alleviating its enormous individual and societal impact due to the high prevalence, associated disability, and extensive costs.MethodsPotential research priorities and initial rankings were pre-identified via surveys and the 1000Minds process by OA consumers and the research community. The OA Summit was held to decide key research priorities that match the strengths and expertise of the Australian OA research community and align with the needs of consumers. Facilitated breakout sessions were conducted to identify initiatives and strategies to advance OA research into agreed priority areas, and foster collaboration in OA research by forming research networks.ResultsFrom the pre-Summit activities, the three research priority areas identified were: treatment adherence and behaviour change, disease modification, and prevention of OA. Eighty-five Australian and international leading OA experts participated in the Summit, including specialists, allied health practitioners, researchers from all states of Australia representing both universities and medical research institutes; representatives from Arthritis Australia, health insurers; and persons living with OA. Through the presentations and discussions during the Summit, there was a broad consensus on the OA research priorities across stakeholders and how these can be supported across government, industry, service providers and consumers.ConclusionThe Australian OA Summit brought consumers, experts and opinion leaders together to identify OA research priorities, to enhance current research efforts by fostering collaboration that offer the greatest potential for alleviating the disease burden.

Sustainable response to prescribed opioid misuse

Sustainable response to prescribed opioid misuse

Using the behavior change wheel to identify barriers to and potential solutions for primary care clinical guideline use in four provinces in South Africa

BackgroundClinical practice guidelines risk having little impact on healthcare if not effectively implemented. Theory informed, targeted implementation may maximise their impact. Our study explored barriers to and facilitators of guideline implementation and use by South African primary care nurses and allied healthcare workers in four provinces in South Africa. We also proposed interventions to address the issues identified.MethodsWe used qualitative research methods, comprising focus group discussions using semi-structured topic guides. Seven focus group discussions were conducted (48 providers) in four South African provinces (Eastern Cape, Western Cape, Kwazulu-Natal, Limpopo). Participants included mostly nurses, dieticians, dentists, and allied health practitioners, from primary care facilities in rural and peri-urban settings. The analysis proceeded in three phases. Firstly, two analysts conducted inductive thematic content analysis to develop themes of data. This was followed by fitting emergent themes to the Theoretical Domains Framework and finally to the associated Behaviour Change Wheel to identify relevant interventions.ResultsParticipants are knowledgeable about guidelines, generally trust their credibility and are receptive and motivated to use them. Guidelines are seen by nurses to provide confidence and reassurance, as well as professional authority and independence where doctors are scarce. Barriers to guideline use include: inadequate systems for printed book distribution, insufficient and substandard photocopies, linguistic inappropriateness (e.g. complicated language, lack of summaries, unavailable in local languages), unsupportive auditing procedures, limited involvement of end-users in guideline development, and patchy training that may not filter back to all providers. Future aspirations identified include: improving the design features of guidelines, accessible places to find guidelines, making digitally-formatted versions available, more supplementary materials (e.g. posters) to support patient engagement, accessible clinical support following training, and in-facility training for all professional cadres to ensure fair access, similar levels of capability and interdisciplinary consistency.ConclusionsSouth African primary care nurses and allied health practitioners have high levels of motivation to use guidelines, but face many systemic barriers. We used the Behaviour Change Wheel to suggest relevant, implementable interventions addressing identified barriers. This theory-informed approach may improve clinical guideline implementation and impact healthcare for South Africa.

Paramedic involvement in health education within metropolitan, rural and remote Australia: a narrative review of the literature.

