scholarly journals Integrating health care in Australia: a qualitative evaluation

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Steven A. Trankle ◽  
Tim Usherwood ◽  
Penny Abbott ◽  
Mary Roberts ◽  
Michael Crampton ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Professionals ◽  
Quality Care ◽  
Qualitative Evaluation ◽  
Care Program ◽  
Chronic Illnesses ◽  
Framework Analysis ◽  
Allied Health Professionals ◽  
Care Plans ◽  
Care Facilitators

Abstract Background With aging populations, a growing prevalence of chronic illnesses, higher expectations for quality care and rising costs within limited health budgets, integration of healthcare is seen as a solution to these challenges. Integrated healthcare aims to overcome barriers between primary and secondary care and other disconnected patient services to improve access, continuity and quality of care. Many people in Australia are admitted to hospital for chronic illnesses that could be prevented or managed in the community. Western Sydney has high rates of diabetes, heart and respiratory diseases and the NSW State Ministry of Health has implemented key strategies through the Western Sydney Integrated Care Program (WSICP) to enhance primary care and the outcomes and experiences of patients with these illnesses. Methods We aimed to investigate the WSICP’s effectiveness through a qualitative evaluation focused on the 10 WSICP strategies using a framework analysis. We administered 125 in-depth interviews in two rounds over 12 months with 83 participants including patients and their carers, care facilitators, hospital specialists and nurses, allied health professionals, general practitioners (GPs) and primary care nurses, and program managers. Most participants (71%) were interviewed twice. We analysed data within a framework describing how strategies were implemented and used, the experiences around these, their perceived value, facilitators and barriers, and participant-identified suggestions for improvement. Results Care facilitators helped patients access services within the hospital and in primary care and connected general practices with hospital specialists and services. Rapid access and stabilisation clinics with their patient hotlines assisted patients and carers to self-manage chronic illness while connecting GPs to specialists through the GP support-line. Action plans from the hospital informed GPs and their shared care plans which could be accessed by other community health professionals and patients. HealthPathways provided GPs with local, evidence-based guidelines for managing patients. Difficulties persisted in effective widespread access to shared records and electronic communication across sectors. Conclusions The combined WSICP strategies improved patient and carer experience of healthcare and capacity of GPs to provide care in the community. Information sharing required longer-term investment and support, though benefits were evident by the end of our research.

Common musculoskeletal conditions

2019 ◽  
pp. 519-538
Author(s):  
Manoj Sivan ◽  
Margaret Phillips ◽  
Ian Baguley ◽  
Melissa Nott
Keyword(s):  
Primary Care ◽  
Health Professionals ◽  
Rehabilitation Services ◽  
Global Burden ◽  
Allied Health Professionals ◽  
Medical Specialties ◽  
Patient Pathway ◽  
Disease Study ◽  
The Uk ◽  
Years Lived With Disability

The Global Burden of Disease study identified musculoskeletal (MSK) conditions as the largest single cause of years lived with disability. MSK medicine and rehabilitation services worldwide are heterogeneous in nature in terms of patient pathway and involvement of various healthcare professionals. The service can be led by consultants in different medical specialties; in primary care by General Practitioners with a special interest in MSK disorders and in secondary care by rheumatologists, orthopaedic surgeons, neurosurgeons, pain specialists, rehabilitation and MSK physicians. Allied health professionals such as physiotherapists and extended scope practitioners now have a far greater role in managing MSK conditions in some countries such as the UK.

scholarly journals P070: Improving handovers in the emergency department: implementation of a standardized team approach

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S101-S102 ◽  
Author(s):  
E.S. Kwok ◽  
S. White
Keyword(s):  
Health Professionals ◽  
Allied Health ◽  
Tertiary Care ◽  
Team Approach ◽  
Tertiary Care Centre ◽  
Risk Area ◽  
Post Intervention ◽  
Allied Health Professionals ◽  
Specific Content ◽  
Care Plans

