Register      Login
Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
Shopping Cart: ( empty )
You are here: Home > Journals > AH > AH15044
RESEARCH ARTICLE
Contents Vol 40(2)

Allied health: integral to transforming health

Lucylynn Lizarondo A C , Catherine Turnbull B , Tracey Kroon B , Karen Grimmer A , Alison Bell A , Saravana Kumar A , Maureen McEvoy A , Steve Milanese A , Mary Russell A , Lorraine Sheppard A , Julie Walters A and Louise Wiles A
+ Author Affiliations
- Author Affiliations

A International Centre for Allied Health Evidence (iCAHE), P4–18 City East Campus, University of South Australia, Adelaide, SA 5001, Australia. Email: karen.grimmer@unisa.edu.au; Alison.Bell@unisa.edu.au; Saravana.Kumar@unisa.edu.au; Maureen.McEvoy@unisa.edu.au; steve.milanese@unisa.edu.au; Mary.Russell@unisa.edu.au; lorraine.sheppard@unisa.edu.au; julie.walters@unisa.edu.au; Louise.Wiles@unisa.edu.au

B Allied & Scientific Health Office (ASHO), SA Health, Level 5, 11 Hindmarsh Square, Adelaide, SA 5000, Australia. Email: catherine.turnbull@health.sa.gov.au; Tracey.Kroon2@health.sa.gov.au

C Corresponding author. Email: lucylynn.lizarondo@adelaide.edu.au

Australian Health Review 40(2) 194-204 https://doi.org/10.1071/AH15044
Submitted: 13 March 2015  Accepted: 26 May 2015   Published: 27 July 2015

Abstract

Objective South Australia is taking an innovative step in transforming the way its healthcare is organised and delivered to better manage current and future demands on the health system. In an environment of transforming health services, there are clear opportunities for allied health to assist in determining solutions to various healthcare challenges. A recent opinion piece proposed 10 clinician-driven strategies to assist in maximising value and sustainability of healthcare in Australia. The present study aimed to seek the perspectives of allied health clinicians, educators, researchers, policy makers and managers on these strategies and their relevance to allied health.

Methods A survey of allied health practitioners was undertaken to capture their perspectives on the 10 clinician-driven strategies for maximising value and sustainability of healthcare in Australia. Survey findings were then layered with evidence from the literature.

Results Highly relevant across allied health are the strategies of discontinuation of low value practices, targeting clinical interventions to those getting greatest benefit, active involvement of patients in shared decision making and self-management and advocating for integrated systems of care.

Conclusions Allied health professionals have been involved in the South Australian healthcare system for a prolonged period, but their services are poorly recognised, often overlooked and not greatly supported in existing traditional practices. The results of the present study highlight ways in which healthcare services can implement strategies not only to improve the quality of patient outcomes, but also to offer innovative solutions for future, sustainable healthcare. The findings call for concerted efforts to increase the utilisation of allied health services to ensure the ‘maximum value for spend’ of the increasingly scarce health dollar.

What is known about the topic? In medicine, clinician-driven strategies have been proposed to minimise inappropriate and costly care and maximise highly appropriate and less expensive care. These strategies were developed based on clinical experiences and with supporting evidence from scientific studies.

What does this paper add? Major changes to the health system are required to slow down the growth in healthcare expenditure. This paper describes opportunities in which allied health practitioners can implement similar strategies not only to improve the quality of patient outcomes, but also to offer cost-effective solutions for a sustainable healthcare.

What are the implications for practitioners? Allied health practitioners can provide solutions to healthcare challenges and assist in the transformation of healthcare in Australia. However, for this to happen, there should be concerted efforts to increase recognition of and support for the use of allied health services.


References

[1]  Department for Health and Ageing. Transforming health. Adelaide: Government of South Australia; 2014.

[2]  Department for Health and Ageing. Transforming health discussion paper. Adelaide: Government of South Australia; 2014.

[3]  Australian Bureau of Statistics. Population projections Australia 2012–2101. Canberra: ABS; 2013.