Objective A growing body of research indicates that paramedics may have a greater role to play in health care service provision, beyond the traditional models of emergency health care. The aim of this study was to identify and synthesise the literature pertaining to the role of paramedic-initiated health education within Australia, with specific consideration of metropolitan, rural and remote contexts. Methods A literature review was undertaken using the Ovid Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE and Scopus databases. The search time frame was limited from January 2007 to November 2017. The search was performed using key paramedic search terms in combination with keywords such as health education, rural, metropolitan, remote and Australia. Reference lists from relevant papers were also reviewed. Results Fourteen articles met the inclusion criteria for synthesis. Health education in the Australian paramedic context relates largely to expanded-scope paramedics, health promotion and the role of paramedics as key members of local communities. There were no studies specifically related to the paramedic role in health education, although many papers referred to health education as one of many roles paramedics engage in today. Conclusion This review highlights a broadening of paramedicine's traditional scope of practice, and an indication of how vital paramedics could be to local communities, particularly in rural and remote areas. An expanded role may help address health workforce sustainability problems in areas where health care provision is challenged by geographical constraints and low workforce numbers. What is known about the topic? A broadening of paramedicine's traditional scope of practice has been linked to improvements in health workforce sustainability problems in areas where health care provision is challenged by geographical constraints and low workforce numbers, such as rural and remote Australia. Health education, as well as health promotion, primary health care and chronic disease management, have been proposed as potential activities that paramedics could be well placed to participate in, contributing to the health and well-being of local communities. What does this paper add? This paper identifies and synthesises literature focusing on paramedic-initiated health education in the Australian context, assessing the current health education role of paramedics in metropolitan, rural and remote areas. It provides an understanding of different geographical areas that may benefit from expanded-scope prehospital practice, indicating that the involvement of paramedics in health education in Australia is significantly determined by their geographical place of work, reflecting the influence of the availability of healthcare resources on individual communities. What are the implications for practitioners? Today's paramedics fill broader roles than those encompassed within traditional models of prehospital care. Rural and remote communities facing increasing difficulty in obtaining health service provision appear to benefit strongly from the presence of expanded-scope paramedics trained in health promotion, primary injury prevention, chronic disease management and health education: this should be a consideration for medical and allied health practitioners in these areas. Australian paramedics are uniquely placed to 'fill the gaps' left by shortages of healthcare professionals in rural and remote areas of the country.

Beyond Right or Wrong: Attitudes and Practices of Physicians, Nurses, Psychologists, and Social Workers Regarding Attendance at Patient Funerals.

Health professionals' bereavement practices, including funeral attendance, have attracted relatively little attention from researchers. There may be a number of motivations and perceived benefits for health professionals to attend patient funerals. There are no published data comparing different groups of health professionals' perceptions of and practices in attending the funerals of their patients. To understand the attitudes and practices of health professionals toward attendance at patient funerals. Cross-sectional nationwide online survey of attitudes and practices toward attendance at patient funerals based upon data from interviews with health professionals. Australian health practitioners from medicine, nursing, psychology, social work, and other allied health professions (n = 1098). Attendance at patient funerals was predicted by age, telling colleagues about own funeral attendance practices, having discussions with colleagues about funeral attendance, having long relationships with patients, and having a majority of patients at the end of life. Nonattendance was predicted by believing that if they cannot attend all funerals, they prefer not to attend any, feeling that colleagues disapprove of funeral attendance, believing that attending funerals is crossing the line between the personal and the professional, and being a psychologist. Our findings emphasize the need for more open discussions and reflection among individuals and groups of health practitioners regarding attendance at funerals. Understanding the motivations of physicians, nurses, social workers, and other allied health practitioners to attend or not attend patient funerals is an important first step in working toward policies, protocols, and guidelines to support best practice.

