Process to establish 11 primary contact allied health pathways in a public health service
Michelle Stute A C , Nicole Moretto A , Maree Raymer A , Merrilyn Banks A , Peter Buttrum A , Sonia Sam A , Marita Bhagwat A and Tracy Comans A B
+ Author Affiliations
- Author Affiliations
A Metro North Hospital and Health Service. Royal Brisbane and Women’s Hospital, Butterfield Street Herston, Qld 4006, Australia. Email: nicole.moretto@health.qld.gov.au; maree.raymer@health.qld.gov.au; merrilyn.banks@health.qld.gov.au; peter.buttrum@health.qld.gov.au; sonia.sam@health.qld.gov.au; marita.bhagwat@health.qld.gov.au
B Menzies Health Institute Queensland, Griffith University, The Circuit, Nathan Campus, Nathan, Qld 4111, Australia. Email: t.comans@griffith.edu.au
C Corresponding author. Email: michelle.stute@health.qld.gov.au
Australian Health Review 42(3) 258-265 https://doi.org/10.1071/AH16206
Submitted: 13 September 2016 Accepted: 17 March 2017 Published: 9 May 2017
Abstract
Objective Faced with longstanding and increasing demand for specialist out-patient appointments that was unable to be met through usual medical consultant led care, Metro North Hospital and Health Service in 2014–15 established 11 allied health primary contact out-patient models of care.
Methods The models involved six different allied health professions and nine specialist out-patient departments.
Results All the allied health models have been endorsed for continuation following demonstration of their contribution to managing demand on specialist out-patient services.
Conclusion This paper describes key features of the allied health primary contact models of care and presents preliminary data including new case throughput, effect on wait times and enablers and challenges for clinic establishment.
What is known about the topic? Allied health clinics have been demonstrated to result in high patient, referrer and consultant satisfaction, and are a cost-effective management strategy for wait list demand. In Queensland, physiotherapy-led orthopaedic clinics have been operating since 2005.
What does this paper add? This paper describes the establishment of 11 allied health primary contact models of care in speciality out-patient areas including Ear, Nose and Throat, Gynaecology, Urology, Neurology, Neurosurgery, Orthopaedics and Plastic Surgery, and involving speech pathologists, audiologists, physiotherapists, occupational therapists and podiatrists as primary contact practitioners. Observations of enablers for and challenges to implementation are presented as key lessons.
What are the implications for practitioners? The new allied health primary contact models of care described in this paper should be considered by health service executives, allied health leaders and specialist out-patient departments as one strategy to address unacceptably long specialist wait lists.
References
[1] Queensland Government. Waiting lists. 2016. Available at: https://www.qld.gov.au/health/services/hospital-care/waiting-lists/ [verified 15 March 2016].[2] Curtis AJ, Russell CO, Stoelwinder JU, McNeil JJ. Waiting lists and elective surgery; ordering the queue. Med J Aust 2010; 192 217–20.
[3] Ballini L, Negro A, Maltoni S, Vignatelli L, Flodgren G, Simera L, Holmes J, Grilli R. Interventions to reduce waiting times for elective procedures. Cochrane Database Syst Rev 2015;
| Interventions to reduce waiting times for elective procedures.Crossref | GoogleScholarGoogle Scholar |
[4] Thomas RE, Grimshaw JM, Mollison J, McClinton S, McIntosh E, Deans H, Repper J. Cluster randomized trial of a guidelines-based open access urological investigation service. Fam Pract 2003; 20 646–54.
| Cluster randomized trial of a guidelines-based open access urological investigation service.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2c%2FhsFeitQ%3D%3D&md5=e6163c47324f8544ef2578bf94992e4dCAS |
[5] Mallard SD, Leakeas T, Duncan WJ, Fleenor ME, Sinsky RJ. Same-day scheduling in a public health clinic: a pilot study. J Public Health Manag Pract 2004; 10 148–55.
| Same-day scheduling in a public health clinic: a pilot study.Crossref | GoogleScholarGoogle Scholar |
[6] Bibi Y, Cohen AD, Golfarb D, Rubinshtein E, Vardy DA. Intervention program to reduce waiting time of a dermatological visit: managed overbooking and service centralization as effective management tools. Int J Dermatol 2007; 46 830–4.
| Intervention program to reduce waiting time of a dermatological visit: managed overbooking and service centralization as effective management tools.Crossref | GoogleScholarGoogle Scholar |
[7] Allied Health Professions’ Office of Queensland. Ministerial Taskforce on health practitioner expanded scope of practice: final report. Brisbane: Queensland Government; 2014.