[4]  Oldsberg D, Winters M. Ageing in place: intergenerational and intrafamilial housing transfers and shifts in later life. AHURI Res Policy Bull 2005; October 67

[5]  Productivity Commission. An ageing Australia: preparing for the future. Commission research paper overview. Canberra: Media and Publications Productivity Commission; 2013.

[6]  Grimmer K, Lizarondo L, Kumar S, Bell E, Buist M, Weinstein P. An evidence-based framework to measure quality of allied health care. Health Res Policy Syst 2014; 12 10
| An evidence-based framework to measure quality of allied health care.Crossref | GoogleScholarGoogle Scholar | 24571857PubMed |

[7]  Turnbull C, Grimmer-Somers K, Kumar S, May S, Law D, Ashworth E. Allied, scientific and complementary health professionals: a new model for Australian allied health. Aust Health Rev 2009; 33 27–37.
| Allied, scientific and complementary health professionals: a new model for Australian allied health.Crossref | GoogleScholarGoogle Scholar | 19203331PubMed |

[8]  McWhinnie C. Allied health in primary care. 2014. Available at: http://www.nbmml.com.au/Allied-Health/Allied-Health-Support/Allied-Health-in-Primary-Care.aspx [verified 19 June 2015].

[9]  Australian Medicare Local Alliance. Australian Medicare Local Alliance response to the Australian Government’s National Commission of Audit. Canberra: Australian Medicare Local Alliance; 2013.

[10]  Scott I. Ten clinician-driven strategies for maximising value of Australian health care. Aust Health Rev 2014; 38 125–33.
| Ten clinician-driven strategies for maximising value of Australian health care.Crossref | GoogleScholarGoogle Scholar | 24820956PubMed |

[11]  Park ES, Rha D. Botulinum toxin type A injection for management of upper limb spasticity in children with cerebral palsy: a literature review. Yonsei Med J 2006; 47 589–603.
| Botulinum toxin type A injection for management of upper limb spasticity in children with cerebral palsy: a literature review.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD28Xht12qsr%2FM&md5=79501f0c63f3387bfcb4bd40f852f1c7CAS | 17066503PubMed |

[12]  Yelnik AP, Simon O, Parratte B, Gracies JM. How to clinically assess and treat muscle overactivity in spastic paresis. J Rehabil Med 2010; 42 801–7.
| How to clinically assess and treat muscle overactivity in spastic paresis.Crossref | GoogleScholarGoogle Scholar | 20878038PubMed |

[13]  Canavan A, Arant BS. Diagnosis and management of dehydration in children. Am Fam Physician 2009; 80 692–6.
| 19817339PubMed |

[14]  Wittenbrook W. Nutritional assessment and intervention in cerebral palsy. Pract Gastroenterol 2011; 92 16–32.

[15]  Graybeal C. Strengths-based social work assessment: transforming the dominant paradigm. Fam Soc 2001; 82 233–42.
| Strengths-based social work assessment: transforming the dominant paradigm.Crossref | GoogleScholarGoogle Scholar |

[16]  Harkness D. The diagnosis of mental disorders in clinical social work: a review of standards of care. Clin Soc Work J 2011; 39 223–31.

[17]  van der Windt DAWM, van der Heijden GJMG, van den Berg SGM, ter Riet G, de Winter AF, Boutera LM. Ultrasound therapy for musculoskeletal disorders: a systematic review. Pain 1999; 81 257–71.
| Ultrasound therapy for musculoskeletal disorders: a systematic review.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1MzlvVKlsg%3D%3D&md5=bee24baa44eb2d7fe10998e4d9002c17CAS |

[18]  Nnoaham KE, Kumbang J. Transcutaneous electrical nerve stimulation (TENS) for chronic pain. Cochrane Database Syst Rev 2008; 3 CD003222
| Transcutaneous electrical nerve stimulation (TENS) for chronic pain.Crossref | GoogleScholarGoogle Scholar | 18646088PubMed |