Developing allied health leaders to enhance person-centred healthcare

PurposeThe purpose of this paper is to present findings from a mixed methods study investigating leadership development of allied health practitioners within a large public healthcare organization in Australia.Design/methodology/approachThe South Eastern Sydney Local Health District Allied Health Leadership Development Program was undertaken with an allied health cohort (n=16) between May 2014 and March 2015 and comprised all-day workshops, action learning sets and individual coaching. Using experiential learning, the program tested whether practice development methods and action learning approaches developed the leadership skills of participants compared with a control group (n=17). Descriptive statistics were collected to evaluate participant and program outcomes. Leadership, workplace culture and engagement measures were analyzed as part of the study.FindingsThe Allied Health Leadership Development Program received high ratings by participants. They reported enhanced skills in leading self and others through mechanisms such as critical reflection and facilitation, and greater confidence managing change and with engaging staff, colleagues and patients in decision making, affecting the quality and safety of healthcare. Statistically significant differences were found with transformational leadership elements, leadership outcomes, and measures of workplace culture and engagement after program completion for intervention group participants, compared with the control group.Research limitations/implicationsResults provide new empirical evidence about the effectiveness of using practice development for allied health leadership development.Practical implicationsThis low-cost leadership program can be replicated by other organizations.Originality/valueOutcomes from an Allied Health Leadership Development Program have not been previously reported in the literature.

Assessing Spiritual Well-Being in Residential Aged Care: An Exploratory Review.

With the emerging incorporation of spiritual care into the allied health stream, there is a need for a clear and validated process of spiritual review that can be understood across multidisciplinary teams. The aim and purpose of this paper was to critically review the literature regarding spiritual screening, history-taking and assessment, and explore the merits of developing a brief instrument focussed on assessing and improving the spiritual well-being of consumers within residential aged care. Following an exploratory review of the literature, the results indicate that effective processes are noted regarding the triage and identification of the needs and spiritual assessment of consumers; however, many of these tools are overly religious in content, unwieldy in size, or not specifically aimed at identifying the immediate crisis confronting the consumer. It is recommended that an assessment instrument be developed which is communicable across all allied health practitioners (including spiritual carers), which may contribute towards a taxonomy of common consumer conditions, and which will enable the development and delivery of more targeted care plans.

Perspectives of psychology graduates on the registration of psychologists in Zimbabwe

This study sought to explore the views of psychology graduates on the process of registration as a psychologist in Zimbabwe. Specific areas of interest to the researchers were the views of psychology graduates on the academic qualifications required for registration, the post graduate internship programme, continuing professional development and the board examinations. An interpretative phenomenological analysis (IPA) was done by conducting semi-structured in-depth interviews to twelve purposely selected psychology graduates. All participants had a master’s degree of which five were registered psychologists and the rest were not registered. Three major themes were generated from the analysis of the participants’ interviews and these were: academic qualifications for registration, post graduate internship, board examinations and continuing professional development. Generally, the results reveal lack of choices at masters’ degree programmes resulting in participants embarking on counselling and community psychology degrees. They also showed dislike on the continuing professional development points due to barriers such as localisation of workshops and lack of time to do research. The board of examination was viewed positively. The study recommends that the Allied Health Practitioners Council of Zimbabwe needs to collaborate with universities, psychology interns and registered psychologists in the best way forward in registration and practice of psychologists.
 Key Words: Registration; Internship; Psychologist; Qualification; Board Examination

Audiology Awareness of Undecided College Students

Audiology Awareness of Undecided College Students

Trans-disciplinary advanced allied health practitioners for acute hospital inpatients: a feasibility study.

To explore cost-efficiency, safety and acceptability of trans-disciplinary advanced allied health (AH) practitioners for acute adult general medicine inpatients. Quasi-experimental feasibility study. Three acute general medical units in an Australian urban hospital. Two hundred and fifty-six acute hospital inpatients. Cost-efficiency measures included AH service utilization and length of stay (LOS). Patient outcomes were functional independence, discharge destination, adverse events, unplanned admissions within 28 days, patient satisfaction and quality of life data on admission, and 30 days post-discharge. Ward staff were surveyed regarding satisfaction with the service model, and advanced health practitioners (AHPs) rated their confidence in their own ability to meet the performance standards of the role. Patients allocated to AHPs (n = 172) received 0.91 less hours of AH intervention (adjusted for LOS) (95% confidence intervals (CI): -1.68 to -0.14; P = 0.02) and had 1.76 days shorter LOS relative to expected (95%CI: 0.18-3.34; P = 0.03) compared with patients receiving standard AH (n = 84). There were no differences in patient outcomes or satisfaction. AHPs demonstrated growth in job satisfaction and skill confidence. Trans-disciplinary advanced AH roles may be feasible and cost-efficient compared with traditional roles for acute general medical inpatients. Further development of competency frameworks is recommended.

