A systematic review of evidence about extended roles for allied health professionals

McPherson, Kathryn; Kersten, Paula; George, Steve; Lattimer, Valerie; Breton, Alice; Ellis, Bridget; Kaur, Dawn; Frampton, Geoff K

doi:10.1258/135581906778476544

Cited by 128 publications

(136 citation statements)

References 33 publications

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“…plain film reporting) as means of increasing (reporting) capacity [159,160]. A previous review [15] of the evidence on the effectiveness of ESP concluded that most of the studies explored the acceptance of these roles by other professional colleagues; however, their impacts on services were not evaluated. We found three ESP studies, all performed within the NHS, UK.…”

Section: Discussionmentioning

confidence: 99%

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The Effectiveness of Service Delivery Initiatives at Improving Patients’ Waiting Times in Clinical Radiology Departments: A Systematic Review

et al. 2014

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We reviewed the literature for the impact of service delivery initiatives (SDIs) on patients' waiting times within radiology departments. We searched MEDLINE, EMBASE, CINAHL, INSPEC and The Cochrane Library for relevant articles published between 1995 and February, 2013. The Cochrane EPOC risk of bias tool was used to assess the risk of bias on studies that met specified design criteria. Fifty-seven studies met the inclusion criteria. The types of SDI implemented included extended scope practice (ESP, three studies), quality management (12 studies), productivity-enhancing technologies (PETs, 29 studies), multiple interventions (11 studies), outsourcing and pay-for-performance (one study each). The uncontrolled pre-and post-intervention and the postintervention designs were used in 54 (95 %) of the studies. The reporting quality was poor: many of the studies did not test and/or report the statistical significance of their results. The studies were highly heterogeneous, therefore metaanalysis was inappropriate. The following type of SDIs showed promising results: extended scope practice; quality management methodologies including Six Sigma, Lean methodology, and continuous quality improvement; productivityenhancing technologies including speech recognition reporting, teleradiology and computerised physician order entry systems. We have suggested improved study design and the mapping of the definitions of patient waiting times in radiology to generic timelines as a starting point for moving towards a situation where it becomes less restrictive to compare and/or pool the results of future studies in a meta-analysis.

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Section: Discussionmentioning

confidence: 99%

“…Pooling of results in a metaanalysis is inappropriate for the current review due to a high level of heterogeneity. The narrative synthesis is widely used in this situation [15,16]. Therefore, we present a narrative synthesis of our findings.…”

Section: Data Synthesismentioning

confidence: 97%

The Effectiveness of Service Delivery Initiatives at Improving Patients’ Waiting Times in Clinical Radiology Departments: A Systematic Review

et al. 2014

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“…Positive outcomes of these expanded roles include improved wait times for surgery, decreased health care costs, earlier diagnoses, fewer duplicate referrals, and increased patient satisfaction. [5][6][7][8][9][10][11][12] Physiotherapists practising beyond their regulated entry-level scope of practice-that is, those who have undertaken formal continuing education programs to gain additional knowledge and skills that are formally recognized 13 -are known as advanced practitioners in Canada, Australia, and New Zealand; the United States and the United Kingdom use the terms extended scope physiotherapist or consultant. 14 In this article, we use advanced practitioners to describe physiotherapists practising in this capacity.…”

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confidence: 99%

Ordering Diagnostic Imaging: A Survey of Ontario Physiotherapists' Opinions on an Expanded Scope of Practice