[8] O’Farrell S, Smart LM, Caffrey A, Daly O, Doody C. Orthopaedic triage at a physiotherapist-led ‘Musculoskeletal Assessment Clinic’: a seven-month service evaluation of outcomes. Ir J Med Sci 2014; 183 565–71.
| Orthopaedic triage at a physiotherapist-led ‘Musculoskeletal Assessment Clinic’: a seven-month service evaluation of outcomes.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2c3msVGisw%3D%3D&md5=6f6c01c97df16423f634d3074a267f15CAS |
[9] Razmjou H, Robarts S, Kennedy D, McKnight C, MacLeod A, Holtby R. Evaluation of an advanced-practice physical therapist in a specialty shoulder clinic: diagnostic agreement and effect on wait times. Physiother Can 2013; 65 46–55.
| Evaluation of an advanced-practice physical therapist in a specialty shoulder clinic: diagnostic agreement and effect on wait times.Crossref | GoogleScholarGoogle Scholar |
[10] Murphy S, Blake C, Power CK, Fullen BM. The role of clinical specialist physiotherapists in the management of low back pain in a spinal triage clinic. Ir J Med Sci 2013; 182 643–50.
| The role of clinical specialist physiotherapists in the management of low back pain in a spinal triage clinic.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3srjtVWnsg%3D%3D&md5=7b45ad0e190cf9f1db25d591a1062443CAS |
[11] Exton JP. Physiotherapy led clinic reduces orthopaedic spinal waitlist times – outcomes of a 6 month retrospective audit. NZ J Physiother 2010; 38 68–9.
[12] Blackburn MS, Cowan SM, Cary B, Nall C. Physiotherapy-led triage clinic for low back pain. Aust Health Rev 2009; 33 663–70.
| Physiotherapy-led triage clinic for low back pain.Crossref | GoogleScholarGoogle Scholar |
[13] Napier C, McCormack R, Hunt M, Brooks-Hill A. A physiotherapy triage service for orthopaedic surgery: an effective strategy for reducing wait times. Physiother Can 2013; 65 358–63.
| A physiotherapy triage service for orthopaedic surgery: an effective strategy for reducing wait times.Crossref | GoogleScholarGoogle Scholar |
[14] Burn D, Beeson E. Orthopaedic triage: cost effectiveness, diagnostic/surgical and management rates. Clin Gov Int J 2014; 19 126–36.
| Orthopaedic triage: cost effectiveness, diagnostic/surgical and management rates.Crossref | GoogleScholarGoogle Scholar |
[15] Wood L, Hendrick P, Boszczyk B, Dunstan E. A review of the surgical conversion rate and independent management of spinal extended scope practitioners in a secondary care setting. Ann R Coll Surg Engl 2016; 98 187–91.
| A review of the surgical conversion rate and independent management of spinal extended scope practitioners in a secondary care setting.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC28rnsl2rsA%3D%3D&md5=b073646bad455696040244264084eddcCAS |
[16] Homeming L, Kuipers P, Nihal A. Orthopaedic podiatry triage: process outcomes of a skill mix initiative. Aust Health Rev 2012; 36 457–60.
| Orthopaedic podiatry triage: process outcomes of a skill mix initiative.Crossref | GoogleScholarGoogle Scholar |
[17] Kasbekar AV, Mullin N, Morrow C, Youssef AM, Kay T, Lesser TH. Development of a physiotherapy-led balance clinic: the Aintree model. J Laryngol Otol 2014; 128 966–71.
| Development of a physiotherapy-led balance clinic: the Aintree model.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2M7pvFKjtQ%3D%3D&md5=6b59ffcadaa46ca84513927ca6d95af5CAS |
[18] Rose R, Probert S. Development and implementation of a hand therapy extended scope practitioner clinic to support the 18-week waiting list initiative. Hand Ther 2009; 14 95–104.
| Development and implementation of a hand therapy extended scope practitioner clinic to support the 18-week waiting list initiative.Crossref | GoogleScholarGoogle Scholar |
[19] Storey PA, Dear H, Bradley MJ, Couchman L, Burke FD. Audit of a therapist-led clinic for carpal tunnel syndrome in primary care. Br J Hand Ther 2008; 13 72–8.