Appreciative Inquiry

Purpose: In this action study, researchers worked with a team of interdisciplinary practitioners to co-develop knowledge and practice in a medical unit of a large urban hospital in Canada. An appreciative inquiry approach was utilized to guide the project. This article specifically focuses on examining the research experiences of practitioners and their accounts on how the research influenced their practice development to enact person-centered care. Method: The project took place in the hospital’s medical unit. A total of 50 staff participants attended focus groups including nursing staff, allied health practitioners, unit leaders, and physicians. One senior hospital administrator was interviewed individually. In total, 36 focus groups were conducted to bring participants together to co-vision and co-develop person-centered care. Results: Analysis of the data produced three themes: (a) appreciating the power of co-inquiry, (b) building team capacity, and (c) continuous development. Furthermore, 10 key enablers for engaging staff in the research process were developed from the data. A conceptual tool, “team Engagement Action Making” (TEAM) has been created to support others to do similar work in practice development. Conclusion: An appreciative inquiry approach has the potential to address gaps in knowledge by revealing ways to take action. Future research should further investigate how the appreciative inquiry approach may be used to support bridging research and practice.

The professionalism of psychiatry registrars as perceived by patients and various health practitioners at Weskoppies Psychiatric Hospital, Pretoria.

ObjectivesAmidst calls for improved professionalism, this study examined the professionalism of psychiatry registrars at Weskoppies Hospital as evaluated by their patients, themselves, their consultants and other health practitioners. The second objective was to examine the perceived importance of aspects of professionalism and compare these descriptively among the various health practitioners and patients.MethodParticipants completed the Professionalism Mini-Evaluation Exercise Questionnaire in evaluating the professionalism of the registrar. The number of questionnaires completed by patients, allied health practitioners, consultant psychiatrists and psychiatry registrars were, respectively, 100, 50, 25 and 20; thus, 195 in total. This previously validated questionnaire consists of 21 items that enquire about doctor-patient relationship skills, reflective skills, time management and interprofessional relationship skills. Participants also ranked the three items of the questionnaire that they considered most important.ResultsHighly statistically significant differences among four groups emerged for both the total and all four subscale scores, with patients generally rating the professionalism of registrars as lower, and not meeting with expectations. All four groups ranked ‘listened actively to patient’ and ‘showed interest in patient as person’ highly. Patients and allied health practitioners ranked the attribute ‘was on time’ highly, while consultants and registrars did not.ConclusionImproving professionalism requires that the attributes ‘listening actively to patient’ and ‘recognising and meeting patient needs’ are taken seriously. Doing so requires that patients also evaluate the professionalism of registrars, rather than relying merely on the evaluation by consultants as being sufficient.

Perceptions of primary health staff about falls prevention in primary care settings in the west of Ireland

Introduction Primary care is an emerging area of practice for allied health practitioners. The effective integration of primary care services provided by different professions using diverse funding sources is challenging. Ireland has implemented a primary care strategy and set up primary care teams to address this. Acknowledging the ageing population in the community, fall prevention needs to be a core function of these services. This study aimed to explore the perceptions of general practitioners, occupational therapists and physiotherapists working in the primary care setting about falls prevention in their practice. Method Three general practitioners, five occupational therapists and three physiotherapists were interviewed from primary care teams in the counties of Limerick, Clare and North Tipperary, Ireland. Interviews were in person or by telephone and audiotaped, transcribed and analysed thematically. Results Two key themes emerged from the data: the level of primary care team integration and the nature of community fall prevention, linked by referral mechanisms. Conclusion Providing comprehensive falls prevention services in the primary care context is complex. Integrated processes and pathways in primary care teams are needed to identify older people at risk of falls and to engage a whole of primary care approach to fall prevention.