[19]  Ng SSM, Hui-Chan CWY. Transcutaneous electrical nerve stimulation combined with task-related training improves lower limb functions in subjects with chronic stroke. Stroke 2007; 38 2953–9.
| Transcutaneous electrical nerve stimulation combined with task-related training improves lower limb functions in subjects with chronic stroke.Crossref | GoogleScholarGoogle Scholar |

[20]  Todd J, Schmidt M, Christian J, Williams R. The low-bacteria diet for immunocompromised patients. Cancer Pract 1999; 7 205–7.
| The low-bacteria diet for immunocompromised patients.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c7lt1ajsA%3D%3D&md5=8ffa37291df997304c8ecf7128815a30CAS | 10687586PubMed |

[21]  van Dalen EC, Mank A, Leclercq E, Mulder RL, Davies M, Kersten MJ, van de Wetering MD. Low bacterial diet versus control diet to prevent infection in cancer patients treated with chemotherapy causing episodes of neutropenia. Cochrane Database Syst Rev 2012; 9 CD006247
| Low bacterial diet versus control diet to prevent infection in cancer patients treated with chemotherapy causing episodes of neutropenia.Crossref | GoogleScholarGoogle Scholar | 22972091PubMed |

[22]  Jubelirer SJ. The benefit of the neutropenic diet: fact or fiction? Oncologist 2011; 16 704–7.
| The benefit of the neutropenic diet: fact or fiction?Crossref | GoogleScholarGoogle Scholar | 21471277PubMed |

[23]  Bennett S, Tooth L, McKenna K, Rodger S, Strong J, Ziviani J, Mickan S, Gibson L. Perceptions of evidence-based practice: a survey of Australian occupational therapists. Aust Occup Ther J 2003; 50 13–22.
| Perceptions of evidence-based practice: a survey of Australian occupational therapists.Crossref | GoogleScholarGoogle Scholar |

[24]  Iles R, Davidson M. Evidence based practice: a survey of physiotherapists’ current practice. Physiother Res Int 2006; 11 93–103.
| Evidence based practice: a survey of physiotherapists’ current practice.Crossref | GoogleScholarGoogle Scholar | 16808090PubMed |

[25]  Jette DU, Bacon K, Batty C, Carlson M, Ferland A, Hemingway RD, Hill JC, Ogilive L, Volk D. Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists. Phys Ther 2003; 83 786–805.
| 12940766PubMed |

[26]  McEvoy M, Williams M, Olds T, Lewis L, Petkov J. Evidence-based practice profiles of physiotherapists transitioning into the workforce: a study of two cohorts. BMC Med Educ 2011; 11 100–9.
| Evidence-based practice profiles of physiotherapists transitioning into the workforce: a study of two cohorts.Crossref | GoogleScholarGoogle Scholar | 22126299PubMed |

[27]  Metcalfe C, Lewin R, Wisher S, Perry S, Bannigan K, Klaber Moffett J. Barriers to implementing the evidence base in four NHS therapies. Physiotherapy 2001; 87 433–41.
| Barriers to implementing the evidence base in four NHS therapies.Crossref | GoogleScholarGoogle Scholar |

[28]  Döpp CME, Graff MJL, Rikkert MGMO, Nijhuis van der Sanden MWG, Vernooij-Dassen MJFJ. Determinants for the effectiveness of implementing an occupational therapy intervention in routine dementia care. Implement Sci 2013; 8 131
| Determinants for the effectiveness of implementing an occupational therapy intervention in routine dementia care.Crossref | GoogleScholarGoogle Scholar |

[29]  Hanekom S, Louw QA, Coetzee AR. Implementation of a protocol facilitates evidence-based physiotherapy practice in intensive care units. Physiotherapy 2013; 99 139–45.
| Implementation of a protocol facilitates evidence-based physiotherapy practice in intensive care units.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3s7ps1Chuw%3D%3D&md5=7292165512387ea6550c2403e6cc7ae8CAS | 23219640PubMed |

[30]  van der Wees PJ, Jamtvedt G, Rebbeck T, de Bie RA, Dekker J, Hendriks EJ. Multifaceted strategies may increase implementation of physiotherapy clinical guidelines: a systematic review. Aust J Physiother 2008; 54 233–41.
| Multifaceted strategies may increase implementation of physiotherapy clinical guidelines: a systematic review.Crossref | GoogleScholarGoogle Scholar | 19025503PubMed |

