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

Dennis, Sarah; Ball, Lauren; Harris, Mark; Refshauge, Kathryn

doi:10.1071/py21076

Cited by 8 publications

(7 citation statements)

References 29 publications

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“…However, additional barriers to complete integration were cited which overlap with reasons suggested in other studies, including issues with sustainability. For example, the issue of funding future models was cited by GPs in this study given that allied health professionals are currently poorly integrated into Australian general practice and the current fee‐for‐service model in this context could contribute to inequitable access 57 . In Australia, PR programmes receive dedicated public funding.…”

Section: Discussionmentioning

confidence: 99%

“…For example, the issue of funding future models was cited by GPs in this study given that allied health professionals are currently poorly integrated into Australian general practice and the current fee-for-service model in this context could contribute to inequitable access. 57 In Australia, PR programmes receive dedicated public funding. However, this funding is only available to hospital-based programmes, not programmes accessed through primary care.…”

Section: Perceived Barriersmentioning

confidence: 99%

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Acceptability and barriers of a GP–physiotherapist partnership in the diagnosis and management of COPD in primary care: A qualitative study

Pagano,

McKeough,

Wootton

et al. 2023

Health Expectations

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IntroductionChronic obstructive pulmonary disease (COPD) is commonly diagnosed and managed in primary care but there is evidence that this has been suboptimal, with low confidence expressed in providing interventions requiring behaviour change. The aim of this study was to determine the acceptability of a general practitioner (GP)–physiotherapist partnership in the diagnosis and management of COPD in primary care and to explore the experiences of participants during the implementation of the model.MethodsSemi‐structured interviews were conducted with physiotherapists (n = 3), GPs (n = 2), practice nurses (PNs) (n = 2) and patients (n = 12) who had participated in the InNovaTivE Gp‐physiotheRapist pArTnErship for copD (INTEGRATED) trial. We sought to explore participants' views about their experiences and perceived benefits, barriers and facilitators to the implementation of this model of care. Interviews were transcribed, coded and thematically analysed. Synthesis of the data was guided by the Theoretical Domains Framework for clinician interviews and the health belief model for patient interviews.ResultsAll clinicians felt that this integrated model helped to optimise care for patients with COPD by facilitating evidence‐based practice. GPs and PNs valued the physiotherapist's knowledge and skills relating to diagnosis and management, which was reported to complement their own management and improve patient outcomes. Patients reported a sense of empowerment following their appointments and acknowledged improved self‐management skills. However, physiotherapists reported many patients were already engaging in positive health behaviours. Responses were mixed on the effectiveness of the model in facilitating teamwork between clinicians with different perspectives concerning management, communication pathways and logistical issues, such as time and room availability, being cited as barriers.ConclusionsAn experienced cardiorespiratory physiotherapist embedded into a small number of primary care practices to work in partnership with GPs for COPD diagnosis and management was acceptable and viewed as beneficial for patients. Barriers relating to logistics and resources remain, which must be addressed to optimise implementation.Patient or Public ContributionPatient input was obtained from qualitative feedback from a prior study conducted by two authors and was used to refine the model of care to determine the added value of a physiotherapist integrated into the primary care team. This feedback was also used to refine the interview guides utilised in this study determine the acceptability of this model of care. We had health service involvement from the rehabilitation service of the local health district who were directly involved in determining study aims and establishing the project around the priorities for their chronic disease integration service. For example, this project aimed to engage with a less severe patient population in primary care who would benefit from pulmonary rehabilitation. The findings from this study will be used to further tailor the model of care to the needs of the public and patients. Trial Registration: ACTRN12619001127190

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Section: Discussionmentioning

confidence: 99%

Section: Perceived Barriersmentioning

confidence: 99%

Acceptability and barriers of a GP–physiotherapist partnership in the diagnosis and management of COPD in primary care: A qualitative study

Pagano,

McKeough,

Wootton

et al. 2023

Health Expectations

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“…Individuals with PHI can always access the public system in Australia, where OOPE appears to be less of an issue. 10 Furthermore, PHI for ancillary services may help address unmet need for services that are not provided in the public system (Dennis et al, 2021 ). That some OOPE is required in these cases may be unavoidable and, in some cases, even desirable, particularly if the overall level of OOPE is moderate.…”

Section: Discussionmentioning

confidence: 99%

“… 9 Such greater use of ancillary healthcare services may also be beneficial for health, relative to individuals without PHI who forego allied healthcare even if they need it, with potentially negative long-term consequences (Dennis et al, 2021 ). …”

mentioning

confidence: 99%

Out-of-pocket expenditure, need, utilisation, and private health insurance in the Australian healthcare system

Ludlow,

Fooken,

Rose

et al. 2023

Int J Health Econ Manag.

