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Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

Allied health are key to improving health for people with chronic disease: but where are the outcomes and where is the strategy?

Sarah Dennis A B E , Lauren Ball C , Mark Harris D and Kathryn Refshauge A
+ Author Affiliations
- Author Affiliations

A Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia.

B South West Sydney Local Health District, Liverpool, NSW 2170, Australia.

C Menzies Health Institute – Centre for Health Practice Innovation, Gold Coast Campus, Griffith University, Qld 4222, Australia.

D Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2052, Australia.

E Corresponding author. Email: sarah.dennis@sydney.edu.au

Australian Journal of Primary Health 27(6) 437-441 https://doi.org/10.1071/PY21076
Submitted: 7 April 2021  Accepted: 1 October 2021   Published: 26 November 2021

Abstract

The global burden of chronic disease has forced health systems to focus on improved care. This has led to improved health outcomes for some populations, but not for all people or for all conditions. The rising prevalence of chronic disease has also significantly increased demands on healthcare systems, with unsustainable costs to funders. To improve health and social outcomes for all people with chronic disease, it is critical to embrace allied health professionals as key members of primary healthcare teams. The recognised efficacy and cost-effectiveness of many allied health interventions suggest that implementation into usual care would result in enhanced outcomes for people accessing healthcare, their families and communities, and for health systems. Our aim is to highlight the current unacceptable lack of allied health integration into primary healthcare teams, and illustrate the potential value of improved and equitable access to allied health professionals for managing chronic conditions and multimorbidity.

Keywords: allied health, primary care, chronic conditions, multidisciplinary team care, equity, access, hospital avoidance, integration.


References

Atsou K, Crequit P, Chouaid C, Hejblum G (2016) Simulation-based estimates of the effectiveness and cost-effectiveness of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease in France. PLoS One 11, e0156514
Simulation-based estimates of the effectiveness and cost-effectiveness of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease in France.Crossref | GoogleScholarGoogle Scholar | 27327159PubMed |

Australian Institute of Health and Welfare (2018a) Admitted patient care 2016–17: Australian hospital statistics. Health services series no. 84, Catalogue no. HSE 201. AIHW, Canberra, ACT, Australia

Australian Institute of Health and Welfare (2018b) Australia’s health 2018. Australia’s health series no. 16. AUS 221. AIHW, Canberra, ACT, Australia.

Australian Institute of Health and Welfare (2019) Developing a National Primary Health Care Data Asset: consultation report. AIHW, Canberra, ACT, Australia.

Australian Institute of Health and Welfare (2020) Australia’s health 2020. AIHW, Canberra, ACT, Australia.

Barr ML, Welberry H, Comino EJ, Harris-Roxas BF, Harris E, Lloyd J, Whitney S, O’Connor C, Hall J, Harris MF (2019) Understanding the use and impact of allied health services for people with chronic health conditions in Central and Eastern Sydney, Australia: a five-year longitudinal analysis. Primary Health Care Research and Development 20, e141

Bonciani M, Schäfer W, Barsanti S, Heinemann S, Groenewegen PP (2018) The benefits of co-location in primary care practices: the perspectives of general practitioners and patients in 34 countries. BMC Health Services Research 18, 132
The benefits of co-location in primary care practices: the perspectives of general practitioners and patients in 34 countries.Crossref | GoogleScholarGoogle Scholar | 29466980PubMed |

Brown JA, Lee P, Ball L (2016) Time and financial outcomes of private practice dietitians providing care under the Australian Medicare program: a longitudinal, exploratory study. Nutrition & Dietetics: the Journal of the Dietitians Association of Australia 73, 296–302.
Time and financial outcomes of private practice dietitians providing care under the Australian Medicare program: a longitudinal, exploratory study.Crossref | GoogleScholarGoogle Scholar |

Cameron ID, Fairhall N, Langron C, Lockwood K, Monaghan N, Aggar C, et al (2013) A multifactorial interdisciplinary intervention reduces frailty in older people: randomized trial. BMC Medicine 11, 65
A multifactorial interdisciplinary intervention reduces frailty in older people: randomized trial.Crossref | GoogleScholarGoogle Scholar | 23497404PubMed |

Cant RP (2010) Patterns of delivery of dietetic care in private practice for patients referred under Medicare Chronic Disease Management: results of a national survey. Australian Health Review 34, 197–203.
Patterns of delivery of dietetic care in private practice for patients referred under Medicare Chronic Disease Management: results of a national survey.Crossref | GoogleScholarGoogle Scholar | 20497733PubMed |