[31]  Farag I, Sherrington C, Ferreira M, Howard K. A systematic review of the unit costs of allied health and community services used by older people in Australia. BMC Health Serv Res 2013; 13 69
| A systematic review of the unit costs of allied health and community services used by older people in Australia.Crossref | GoogleScholarGoogle Scholar | 23421756PubMed |

[32]  O’Brien BJ, Drummond MF, Labelle R, Willan A. In search of power and significance: issues in the design and analysis of stochastic cost-effectiveness studies in health care. Med Care 1994; 32 150–63.
| In search of power and significance: issues in the design and analysis of stochastic cost-effectiveness studies in health care.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2c7jtlOrtA%3D%3D&md5=4766a7cfbdf8e608f1dd1296c34dce66CAS | 8302107PubMed |

[33]  Sargent-Cox K, Butterworth P, Anstey KJ. The global financial crisis and psychological health in a sample of Australian older adults: a longitudinal study. Soc Sci Med 2011; 73 1105–12.
| The global financial crisis and psychological health in a sample of Australian older adults: a longitudinal study.Crossref | GoogleScholarGoogle Scholar | 21831493PubMed |

[34]  Franek J. Self-management support interventions for persons with chronic disease: an evidence based analysis. Ont Health Technol Assess Ser 2013; 13 1–60.
| 1:STN:280:DC%2BC2c7jsVaisQ%3D%3D&md5=d6a1b2c5c5f41c88c6cf6a5d03038a19CAS | 24194800PubMed |

[35]  Saxon RL, Gray MA, Oprescu FI. Extended roles for allied health professionals: an updated systematic review of the evidence. J Multidiscip Healthc 2014; 7 479–88.
| Extended roles for allied health professionals: an updated systematic review of the evidence.Crossref | GoogleScholarGoogle Scholar | 25342909PubMed |

[36]  Davis A, Smith PA, Booth M, Martin M. Diagnosing patients with age-related hearing loss and tinnitus: supporting GP clinical engagement through innovation and pathway redesign in audiology services. Int J Otolaryngol 2012; 2012 1–5.
| Diagnosing patients with age-related hearing loss and tinnitus: supporting GP clinical engagement through innovation and pathway redesign in audiology services.Crossref | GoogleScholarGoogle Scholar |

[37]  Halkett G, Ciccarelli M, Keesing S, Aoun S. Occupational therapy in palliative care: is it underutilised in Western Australia. Aust Occup Ther J 2010; 57 301–9.
| Occupational therapy in palliative care: is it underutilised in Western Australia.Crossref | GoogleScholarGoogle Scholar | 20868419PubMed |

[38]  Kasven-Gonzalez N, Souverain R, Miale S. Improving quality of life through rehabilitation in palliative care: case report. Palliat Support Care 2010; 8 359–69.
| Improving quality of life through rehabilitation in palliative care: case report.Crossref | GoogleScholarGoogle Scholar | 20875180PubMed |

[39]  Pearson E, Todd J, Futcher J. How can occupational therapists measure outcomes in palliative care. Palliat Med 2007; 21 477–85.
| How can occupational therapists measure outcomes in palliative care.Crossref | GoogleScholarGoogle Scholar | 17846087PubMed |

[40]  Rexe K, Lammi BM, von Zweck C. Occupational therapy: cost-effective solutions for changing health system needs. Healthc Q 2013; 16 69–75.
| 24863311PubMed |

[41]  Bicego D, Brown K, Ruddick M, Storey D, Wong C, Harris SR. Exercise for women with or at risk for breast cancer-related lymphedema. Phys Ther 2006; 86 1398–405.
| Exercise for women with or at risk for breast cancer-related lymphedema.Crossref | GoogleScholarGoogle Scholar | 17012644PubMed |