Introduction: Handovers in the ED are a high risk area for breakdown in team communication, discontinuity of patients’ clinical course, and potential medical errors. This is especially true for morning handovers at our center, when one single overnight MD working with limited resources hands over the entire ED to an oncoming day team of MDs and allied health professionals. We describe a quality improvement (QI) project to implement an inter-professional team approach during handovers. Methods: This prospective QI project took place at an academic tertiary care centre with >160,000 ED visits/yr. An expert working group identified key components of the ideal morning handover, and developed an intervention consisting of standardizing the “location”, “participants”, and “time” components of our handover processes. A research assistant directly observed all 8am handovers for 2 weeks pre- and 2 weeks post-intervention. Outcomes include participant attendance; # of beside RN issues proactively brought forward; frequency of new allied health consults and/or involvement triggered; # of physician interruptions; and time metrics. We report descriptive statistics. Results: During the study period a total of 308 individual patient handovers were observed [Pre:162, Post:146]. Average duration of total handover each morning decreased from 24.9min to 16.3min (p=0.051). Frequency of attendance at handovers increased for various allied health professionals, including care facilitators [Pre:35.7%; Post:91.7%, p=0.005], social workers [Pre:7.1%; Post:66.7%, p=0.003], geriatrics EM (GEM) RNs [Pre:64.3%; Post:83.3%, p=0.391], pharmacists [Pre:0.0%; Post:58.3%, p=0.001], and physiotherapists [Pre:0.0%; Post:58.3%, p=0.001]. Number of specific beside RN issues proactively brought forward increased [Pre:0; Post:4, p=0.049], while the number of physician interruptions during handover decreased [Pre:20; Post:0, p<0.0001]. Frequency of new allied health consults and/or involvement triggered as a result of handover participation increased from 6.8% to 13.7% (p=0.057). Conclusion: Implementation of a standardized team approach to morning handovers in the ED led to significant improvements in inter-professional contributions to patient care plans and overall efficiency. Future planned phases will build on this QI initiative by standardizing specific content of ED handovers.

scholarly journals Does Enhanced Primary Care enhance primary care? Policy‐induced dilemmas for allied health professionals

2008 ◽  
Vol 188 (1) ◽  
pp. 29-32 ◽  
Author(s):  
Michele M Foster ◽  
Geoffrey Mitchell ◽  
Terry Haines ◽  
Sean Tweedy ◽  
Petrea Cornwell ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Professionals ◽  
Allied Health ◽  
Care Policy ◽  
Allied Health Professionals

scholarly journals Characteristics of patients receiving health assessments, care plans or case conferences by general practitioners, as part of the Enhanced Primary Care program between November 1999 and October 2001

2002 ◽  
Vol 25 (6) ◽  
pp. 120
Author(s):  
David Wilkinson ◽  
Heather McElroy ◽  
Justin Beilby ◽  
Kathy Mott ◽  
Kay Price ◽  
...  
Keyword(s):  
Primary Care ◽  
Older People ◽  
Indigenous People ◽  
Care Program ◽  
The Elderly ◽  
Care Plans ◽  
Department Of Health ◽  
Health Assessments ◽  
Case Conferences ◽  
Gender Patterns

We aimed to describe the characteristics of patients receiving health assessments (HA), care plans (CP) or case conferences (CC) through the Enhanced Primary Care (EPC) program between November 1999 and October 2001. The Commonwealth Department of Health and Ageing provided data. In all, 43%of non-Indigenous people who had a HA were aged 75-79 years and 32%were aged 80-84 years. Those having a HA at home were older (30.3% aged 85 years and above) than those having a HA in GP's rooms (20.2%85 years and above). For Indigenous people, between 12 and 17%of all HAs were done among each five-year age group between 55 and 84 years. As a group, CPs were mostly done among older people, with a higher proportion done among older women (74.2%among those 55 years and above) than older men (66.4%). Most CCs were also done among older people (60.4%55 years and above). Of the 286,250 people that had at least one EPC service, most (219,210; 76.6%)had only one. Of these, 153,624 (70.1%)had a HA. Of those having at least one EPC service, 95.7%had two services (most often a HA plus a CP). To date EPC activity has been concentrated among the elderly, gender patterns are similar, and few patients have received more than a single EPC service, which is usually a HA.

scholarly journals Methods and Effectiveness of Communication Between Hospital Allied Health and Primary Care Practitioners: a Systematic Narrative Review

2020 ◽  
Author(s):  
Jacinta Sheehan ◽  
Kate Laver ◽  
Anoo Bhopti ◽  
Miia Rahja ◽  
Tim Usherwood ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Health Professionals ◽  
Information Technologies ◽  
Allied Health ◽  
Allied Health Professionals ◽  
Multidisciplinary Communication ◽  
Gold Standard Method ◽  
Health Information Technologies ◽  
Primary Care Practitioners

