Provision Of Allied Health Services Research Articles

Reform and reverberation: Australian aged care policy changes and the unintended consequences for allied health.

Allied health has a valuable role in providing services to people living in residential aged care. The recent Royal Commission into Aged Care Quality and Safety included several important recommendations relating to the nursing, personal care, and allied health workforce and the care that they provide. The purpose of this paper is to review these recommendations and the Australian Government's policy responses and explore the emerging changes in allied health service provision in residential aged care. Data from the four available Quarterly Financial Reports from the 2022-2023 financial year were extracted and analysed in relation to staff costs and time per person per day across personal care, nursing, and allied health workers. Supplementary data sources including the 2020 Aged Care Workforce Census were accessed to provide contextual data relating to individual allied health professions, including occupational therapy. The analysis shows a modest increase in median registered nurse minutes per person per day, and cost per person per day, from the first to second quarter, and again in the third and fourth. By contrast, median time and cost for allied health declined. From 5.6minutes per person per day in the first quarter, reported allied health minutes fell to 4.6minutes per person per day in the second quarter, an 18% decrease, and by the fourth quarter was 4.3minutes per person per day. This is just over half the Australian average of 8minutes reported to the RCACQS in 2019. Under recent residential aged care reforms, aged care providers have regulatory incentives to concentrate their financial resources on meeting the mandated care hours for registered nurses, enrolled nurses, personal care workers, and assistants in nursing. These same reforms do not mandate minutes of allied health services. Although providers of residential aged care in Australia continue to employ and value allied health, we argue that mandating care minutes for personal and nursing care without mandating the provision of allied health creates a perverse incentive whereby access to allied health services is unintentionally reduced.

Therapy-based allied health delivery in residential aged care, trends, factors, and outcomes: a systematic review

BackgroundAllied health professionals in residential aged care facilities (RACFs) make important contributions to the physical and mental wellbeing of residents. Yet to date, health services research in RACFs has focused almost exclusively on nursing disciplines. This review aims to synthesise the current evidence on allied health services in RACF; specifically, how therapy-based allied health is delivered, what factors impact the quantity delivered, and the impact of services on resident outcomes and care quality.MethodsEmpirical peer-reviewed and grey literature focusing on allied health service delivery in RACFs from the past decade was identified through systematic searches of four databases and over 200 targeted website searches. Information on how allied health delivered, factors impacting service delivery, and impact on resident outcomes were extracted. The quality of included studies was appraised using the Mixed Methods Appraisal Tool (MMAT) and the AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) checklist.ResultsTwenty-eight unique studies were included in this review; 26 peer-reviewed and two grey literature studies. Sixteen studies discussed occupational therapy and 15 discussed physiotherapy, less commonly studied professional groups included dieticians (n = 9), allied health assistants (n = 9), and social workers (n = 6). Thirteen studies were assigned a 100% quality rating. Levels of allied health service provision were generally low and varied. Five studies examined the association between system level factors and allied health service provision, and seven studies examined facility level factors and service provision. Higher levels of allied health provision or access to allied health services, specifically physiotherapy, occupational therapy, and nutrition, were associated with reduced falls with injury, improved care quality, activities of daily living scores, nutritional status, and meal satisfaction in five studies.ConclusionEvidence on how allied health is delivered in RACFs, and its impact on resident health outcomes, is lacking globally. While there are some indications of positive associations between allied health staffing and resident outcomes and experiences, health systems and researchers will need commitment to consistent allied health data collection and health services research funding in the future to accurately determine how allied health is delivered in RACFs and its impact on resident wellbeing.

Variation in inpatient allied health service provision in Australian and New Zealand hospitals.

To describe the variability of allied health services on weekends, relative to weekdays, throughout Australian and New Zealand hospitals. A prospective, cross-sectional observational study embedded within a cluster randomised control trial. Allied health managers provided administrative data relating to allied health service events. In one month, there were a total of 243549 allied health service events recorded from 91 sampled hospitals. The mean difference between weekday and weekend allied health service events (daily, per ward) for physiotherapy was 6.52 (95% CI 5.65 to 7.40), acute wards 12.03 (95% CI 10.25 to 13.82) and for metropolitan hospitals 14.47 (95% CI 12.22 to 16.73), revealing more allied health service events of longer duration on weekdays compared to weekends. This research is the first of its kind to describe variation in allied health service provision and potential research to practice gaps across weekday and weekend days in various inpatient settings.