[42]  Clay CA, Perera S, Wagner JM, Miller ME, Nelson JB, Greenspan SL. Physical function in men with prostate cancer on androgen deprivation therapy. Phys Ther 2007; 87 1325–33.
| Physical function in men with prostate cancer on androgen deprivation therapy.Crossref | GoogleScholarGoogle Scholar | 17684084PubMed |

[43]  Keays KS, Harris SR, Lucyshyn JM, MacIntyre DL. Effects of Pilates exercise on shoulder range of motion, pain, mood, and upper extremity function in women living with breast cancer: a pilot study. Phys Ther 2008; 88 494–510.
| Effects of Pilates exercise on shoulder range of motion, pain, mood, and upper extremity function in women living with breast cancer: a pilot study.Crossref | GoogleScholarGoogle Scholar | 18218823PubMed |

[44]  Kumar SP, Jim A. Physical therapy in palliative care: from symptom control to quality of life: a critical review. Indian J Palliat Care 2010; 16 138–46.
| Physical therapy in palliative care: from symptom control to quality of life: a critical review.Crossref | GoogleScholarGoogle Scholar | 21218003PubMed |

[45]  Narayanan V, Koshy C. Fatigue in cancer: a review of literature. Indian J Palliat Care 2009; 15 19–25.
| Fatigue in cancer: a review of literature.Crossref | GoogleScholarGoogle Scholar | 20606851PubMed |

[46]  Santiago-Palma J, Payne R. Palliative care and rehabilitation. Cancer 2001; 92 1049–52.
| Palliative care and rehabilitation.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MvnsFaltg%3D%3D&md5=a6d46ae3aec904570a0c039343050547CAS | 11519032PubMed |

[47]  Watson T, Mock V. Exercise as an intervention in cancer-related fatigue. Phys Ther 2004; 84 736–43.
| 15283624PubMed |

[48]  McCaffrey N, Agar M, Harlum J, Karnon J, Currow D, Eckermann S. Is home-based palliative care cost-effective? An economic evaluation of the Palliative Care Extended Packages at Home (PEACH) pilot. BMJ Support Palliat Care 2013; 3 431–5.
| Is home-based palliative care cost-effective? An economic evaluation of the Palliative Care Extended Packages at Home (PEACH) pilot.Crossref | GoogleScholarGoogle Scholar | 24950523PubMed |

[49]  Bainbridge LA, Harris SR. Informed shared decision-making: a model for physical therapy education and practice. Physiother Can 2006; 58 74–81.
| Informed shared decision-making: a model for physical therapy education and practice.Crossref | GoogleScholarGoogle Scholar |

[50]  Desroches S, Gagnon MP, Tapp S, Légaré F. Implementing shared decision-making in nutrition clinical practice: a theory-based approach and feasibility study. Implement Sci 2008; 3 1–7.

[51]  Department of Human Services and Department of Education and Early Childhood Development. Family-centred, person-centred allied health: a guide for practitioners in private practice, schools and clinical settings. Melbourne: State Government of Victoria; 2012.

[52]  Richardson J, Loyola-Sanchez A, Sinclair S, Harris J, Letts L, MacIntyre NJ, Wilkins S, Burgos-Martinez G, Wishart L, McBay C, Martin Ginis K. Self-management interventions for chronic disease: a systematic scoping review. Clin Rehabil 2014; 28 1067–77.
| 24784031PubMed |

[53]  Ermel S, Parker C. Allied health assistant: remote supervision workforce model. In: Conference Handbook; 7–10 April 2013; Adelaide Convention Centre, South Australia, Australia. National Rural Health Alliance; 2013. P. 170.

[54]  NSW Ministry of Health. Allied health assistant framework. North Sydney: Ministry of Health; 2013.

[55]  Arendts G, Fitzhardinge S, Pronk K, Donaldson M, Hutton M, Nagree Y. The impact of early emergency department allied health intervention on admission rates in older people: a non-randomized clinical study. BMC Geriatr 2012; 12 1–6.

[56]  Beck E, Carrie M, Lambert K, Mason S, Milosavljevic M. Implementation of malnutrition screening and assessment by dietitians: malnutrition exists in acute and rehabilitation settings. Aust J Nutr Diet 2001; 58 92–7.