Chong

Luca

Goldan³

et al. 2015

Physiotherapy Canada

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Purpose: To explore Ontario physiotherapists' opinions on their ability to order diagnostic imaging (DI). Methods: An online questionnaire was sent to all registered members of the College of Physiotherapists of Ontario. Descriptive statistics were calculated using response frequencies. Practice characteristics were compared using w 2 tests and Wilcoxon rank-sum tests. Results: Of 1,574 respondents (21% response rate), 42% practised in orthopaedics and 53% in the public sector. Most physiotherapists were interested in ordering DI (72% MRI/diagnostic ultrasound, 78% X-rays/computed tomography scans). Respondents with an orthopaedic caseload of 50% or more (p < 0.001) and those in the private sector (p < 0.001) were more interested in ordering DI. Respondents preferred a DI course that combined face-to-face and Web-based components and one that was specific to their area of practice. Most respondents perceived minimal barriers to the uptake of ordering DI, and most agreed that support from other health care professionals would facilitate uptake. Conclusion: The majority of Ontario physiotherapists are interested in ordering DI. For successful implementation of a health care change, such as physiotherapists' ability to order DI, educational needs and barriers to and facilitators of the uptake of the authorized activity should be considered.Key Words: diagnostic imaging; education; survey. RÉ SUMÉObjet: Connaître l'opinion des physiothé rapeutes de l'Ontario sur leur capacité d'ordonner des imageries diagnostiques (ID). Mé thodes: Un questionnaire en ligne a é té envoyé à tous les membres enregistré s de l'Ordre des physiothé rapeutes de l'Ontario. Des statistiques descriptives ont é té calculé es selon les fré quences des ré ponses obtenues. Les caracté ristiques de la pratique ont é té comparé es au moyen de tests du chi carré et de tests de Wilcoxon. Ré sultats: Parmi les 1 574 ré pondants (taux de ré ponse de 21%), 42% pratiquent l'orthopé die et 53% travaillent dans le secteur public. La majorité des physiothé rapeutes se sont dits inté ressé s à ordonner des ID (72% é taient inté ressé s par l'imagerie par ré sonance magné tique ou l'ultrasonoscopie et 78%, par les radiographies ou la tomodensitomé trie). Les ré pondants dont la charge de travail é tait composé e à plus de 50% de cas d'orthopé die (p < 0.001) et ceux qui travaillent dans le secteur public (p < 0.001) sont plus inté ressé s que les autres ré pondants. Les ré pondants ont indiqué qu'ils pré fè rent un cours d'imagerie diagnostique qui combine de l'enseignement en personne et des é lé ments d'apprentissage en ligne et qui soit spé cialisé dans leur domaine de pratique. La majorité des ré pondants perc¸oivent des obstacles minimaux au fait de prendre en charge la prescription d'ID et ont convenu qu'un soutien d'autres professionnels de la santé faciliterait cette prise en charge. Conclusion: La majorité des physiothé rapeutes de l'Ontario se sont dits inté ressé s à ordonner des ID. Pour assurer la ré ussite de la mise en oeuvre d'un chang...

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“…Extended scope physiotherapists (ESPs) work within a range of services crossing established boundaries of practice between medicine, nursing and allied health professionals (Gardiner and Turner, 2002;McPherson et al 2006). Enhancing pathways to appropriate management has been a key UK government directive (DOH, 2006;2013) and in response many services have looked at innovative ways to deliver care, such as providing extended roles, which in turn has fuelled the growth of ESP practice.…”

Section: Study Contextmentioning

confidence: 99%

The clinical reasoning processes of extended scope physiotherapists assessing patients with low back pain

2015

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a b s t r a c tIntroduction: Employing allied health professionals in extended scope roles has developed relatively recently in health-care. Within physiotherapy, the extended role has provided clinicians with autonomy to use knowledge and clinical acumen to request investigations such as Magnetic Resonance Imaging (MRI) and X-ray as part of the diagnostic process, a practice beyond the traditional scope of physiotherapy. In these advancing roles, little is written about the clinical reasoning processes that clinicians use in managing patients with musculoskeletal pain and knowledge of these processes would advance training for new recruits to this arena. Study: This qualitative study has explored the processes by which extended scope physiotherapists (ESPs) clinically reason their decisions regarding patients reporting low back pain in a musculoskeletal outpatient setting. The study used a multiple case study design informed by grounded theory methodology, using focus groups (involving ESPs and non-ESPs/musculoskeletal physiotherapists) and semistructured interviews with a think-aloud method (ESPs only) to investigate these processes. Conclusions: The themes identified include: prior thinking; patient interaction; formal testing; time; safety and accountability; external and internal factors; and gut-feeling (which challenges current physiotherapy models of reasoning). Extended scope physiotherapists reported experiencing greater stress due to higher levels of perceived accountability, safety requirements and internal drivers for competence than non-ESPs. Further research is indicated to explore the role of gut-feeling in musculoskeletal physiotherapy clinical reasoning.

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A systematic review of evidence about extended roles for allied health professionals

Cited by 128 publications

References 33 publications

The Effectiveness of Service Delivery Initiatives at Improving Patients’ Waiting Times in Clinical Radiology Departments: A Systematic Review

The Effectiveness of Service Delivery Initiatives at Improving Patients’ Waiting Times in Clinical Radiology Departments: A Systematic Review

Ordering Diagnostic Imaging: A Survey of Ontario Physiotherapists' Opinions on an Expanded Scope of Practice

The clinical reasoning processes of extended scope physiotherapists assessing patients with low back pain

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