Incidence of intensive care unit acquired weakness and evaluation of multidisciplinary allied health management in a tertiary ICU

Introduction: Intensive Care Unit Acquired Weakness (ICU-AW) occurs in approximately 40% of patients and results in prolonged recovery and poorer quality of life. These patients require significant Allied Health (AH) input however resource utilisation and the impact on patient outcomes is unknown. Objectives/Aims: To determine incidence of ICU-AW and AH service provision and explore associations with functional related outcomes. Methods: Prospective, observational study in a tertiary ICU from January to October 2018. Patients who were mechanically ventilated for >48h and expected to stay in ICU ≥4 days, were screened for ICU-AW using the Medical Research Council sum-score (MRC-ss). Outcomes included: muscle strength (MRC-ss and grip strength), physical function (Physical Function in Intensive care Test-scored (PFIT-s)), nutritional adequacy (percentage prescribed energy requirements met) and weight change in ICU, dysphagia incidence and number of AH interventions. Results: ICU-AW incidence 23% (n=22), 55% female, mean(SD) age 63.2(11.6) years, APACHE II score 19.8(7.8), ICU length of stay(LOS) 14.9(8.0) days. Mean(SD) MRC-ss and PFIT-s were 36.2(9.5) and 3.0(1.5) at awakening and significantly improved at ICU discharge; mean difference MRC-ss [6.4 (95%Cl 2.6-10.0), p=0.002] and PFIT-s [1.0 (95% 0.3-1.7) p=0.011]. Nutritional adequacy was mean(SD) 70(18)% and dysphagia incidence was 41%. A moderate negative correlation was observed between baseline MRC-ss and ICU LOS (r =-0.49, p=0.02), baseline grip strength and weight change (r=-0.59, p=0.03). Patients with dysphagia had lower grip strength [mean difference -7.3kg (95%CI -2.9 to -11.6), p=0.003], and tracheostomy presence was associated with increased ICU LOS [mean difference 13.6 (95%CI 6.6 to 20.6), p = 0.001]. Patients received a median[IQR] of 4.0[2.3-5.0] physiotherapy rehabilitation, 4.0[2.0-5.3] dietetics, 2.0[1.0-7.5] speech pathology and 2.5[1.0-3.0] social work interventions. Conclusion: Despite improvements in strength and function, patients with ICU-AW have significant impairments at ICU discharge. This study describes AH management of patients with ICU-AW and provides a platform for interventional research.

Implementation of evidence-based weekend service recommendations for allied health managers: a cluster randomised controlled trial protocol

BackgroundIt is widely acknowledged that health policy and practice do not always reflect current research evidence. Whether knowledge transfer from research to practice is more successful when specific implementation approaches are used remains unclear. A model to assist engagement of allied health managers and clinicians with research implementation could involve disseminating evidence-based policy recommendations, along with the use of knowledge brokers. We developed such a model to aid decision-making for the provision of weekend allied health services. This protocol outlines the design and methods for a multi-centre cluster randomised controlled trial to evaluate the success of research implementation strategies to promote evidence-informed weekend allied health resource allocation decisions, especially in hospital managers.MethodsThis multi-centre study will be a three-group parallel cluster randomised controlled trial. Allied health managers from Australian and New Zealand hospitals will be randomised to receive either (1) an evidence-based policy recommendation document to guide weekend allied health resource allocation decisions, (2) the same policy recommendation document with support from a knowledge broker to help implement weekend allied health policy recommendations, or (3) a usual practice control group. The primary outcome will be alignment of weekend allied health service provision with policy recommendations. This will be measured by the number of allied health service events (occasions of service) occurring on weekends as a proportion of total allied health service events for the relevant hospital wards at baseline and 12-month follow-up.DiscussionEvidence-based policy recommendation documents communicate key research findings in an accessible format. This comparatively low-cost research implementation strategy could be combined with using a knowledge broker to work collaboratively with decision-makers to promote knowledge transfer. The results will assist managers to make decisions on resource allocation, based on evidence. More generally, the findings will inform the development of an allied health model for translating research into practice.Trial registrationThis trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12618000029291). Universal Trial Number (UTN): U1111-1205-2621.