[57]  Chaw E, Shem K, Castillo K, Wong SL, Chang J. Dysphagia and associated respiratory considerations in cervical spinal cord injury. Top Spinal Cord Inj Rehabil 2012; 18 291–9.
| Dysphagia and associated respiratory considerations in cervical spinal cord injury.Crossref | GoogleScholarGoogle Scholar | 23459678PubMed |

[58]  Youssef A, Alharthi H, Al Khaldi O, Alnaimi F, Alsubaie N, Alfariss N. Effectiveness of text message reminders on nonattendance of outpatient clinic appointments in three different specialties: a randomized controlled trial in a Saudi Hospital. J Taibah Univ Med Sci 2014; 9 23–9.
| Effectiveness of text message reminders on nonattendance of outpatient clinic appointments in three different specialties: a randomized controlled trial in a Saudi Hospital.Crossref | GoogleScholarGoogle Scholar |

[59]  Lim LS, Varkey P. E-mail reminders: a novel method to reduce outpatient clinic nonattendance. Internet J Health Admin 2004; 3 1

[60]  Paul-Ebhohimhen V, Avenell A. A systematic review of the effectiveness of group versus individual treatments for adult obesity. Obes Facts 2009; 2 17–24.
| A systematic review of the effectiveness of group versus individual treatments for adult obesity.Crossref | GoogleScholarGoogle Scholar | 20054200PubMed |

[61]  Reeves S, Zwarenstein M, Goldman J, Barr H, Freeth D, Hammick M, Koppel I. Interprofessional education: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2008; 1 CD002213
| Interprofessional education: effects on professional practice and health care outcomes.Crossref | GoogleScholarGoogle Scholar | 18254002PubMed |

[62]  Hakkennes S, Dodd K. Guideline implementation in allied health professions: a systematic review of the literature. Qual Saf Health Care 2008; 17 296–300.
| Guideline implementation in allied health professions: a systematic review of the literature.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1cvpslKgsA%3D%3D&md5=a60558abd2d57c08768e998766e1f633CAS | 18678729PubMed |

[63]  Scott SD, Albrecht L, O’Leary K, Ball G, Hartling L, Hofmeyer A, Allyson Jones C, Klassen TP, Kovacs Burns K, Newton AS, Thompson D, Dryden DM. Systematic review of knowledge translation strategies in the allied health professions. Implement Sci 2012; 7 70
| Systematic review of knowledge translation strategies in the allied health professions.Crossref | GoogleScholarGoogle Scholar | 22831550PubMed |

[64]  Greenfield D, Braithwaite J. Health sector accreditation research: a systematic review. Int J Qual Health Care 2008; 20 172–83.
| Health sector accreditation research: a systematic review.Crossref | GoogleScholarGoogle Scholar | 18339666PubMed |

[65]  Powell Davies G, Williams AM, Larsen K, Perkins D, Roland M, Harris MF. Coordinating primary health care: an analysis of the outcomes of a systematic review. Med J Aust 2008; 188 S65–8.
| 18429740PubMed |

[66]  Bywood PT, Jackson-Bowers E, Muecke S. Initiatives to integrate primary and acute health care, including ambulatory care services. Policy issue review. Adelaide: Primary Health Care Research & Information Service; 2011.

[67]  Gholve PA, Kosygan KP, Sturdee SW, Faraj AA. Multidisciplinary integrated care pathway for fractured neck of femur. A prospective trial with improved outcome. Injury 2005; 36 93–8.
| 1:STN:280:DC%2BD2cnitlOqsg%3D%3D&md5=6ad96ecea1b09e40165ae87590a311e4CAS | 15589925PubMed |

[68]  Grimmer-Somers K, Dolejs W, Atkinson J, Worley A. Integrated GP and allied health care for patients with type 2 diabetes. Aust Fam Physician 2008; 37 774–9.
| 18797537PubMed |

[69]  Allied Health Professions Australia. Policy paper: Australia’s workforce of allied health professionals. Melbourne: Allied Health Profession; 2013.