[20] Bornhoft L, Larsson M, Thorn J. Physiotherapy in primary care triage – the effects on utilisation of medical services at primary health care clinics by patients and sub-groups of patients with musculoskeletal disorders: a case control study. Physiother Theory Pract 2015; 31 45–52.
| Physiotherapy in primary care triage – the effects on utilisation of medical services at primary health care clinics by patients and sub-groups of patients with musculoskeletal disorders: a case control study.Crossref | GoogleScholarGoogle Scholar |
[21] O’Brien L, Hardman A, Goldby S. The impact of a hand therapy screening and management clinic for patients referred for surgical opinion in an Australian public hospital. J Hand Ther 2013; 26 318–22.
| The impact of a hand therapy screening and management clinic for patients referred for surgical opinion in an Australian public hospital.Crossref | GoogleScholarGoogle Scholar |
[22] Comans T, Raymer M, O’Leary S, Smith D, Scuffham P. Cost-effectiveness of a physiotherapist-led service for orthopaedic outpatients. J Health Serv Res Policy 2014; 19 216–23.
| Cost-effectiveness of a physiotherapist-led service for orthopaedic outpatients.Crossref | GoogleScholarGoogle Scholar |
[23] Standfield L, Comans T, Raymer M, O’Leary S, Moretto N, Scuffham P. The efficiency of increasing the capacity of physiotherapy screening clinics or traditional medical services to address unmet demand in orthopaedic outpatients: a practical application of discrete event simulation with dynamic queuing. Appl Health Econ Health Policy 2016; 14 479–91.
| The efficiency of increasing the capacity of physiotherapy screening clinics or traditional medical services to address unmet demand in orthopaedic outpatients: a practical application of discrete event simulation with dynamic queuing.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC28bjtlOqtA%3D%3D&md5=fd10c2acf8f9089ae01e535d306e55baCAS |
[24] Lilje S, Persson U, Tangen S, Kasamoen S, Skillgate E. Costs and utilities of manual therapy and orthopedic standard care for low prioritized orthopedic outpatients of working age. A cost consequence analysis. Clin J Pain 2014; 30 730–6.
| Costs and utilities of manual therapy and orthopedic standard care for low prioritized orthopedic outpatients of working age. A cost consequence analysis.Crossref | GoogleScholarGoogle Scholar |
[25] Corbett A, Francis K. Participatory action research: a method to improve the management of health service delivery. Aust J Case Manage 2006; 7 10–13.
[26] Schoch PA, Adair L. Successfully reforming orthopaedic outpatients. Aust Health Rev 2012; 36 233–7.
| Successfully reforming orthopaedic outpatients.Crossref | GoogleScholarGoogle Scholar |
[27] Lee A, Jones G, Corcoran J, Premachandra P, Morrison G. A UK hospital based multidisciplinary balance clinic run by allied health professionals: first year results. J Laryngol Otol 2011; 125 661–7.
| A UK hospital based multidisciplinary balance clinic run by allied health professionals: first year results.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3MnitlWltQ%3D%3D&md5=47e6c7dcb0cac2cf864f3fab61c13484CAS |
[28] Habicht T, Habicht J, van Ginneken E. Health reform monitor: strategic purchasing reform in Estonia: reducing inequalities in access while improving care concentration and quality. Health Policy 2015; 119 1011–16.
| Health reform monitor: strategic purchasing reform in Estonia: reducing inequalities in access while improving care concentration and quality.Crossref | GoogleScholarGoogle Scholar |
[29] Hefford B, Holmes A. Booking systems for elective services: the New Zealand experience. Aust Health Rev 1999; 22 61–73.
| Booking systems for elective services: the New Zealand experience.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M%2Fgt1CqsQ%3D%3D&md5=fc7ef21872d561b5df4c14f2d995848cCAS |
[30] Matteson-Kome ML, Lopez KT, Sliger AD, Mathews MJ, Bechtold ML. Improving care access for new patients in an outpatient gastroenterology clinic: a novel approach. Mo Med 2014; 111 512–15.
[31] Stainkey L, Leidl I, Johnson A, Tulloch G, Pain T. The challenge of long waiting lists: how we implemented a GP referral system for non-urgent specialist’ appointments at an Australian public hospital. BMC Health Serv Res 2010; 10 303–8.
| The challenge of long waiting lists: how we implemented a GP referral system for non-urgent specialist’ appointments at an Australian public hospital.Crossref | GoogleScholarGoogle Scholar |
[32] Maddison P, Jones J, Breslin A, Barton C, Fleur J, Lewis R, McSweeney L, Norgain C, Smith S, Thomas C, Tilson C. Improved access and targeting of musculoskeletal services in northwest Wales: targeted early access to musculoskeletal services (TEAMS) program. BMJ 2004; 329 1325–7.
| Improved access and targeting of musculoskeletal services in northwest Wales: targeted early access to musculoskeletal services (TEAMS) program.Crossref | GoogleScholarGoogle Scholar |
[33] Tan S, Mays N. Impact of initiatives to improve access to, and choice of, primary and urgent care in England: a systematic review. Health Policy 2014; 118 304–15.
| Impact of initiatives to improve access to, and choice of, primary and urgent care in England: a systematic review.Crossref | GoogleScholarGoogle Scholar |
[34] Queensland Government. Salary and remuneration. Available at: https://www.health.qld.gov.au/employment/conditions/salary/default.asp [verified 29 July 2016].