Abstract Background There is a compelling rationale that effective communication between hospital allied health professionals and primary care practitioners could improve quality and continuity of patient care. It is not known which methods of communication are used, nor how effectively they facilitate the transition of care when a patient is discharged home from hospital. Our systematic review aims to investigate the methods and effectiveness of communication between hospital allied health professionals and primary care practitioners. Method Systematic review of quantitative and qualitative studies with narrative synthesis. Medline, CINAHL, EMBASE, PsycInfo and Proquest Nursing and Allied Health Sources were searched from January 2003 until January 2020 for studies that examined hospital allied health professionals communicating with primary care practitioners. Risk of bias in the different study designs were appraised using recognised tools and a content analysis conducted of the methodologies used. Results From the located 12,281 papers (duplicates removed), 24 studies met the inclusion criteria with hospital allied health professionals communicating in some form with primary care practitioners. There was, however, limited literature investigating the methods and/or the effectiveness of communication between hospital allied health professionals and primary care practitioners.Conclusion There is currently no 'gold standard' method or measure of communication between hospital allied health professionals and primary care practitioners. There is an urgent need to develop and evaluate multidisciplinary communication with enhanced health information technologies to improve collaboration across healthcare settings and facilitate continuity of integrated people-centred care.Registration: www.crd.york.uk PROSPERO CRD42019120410

scholarly journals Managing diabetes mellitus with comorbidities in primary healthcare facilities: a qualitative study among physicians in Odisha, India

2020 ◽  
Author(s):  
Sandipana Pati ◽  
Sanghamitra Pati ◽  
Marjan van den Akker ◽  
F. (François) G. Schellevis ◽  
Krushna Sahoo ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Care Delivery ◽  
Economic Status ◽  
Quality Care ◽  
Holistic Approach ◽  
Multidisciplinary Teams ◽  
Optimal Care ◽  
Allied Health Professionals ◽  
Healthcare Facilities

Abstract Aim To explore the perceived barriers and facilitators in the management of the patients having diabetes with comorbidities by primary care physicians.Methods A qualitative In-Depth Interview study was conducted among the primary care physicians at seventeen urban primary health care centres at Bhubaneswar city of Odisha, India. The digitally recorded interviews were transcribed verbatim and translated into English. The data were analysed using content analysis.Results Barriers related to physicians, patients and health system were identified. Physicians felt lack of necessary knowledge and skills, communication skills and overburdening due to multiple responsibilities to be major barriers to quality care. Patients’ attitude and beliefs along with socio-economic status played an important role in treatment adherence and in the management of their disease conditions. Poor infrastructure, irregular medicine supply, and shortage of skilled allied health professionals were also found to be barriers to optimal care delivery, as was the lack of electronic medical records and personal treatment records.Conclusion Comprehensive guidelines with on the job training for capacity building of the physicians and creation of multidisciplinary teams at primary care level for a more holistic approach towards management of diabetes with comorbidities could be the way forward to optimal delivery of care.

scholarly journals Uptake of health assessments, care plans and case conferences by general practitioners through the Enhanced Primary Care program between November 1999 and October 2001

2002 ◽  
Vol 25 (4) ◽  
pp. 1 ◽  
Author(s):  
David Wilkinson ◽  
Heather McElroy ◽  
Justin Beilby ◽  
Kathy Mott ◽  
Kay Price ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Health Assessment ◽  
Care Program ◽  
Care Plan ◽  
Steady Increase ◽  
Case Conference ◽  
Care Plans ◽  
Department Of Health ◽  
Primary Care Program

We aimed to describe the uptake of the Enhanced Primary Care (EPC) item numbers listed on the Medicare Benefits Schedule for health assessment (HA), care plan (CP) and case conference (CC) between November 1999 (when these items first became available) and October 2001. We used data provided by the Commonwealth Department of Health and Ageing. General practitioners rendered 371,409 EPC services in all. Most services were HA (225,353;61%), most of the remainder were CP (134,688;36%), and CC comprised the rest (11,368;3%). The number of HA done increased steadily and has stabilised at around 13,000 HA per month. Most CP done (80%) were in the community and with the GP preparing the plan. From a slow start, the number of CP done increased rapidly in 2001 to about 15,000 per month. There has been a slow and steady increase in the number of CC done each month, reaching 8-900 per month. Uptake of the EPC item numbers in the first two years of their availability has been rapid and has reached substantial levels, especially for HA and CP. The uptake of CC has been slower.

scholarly journals Meeting the Mental Health Needs of the Homebound: A Psychiatric Consult Service Within a Home-Based Primary Care Program