Cant R, Ball L (2015) Decade of Medicare: the contribution of private practice dietitians to chronic disease management and diabetes group services. Nutrition & Dietetics 72, 284–290.
Decade of Medicare: the contribution of private practice dietitians to chronic disease management and diabetes group services.Crossref | GoogleScholarGoogle Scholar |

Chartered Society of Physiotherapy (2018) Allied health professionals are key to sustainable general practice, King’s Fund hears [News Item]. Available at https://www.csp.org.uk/news/2018-06-19-allied-health-professionals-are-key-sustainable-general-practice-kings-fund-hears [Verified 19 June 2018]

Dennis S (2016) Secondary prevention of chronic health conditions in patients with multimorbidity: what can physiotherapists do? Journal of Comorbidity 6, 50–52.
Secondary prevention of chronic health conditions in patients with multimorbidity: what can physiotherapists do?Crossref | GoogleScholarGoogle Scholar | 29090173PubMed |

Dennis S, Watts I, Pan Y, Britt H (2017) Who do Australian general practitioners refer to physiotherapy? Australian Family Physician 46, 421–426.

Foster MM, Mitchell GK (2015) ‘The onus is on me’: primary care patient views of Medicare-funded team care in chronic disease management in Australia. Health Expectations 18, 879–891.
‘The onus is on me’: primary care patient views of Medicare-funded team care in chronic disease management in Australia.Crossref | GoogleScholarGoogle Scholar | 23521424PubMed |

Golmohammadi K, Jacobs P, Sin DD (2004) Economic Evaluation of a Community-Based Pulmonary Rehabilitation Program for Chronic Obstructive Pulmonary Disease. Lung 182, 187–196.
Economic Evaluation of a Community-Based Pulmonary Rehabilitation Program for Chronic Obstructive Pulmonary Disease.Crossref | GoogleScholarGoogle Scholar | 15526757PubMed |

Haines TP, Foster MM, Cornwell P, Fleming J, Tweedy S, Hart A, et al (2010) Impact of Enhanced Primary Care on equitable access to and economic efficiency of allied health services: a qualitative investigation. Australian Health Review 34, 30–35.
Impact of Enhanced Primary Care on equitable access to and economic efficiency of allied health services: a qualitative investigation.Crossref | GoogleScholarGoogle Scholar | 20334753PubMed |

Harris MF, Harris-Roxas B, Knight AW (2018) Care of patients with chronic disease: achievements in Australia over the past decade. The Medical Journal of Australia 209, 55–57.
Care of patients with chronic disease: achievements in Australia over the past decade.Crossref | GoogleScholarGoogle Scholar | 29996749PubMed |

Jansen S, Ball L, Lowe C (2015) Impact of the Medicare Chronic Disease Management program on the conduct of Australian dietitians’ private practices. Australian Health Review 39, 183–189.
Impact of the Medicare Chronic Disease Management program on the conduct of Australian dietitians’ private practices.Crossref | GoogleScholarGoogle Scholar | 25514419PubMed |

Korda RJ, Banks E, Clements MS, Young AF (2009) Is inequity undermining Australia’s ‘universal’ health care system? Socio-economic inequalities in the use of specialist medical and non-medical ambulatory health care. Australian and New Zealand Journal of Public Health 33, 458–465.
Is inequity undermining Australia’s ‘universal’ health care system? Socio-economic inequalities in the use of specialist medical and non-medical ambulatory health care.Crossref | GoogleScholarGoogle Scholar | 19811484PubMed |

Lane R, Russell G, Bardoel EA, Advocat J, Zwar N, Davies PGP, et al (2017) When colocation is not enough: a case study of General Practitioner Super Clinics in Australia. Australian Journal of Primary Health 23, 107–113.
When colocation is not enough: a case study of General Practitioner Super Clinics in Australia.Crossref | GoogleScholarGoogle Scholar | 28442054PubMed |

Mackenzie L, Clemson L (2014) Can chronic disease management plans including occupational therapy and physiotherapy services contribute to reducing falls risk in older people? Australian Family Physician 43, 211–215.

McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y (2015) Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2, CD003793
Pulmonary rehabilitation for chronic obstructive pulmonary disease.Crossref | GoogleScholarGoogle Scholar |

Medical Services Advisory Committee (2018) Application No. 1405.1 – MBS Item Number for Pulmonary Rehabilitation. Available at http://www.msac.gov.au/internet/msac/publishing.nsf/Content/55250CADC75A16C5CA258336001AE6C7/$File/1405.1%20-%20Final%20PSD.pdf

Medicare Benefits Schedule Review Taskforce (2020) Report on Primary Care. Department of Health, Canberra, ACT, Australia.

