Allied health primary contact services: results of a 2-year follow-up study of clinical effectiveness, safety, wait times and impact on medical specialist out-patient waitlists
Michelle Stute A C , Nicole Moretto B , Rebecca Waters A , Maree Raymer A , Sonia Sam A , Marita Bhagwat A , Merrilyn Banks A , Tracy Comans
B and Peter Buttrum A
+ Author Affiliations
- Author Affiliations
A Metro North Hospital and Health Service, Butterfield Street, Herston, Qld 4029, Australia. Email: rebecca.waters@health.qld.gov.au; maree.raymer@health.qld.gov.au; sonia.sam@health.qld.gov.au; Marita.Bhagwat@health.qld.gov.au; merrilyn.banks@health.qld.gov.au; peter.buttrum@health.qld.gov.au
B Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital Campus, Woolloongabba, Qld 4102, Australia. Email: n.moretto@uq.edu.au; t.comans@uq.edu.au
C Corresponding author. Email: michelle.stute@health.qld.gov.au
Australian Health Review 45(3) 344-352 https://doi.org/10.1071/AH19225
Submitted: 8 October 2019 Accepted: 25 August 2020 Published: 4 December 2020
Abstract
Objective Long specialist out-patient waitlists are common in public health facilities, but not all patients require consultation with a medical specialist. Studies of single allied health primary contact services have shown they provide timely, appropriate care and reduce demand on medical specialist out-patient waitlists. This study evaluated the collective benefits across multiple allied health primary contact services and models to determine their clinical effectiveness, safety, timeliness of care and impact on medical specialist out-patient waitlists.
Method Using a prospective observational study design, data were collected and analysed for patients attending 47 allied health primary contact services in Queensland public hospitals over a 2-year period. Outcomes reported are global status, adverse events, wait times and impact on medical specialist out-patient waitlists.
Results In all, 10 634 patients were managed in and discharged from the allied health services. Most adult patients (80%) who attended at least two consultations reported an improvement in health status. No adverse events were attributed to the model of care. Approximately 68%, 44% and 90% of urgent, semi-urgent and non-urgent out-patients respectively were seen within clinically recommended time frames. Between 35% and 89% of patients were removed from out-patient waitlists without medical specialist consultation across the service models.
Conclusions Allied health primary contact services provide safe, effective and timely care. The impact on medical specialist out-patient waitlists varied depending on service model and pathway characteristics.
What is known about this topic? Most studies of allied health primary contact services have focused on the management of patients on orthopaedic specialist out-patient waitlists by a physiotherapist. These studies of either individual services or groups of services with the same model cite benefits, including reduced waiting times, high levels of patient and referrer satisfaction, improved conversion to surgery, cost-effectiveness and more effective utilisation of medical specialists.
What does this paper add? This paper highlights that, collectively, allied health primary contact services are safe, effective and provide timely care. The proportion of patients independently managed and removed from various medical specialist out-patient waitlists and the services involved are reported, demonstrating the variety of service models. This study reports outcomes for primary contact services for which there is a dearth of published literature, including dietician services for patients on gastroenterology waitlists, speech pathology and audiology services for patients on ear, nose and throat waitlists, occupational therapy hand services for patients on orthopaedic waitlists and physiotherapy led pelvic-health services for patients on gynaecology waitlists. Possibilities for efficiency gains are identified and discussed.
What are the implications for practitioners? Health service managers should consider allied health primary contact services as a viable option to increase specialist out-patient capacity. Service model characteristics that maximise impact on medical specialist out-patient waitlist management are highlighted to inform resource allocation.
Keywords: allied health led services, allied health primary contact, alternative outpatient pathway, chronic disease management, clinical pathways, models of care.
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