A Randomized Controlled Trial to Determine the Effect of a Model of Restorative Home Care on Physical Function and Social Support Among Older People

ObjectiveTo determine the impact of a restorative model of home care on social support and physical function among community-dwelling older people. DesignCluster-randomized controlled trial. SettingHome care in an urban area. ParticipantsParticipants (N=205) were randomly assigned to an intervention group (n=108; mean age, 79.1y; 71.3% women; 81.5% New Zealand European [NZE]; 50.8% residing in areas of the highest levels of social deprivation) or a usual care group (n=97; mean age, 76.9y; 60.8% women; 73.2% NZE; 53.5% in the highest levels of social deprivation). InterventionParticipants randomly assigned to the intervention group completed a goal facilitation tool with a needs assessor to determine their needs and to establish the aims for the episode of care. Services were structured according to the principles of restorative home care (independence focused with individually tailored activity programs). Usual care participants received a standard needs assessment that informed the delivery of home care services. Main Outcome MeasuresShort Physical Performance Battery (SPPB), Dukes Social Support Index (DSSI). ResultsThere was greater change over time in physical function (measured by SPPB: F=8.30, P=.003) but no associated increase in social support (as determined by DSSI: F=2.58, P=.09). ConclusionsSignificant improvements in physical function were observed after a period of restorative home care services. The absence of an associated change in social support may have been the result of a combination of factors, including the threshold of physical function required for community ambulation, the low rate of allied health service provision, and the time required to reestablish social ties. The findings contribute to a greater understanding of factors necessary to refocus home-based services to emphasize improvements in physical function and independence.

Evaluation of a system of monitoring allied health service provision, quality and outcomes

Allied health professionals provide a diverse range of patient care. However funders and purchasers of allied health services have few mechanisms for defining the interventions carried out by allied health providers; for defining episodic care; or for monitoring the quality and outcomes of allied health provider interventions. As a result, third party funders tend to allocate allied health services by establishing a ceiling on the number of appointments allowed, or capping regardless of the condition or patient need. This paper reports on the effect of the monitoring systems by a third party funder to introduce more patient centred funding models. Aim: To evaluate a system of monitoring allied health service provision, quality and outcomes. Method: A large third party funder piloted the introduction of a comprehensive care planning tool to investigate the potential for post-payment monitoring of service quality. Results: Practitioner perceptions of provider quality were quite different from what was measured and audited. The heterogeneity of allied health services means that no standardised classification system of interventions is appropriate for service benchmarking. There were large variations in service provision, within and between practitioners. Conclusions: Ongoing monitoring should include easily auditable measures, such as occasions of service mapped against broad indicators of type of appointment. There is a need for ongoing systems of quality improvement to ensure the quality of patient care is optimised.

Could Self-Efficacy Relate to Workforce Issues for Rural Physiotherapists with a Specialist Paediatric Caseload? A Literature Review

Rural physiotherapists may need to extend their skills to address the lack of allied health service provision in rural areas but will do so based on their perceived self-efficacy. This narrative review aims to understand self-efficacy amongst rural physiotherapists and contributing factors to self-efficacy, especially in the specialised area of paediatrics.Method: A search of the literature was undertaken to understand the self-efficacy of rural physiotherapists who are expected to undertake specialist paediatric cases. Databases searched included CINAHL, PEDro, Informit, Proquest, PubMed, and Ovid. Articles were assessed for quality in accordance with the National Health and Medical Research Council (NHMRC) evidence ranking system. Using this search strategy and inclusion criteria, a total of forty five articles were found and included in the narrative review. Results: Self-efficacy, a person’s judgement of their capabilities, is a key component in performance, accomplishments, and positive well-being. If the rural physiotherapist has low self-efficacy in their work practices, then physiotherapy specialisation or advance practice may not be considered an achievable career option. However, the caseload of the rural physiotherapist is vast and demanding, spanning across many boundaries and scopes including paediatrics, which has been defined as an area of specialisation within physiotherapy. The work practices of the rural physiotherapist’s are often challenged by the complexities of rural area’s and an unstructured, poorly supportive workforce, thus giving cause for the recognition of rural physiotherapy as a specialist branch of physiotherapy practice. Yet, the majority of the evidence base surrounding this topic has been developed through opinion pieces and observational studies which were rated as level IV evidence. At present, the lack of higher level evidence allowed readers to make assumptions based on opinions and descriptive studies. Conclusion: If the current workforce and structure leads to low self-efficacy in the rural physiotherapy population, this in turn could lead to impaired confidence in the ability to practice as a physiotherapist as well as result in the development of poor coping strategies. Early identification of the self-efficacy beliefs within this cohort will allow the development and evaluation of strategies to help address those issues identified as challenges in rural areas. There is a definite need for stronger, higher levels of evidence on this topic in order to develop more accurate definitions of the work practices and working environments of the rural physiotherapists. Additional higher level research is needed to better understand the self-efficacy of rural physiotherapists and possible contributing factors for low self-efficacy. Higher level research will also establish true clinical implications of low self-efficacy amongst the rural physiotherapist population.