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Despite widespread public service provision, public funding, and private health insurance (PHI), 20% of all healthcare expenditure across the OECD is covered by out-of-pocket expenditure (OOPE). This creates an equity concern for the increasing number of individuals with chronic conditions and greater need, particularly if higher need coincides with lower income. Theoretically, individuals may mitigate OOPE risk by purchasing PHI, replacing variable OOPE with fixed expenditure on premiums. Furthermore, if PHI premiums are not risk-rated, PHI may redistribute some of the financial burden from less healthy PHI holders that have greater need to healthier PHI holders that have less need. We investigate if the burden of OOPE for individuals with greater need increases less strongly for individuals with PHI in the Australian healthcare system. The Australian healthcare system provides public health insurance with full, partial, or limited coverage, depending on the healthcare service used, and no risk rating of PHI premiums. Using data from the Household, Income and Labour Dynamics in Australia survey we find that individuals with PHI spend a greater share of their disposable income on OOPE and that the difference in OOPE share between PHI and non-PHI holders increases with greater need and utilisation, contrary to the prediction that PHI may mitigate OOPE. We also show that OOPE is a greater concern for poorer individuals for whom the difference in OOPE by PHI is the greatest.

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“…In contrast, there was a disconfirming subtheme that patients noticed the lack of allied health services in the PCNs. Although dietitians [ 87 ] and pharmacists [ 88 ] contributed to improved outcomes in the care of diabetes patients, and their roles recommended in diabetes management guidelines [ 89 ], allied health services were not well integrated in primary care [ 90 ]. Presently the nurses in the PCNs have assumed the role for nutrition advice in the absence of a dietitian.…”

Section: Discussionmentioning

confidence: 99%

Patient perspectives of diabetes care in primary care networks in Singapore: a mixed-methods study

Goh,

Szücs,

Siah

et al. 2023

BMC Health Serv Res

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Background Type 2 diabetes (T2D) remains an important chronic condition worldwide requiring integrated patient-centred care as advocated by the Chronic Care Model (CCM). The Primary Care Networks (PCNs) in Singapore organise general practitioners (GPs) with nurses and care coordinators to deliver team-based care for patients with chronic conditions. This study examined the quality of care in the PCNs as defined by the CCM from the patients’ perspective. Methods This study followed a cross-sectional convergent mixed-method design with T2D patients across three PCN types (GP-led, Group, and Cluster). The Patient Assessment of Chronic Illness Care (PACIC, range 1-5) was completed by a convenience sample of 343 patients. Multivariate linear regression was performed to estimate the associations between patient and service characteristics and PACIC summary score. Twenty-four participants were purposively recruited for interviews on the experienced care until thematic saturation was reached. Quantitative and qualitative data were collected concurrently and independently. Integration occurred during study design and data analysis using the CCM as guidance. Quantitative and qualitative results were compared side-by-side in a joint comparison table to develop key concepts supported by themes, subthemes, and patients’ quotes. Results The PACIC mean summary score of 3.21 for 343 patients evidenced that some have received CCM consistent care in the PCNs. Being younger and spending more time with the GP were associated with higher PACIC summary scores. PACIC summary scores did not differ across PCN types. The 24 patients interviewed in the qualitative study reported receiving team-based care, nurse services, good continuity of care, as well as patient-centred care, convenient access, and affordable care. Key concepts showed that integrated care consistent with the CCM was sometimes received by patients in the PCNs. Patient activation, delivery system design/decision support, goal setting/tailoring, and problem-solving/contextual counselling were sometimes received by patients, while follow-up/coordination was generally not received. Conclusions Patients with T2D from the Singapore Primary Care Networks received integrated care consistent with the Chronic Care Model, particularly in patient activation, delivery system design/decision support, goal setting/tailoring, and problem-solving/contextual counselling. Follow-up/coordination needed improvement to ensure higher quality of diabetes care.

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

Cited by 8 publications

References 29 publications

Acceptability and barriers of a GP–physiotherapist partnership in the diagnosis and management of COPD in primary care: A qualitative study

Acceptability and barriers of a GP–physiotherapist partnership in the diagnosis and management of COPD in primary care: A qualitative study

Out-of-pocket expenditure, need, utilisation, and private health insurance in the Australian healthcare system

Patient perspectives of diabetes care in primary care networks in Singapore: a mixed-methods study

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