2015 ◽  
Vol 16 (3) ◽  
pp. 122-128 ◽  
Author(s):  
Jennifer M. Reckrey ◽  
Linda V. DeCherrie ◽  
Micheline Dugue ◽  
Anna Rosen ◽  
Theresa A. Soriano ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Care Program ◽  
Routine Care ◽  
Psychiatric Services ◽  
Depression And Anxiety ◽  
Care Plans ◽  
Home Based Primary Care ◽  
Home Based ◽  
Primary Care Program

The growing population of homebound adults increasingly receives home-based primary care (HBPC) services. These patients are predominantly frail older adults who are homebound because of multiple medical comorbidities, yet they often also have psychiatric diagnoses requiring mental health care. Unfortunately, in-home psychiatric services are rarely available to homebound patients. To address unmet psychiatric need among the homebound patients enrolled in our large academic HBPC program, we piloted a psychiatric in-home consultation service. During our 16-month pilot, 10% of all enrolled HBPC patients were referred for and received psychiatric consultation. Depression and anxiety were among the most common reasons for referral. To better meet patients’ medical and psychiatric needs, HBPC programs need to consider strategies to incorporate psychiatric services into their routine care plans.

scholarly journals General medical services by non-medical health professionals: a systematic quantitative review of economic evaluations in primary care

2019 ◽  
Vol 69 (682) ◽  
pp. e304-e313 ◽  
Author(s):  
Bethany F Anthony ◽  
Alun Surgey ◽  
Julia Hiscock ◽  
Nefyn H Williams ◽  
Joanna M Charles
Keyword(s):  
Primary Care ◽  
Systematic Reviews ◽  
Health Professionals ◽  
Allied Health ◽  
Cost Effective ◽  
Chronic Fatigue ◽  
Cochrane Library ◽  
Economic Evaluations ◽  
Economic Evidence ◽  
Allied Health Professionals

BackgroundPrevious systematic reviews have found that nurses and pharmacists can provide equivalent, or higher, quality of care for some tasks performed by GPs in primary care. There is a lack of economic evidence for this substitution.AimTo explore the costs and outcomes of role substitution between GPs and nurses, pharmacists, and allied health professionals in primary care.Design and settingA systematic review of economic evaluations exploring role substitution of allied health professionals in primary care was conducted. Role substitution was defined as ‘the substitution of work that was previously completed by a GP in the past and is now completed by a nurse or allied health professional’.MethodThe following databases were searched: Ovid MEDLINE, CINAHL, Cochrane Library, National Institute for Health and Care Excellence (NICE), and the Centre for Reviews and Dissemination. The review followed guidance from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).ResultsSix economic evaluations were identified. There was some limited evidence that nurse-led care for common minor health problems was cost-effective compared with GP care, and that nurse-led interventions for chronic fatigue syndrome and pharmacy-led services for the medicines management of coronary heart disease and chronic pain were not. In South Korea, community health practitioners delivered primary care services for half the cost of physicians. The review did not identify studies for other allied health professionals such as physiotherapists and occupational therapists.ConclusionThere is limited economic evidence for role substitution in primary care; more economic evaluations are needed.

scholarly journals Models of psychological service provision under Australia's Better Outcomes in Mental Health Care program

2006 ◽  
Vol 30 (3) ◽  
pp. 277 ◽  
Author(s):  
Jane Pirkis ◽  
Philip Burgess ◽  
Fay Kohn ◽  
Belinda Morley ◽  
Grant Blashki ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Health Professionals ◽  
Allied Health ◽  
Care Program ◽  
Local Context ◽  
Allied Health Professionals ◽  
Psychological Service ◽  
Health Care Program

The Access to Allied Psychological Services component of Australia?s Better Outcomes in Mental Health Care program enables eligible general practitioners to refer consumers to allied health professionals for affordable, evidence-based mental health care, via 108 projects conducted by Divisions of General Practice. The current study profiled the models of service delivery across these projects, and examined whether particular models were associated with differential levels of access to services. We found: � 76% of projects were retaining their allied health professionals under contract, 28% via direct employment, and 7% some other way; � Allied health professionals were providing services from GPs? rooms in 63% of projects, from their own rooms in 63%, from a third location in 42%; and � The referral mechanism of choice was direct referral in 51% of projects, a voucher system in 27%, a brokerage system in 24%, and a register system in 25%. Many of these models were being used in combination. No model was predictive of differential levels of access, suggesting that the approach of adapting models to the local context is proving successful.

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