Menz HB (2009) Utilisation of podiatry services in Australia under the Medicare Enhanced Primary Care program, 2004–2008. Journal of Foot and Ankle Research 2, 30
Utilisation of podiatry services in Australia under the Medicare Enhanced Primary Care program, 2004–2008.Crossref | GoogleScholarGoogle Scholar | 19878562PubMed |

Mitchell LJ, Ball LE, Ross LJ, Barnes KA, Williams LT (2017) Effectiveness of dietetic consultations in primary health care: a systematic review of randomized controlled trials. Journal of the Academy of Nutrition and Dietetics 117, 1941–1962.
Effectiveness of dietetic consultations in primary health care: a systematic review of randomized controlled trials.Crossref | GoogleScholarGoogle Scholar | 28826840PubMed |

Odgers-Jewell K, Ball LE, Kelly JT, Isenring EA, Reidlinger DP, Thomas R (2017) Effectiveness of group-based self-management education for individuals with Type 2 diabetes: a systematic review with meta-analyses and meta-regression. Diabetic Medicine 34, 1027–1039.
Effectiveness of group-based self-management education for individuals with Type 2 diabetes: a systematic review with meta-analyses and meta-regression.Crossref | GoogleScholarGoogle Scholar | 28226200PubMed |

Oliveira JS, Sherrington C, Amorim A, Dario A, Tiedemann A (2017) What is the effect of health coaching on physical activity participation in people aged 60 years and over?: a systematic review of randomised controlled trials. British Journal of Sports Medicine 51, 1425–1432.
What is the effect of health coaching on physical activity participation in people aged 60 years and over?: a systematic review of randomised controlled trials.Crossref | GoogleScholarGoogle Scholar | 28320732PubMed |

Paul SS, Gardner T, Hubbard A, Johnson J, Canning C, Leaver A, Raymond J, Dennis SM (2019) Feasibility of the PHYZ X 2U program: a mobile and cloud-based outreach service to improve chronic disease outcomes in underserviced rural communities. Australian Journal of Primary Health 25, 539–546.
Feasibility of the PHYZ X 2U program: a mobile and cloud-based outreach service to improve chronic disease outcomes in underserviced rural communities.Crossref | GoogleScholarGoogle Scholar | 31708012PubMed |

Primary Health Care Advisory Group (2015) Primary Health Care Advisory Group Final Report: Better Outcomes for People with Chronic and Complex Health Conditions. Department of Health, Canberra, ACT, Australia.

Puhan MA, Gimeno‐Santos E, Cates CJ, Troosters T (2016) Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews CD005305
Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease.Crossref | GoogleScholarGoogle Scholar |

Ramond-Roquin A, Fortin M (2016) Towards increased visibility of multimorbidity research. Journal of Comorbidity 6, 42–45.
Towards increased visibility of multimorbidity research.Crossref | GoogleScholarGoogle Scholar | 29090171PubMed |

Reynolds R, Dennis S, Hasan I, Slewa J, Chen W, Tian D, et al (2018) A systematic review of chronic disease management interventions in primary care. BMC Family Practice 19, 11
A systematic review of chronic disease management interventions in primary care.Crossref | GoogleScholarGoogle Scholar | 29316889PubMed |

Ryan A, Wallace E, O’Hara P, Smith SM (2015) Multimorbidity and functional decline in community-dwelling adults: a systematic review. Health and Quality of Life Outcomes 13, 168
Multimorbidity and functional decline in community-dwelling adults: a systematic review.Crossref | GoogleScholarGoogle Scholar | 26467295PubMed |

Sherrington C, Michaleff ZA, Fairhall N, Paul SS, Tiedemann A, Whitney J, et al (2017) Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. British Journal of Sports Medicine 51, 1750–1758.
Exercise to prevent falls in older adults: an updated systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 27707740PubMed |

Ward B, Lane R, McDonald J, Powell-Davies G, Fuller J, Dennis S, et al (2018) Context matters for primary health care access: a multi-method comparative study of contextual influences on health service access arrangements across models of primary health care. International Journal for Equity in Health 17, 78
Context matters for primary health care access: a multi-method comparative study of contextual influences on health service access arrangements across models of primary health care.Crossref | GoogleScholarGoogle Scholar | 29903017PubMed |

Welberry H, Barr ML, Comino EJ, Harris-Roxas BF, Harris E, Harris MF (2019) Increasing use of general practice management and team care arrangements over time in New South Wales, Australia. Australian Journal of Primary Health 25, 168–175.
Increasing use of general practice management and team care arrangements over time in New South Wales, Australia.Crossref | GoogleScholarGoogle Scholar | 30857588PubMed |

World Health Organization (2017) Rehabilitation 2030: a call for action. Available at https://www.who.int/rehabilitation/rehab-2030/en/