Sport/leisure injury hospitalisation rates—Evidence for an excess burden in remote areas

Information about the regional population distribution of sports injury rates is important for the identification of priority groups for injury prevention and sports medicine service delivery. This study describes the relationship between regional measures of social disadvantage (socio-economic index for areas, SEIFA) and remoteness (accessibility/remoteness index of Australia, ARIA) and the incidence of sport/leisure hospitalisation episodes for 2003–2004. All hospital separations, of New South Wales (NSW, Australia) residents, with an ICD-10-AM principal diagnosis indicating an injury and an activity code indicating sport/leisure activity were included. Age-standardised hospitalisation rates were calculated across SEIFA and ARIA categories. There was no clear trend in hospitalisation rates across SEIFA quintiles, with rates ranging from a low of 150.3/100,000 population (95% CI: 145.5–155.2) in the quintile of most disadvantage to a high of 201.8/100,000 population (196.1–207.4) in the middle quintile. In contrast, there was a strong positive and significant trend across ARIA groups ( p < 0.001) with rates ranging from a low of 156.2/100,000 population (153.2–159.2) in the most urban areas to a high of 335.5/100,000 population (306.5–364.6) in remote areas. Reasons for these trends are unclear but may include differences in medical and allied health service provision, sport/leisure infrastructure and opportunities across regions or differential participation in sport across NSW. Further investigations into why remote and very remote areas, in particular, have such high rates, including exploration of participation rates, sport/leisure opportunity delivery factors and the provision of sports medicine services need to be undertaken before injury rates can be reduced in these areas.

User satisfaction with allied health services delivered to residential facilities via videoconferencing.

We have investigated the role of videoconferencing in allied health service provision to high-care clients in rural residential facilities. Videoconferencing equipment was set up at a rural aged-care facility and a metropolitan allied health centre; ISDN transmission at 384 kbit/s was used to link the equipment. Twelve residents were assessed by both videoconference and face to face across five allied health disciplines (a total of 120 assessments). User satisfaction was measured using questionnaires and focus groups. Face-to-face assessment took significantly longer than videoconferencing assessment. However, the mean satisfaction ratings for face-to-face assessments were higher than for videoconferencing and the majority of the staff preferred the face-to-face format. Videoconferencing was particularly useful for consultations and the initial stages of the assessment process. A number of issues relating to the videoconferencing equipment, to the environment in which assessments were performed and to the clients themselves need to be addressed in order for this form of service delivery to be effective.

Critical issues confronting the advancement of applied sport psychology

Despite considerable progress over the last 10 years, applied sport psychology confronts several persistent issues that continue to limit the growth and development of the field. Specifically, issues requiring more comprehensive and proactive attention and initiatives include: the training of graduate students, the accreditation of graduate programs, the job market, and the establishment of systematic educational outreach programs. Suggestions are offered regarding how enhancements in each of the aforementioned issues can be initiated, and potential benefits gained by students, faculty, and the general public are identified and discussed. Given the climate in many academic institutions emphasizing program downsizing, sport psychology may be approaching and confronting one of the most crucial crossroads in its existence. Without direct efforts to assure academic credibility and public confidence in the standards of training and practice, sport psychology may fail to actualize a meaningful future role in the competitive field of allied health service provision.