Optimizing the interprofessional workforce for centralized intake of patients with osteoarthritis and rheumatoid disease: case study

Suter, Esther; Birney, Arden; Charland, Paola; Misfeldt, Renée; Weiss, Stephen M.; Howden, Jane Squire; Hendricks, Jennifer S.; Lupton, Theresa; Marshall, Deborah A.

doi:10.1186/s12960-015-0033-3

Cited by 17 publications

(13 citation statements)

References 27 publications

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“…In systems constrained by workforce shortages, improved patient flows may be achieved by allocating selected tasks to alternative health care professionals with similar scopes of practice (e.g. [112]). For example, extending the roles of nurses and nurse practitioners in specialty areas such as rheumatology [113], cardiology [114, 115] and oncology [116] can reduce demand for specialists while providing equivalent care with no greater risk of poorer outcomes.…”

Section: Resultsmentioning

confidence: 99%

A categorisation of problems and solutions to improve patient referrals from primary to specialty care

Greenwood-Lee

Jewett

Woodhouse

et al. 2018

BMC Health Serv Res

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BackgroundImproving access to specialty care has been identified as a critical issue in the delivery of health services, especially given an increasing burden of chronic disease. Identifying and addressing problems that impact access to specialty care for patients referred to speciality care for non-emergent procedures and how these deficiencies can be managed via health system delivery interventions is important to improve care for patients with chronic conditions. However, the primary-specialty care interface is complex and may be impacted by a variety of potential health services delivery deficiencies; with an equal range of interventions developed to correct them. Consequently, the literature is also diverse and difficult to navigate. We present a narrative review to identify existing literature, and provide a conceptual map that categorizes problems at the primary-specialty care interface with linkages to corresponding interventions aimed at ensuring that patient transitions across the primary-specialty care interface are necessary, appropriate, timely and well communicated.MethodsWe searched MEDLINE and EMBASE databases from January 1, 2005 until Dec 31, 2014, grey literature and reference lists to identify articles that report on interventions implemented to improve the primary-specialty care interface. Selected articles were categorized to describe: 1) the intervention context, including the deficiency addressed, and the objective of the intervention 2) intervention activities, and 3) intervention outcomes.ResultsWe identified 106 articles, producing four categories of health services delivery deficiencies based in: 1) clinical decision making; 2) information management; 3) the system level management of patient flows between primary and secondary care; and 4) quality-of-care monitoring. Interventions were divided into seven categories and fourteen sub-categories based on the deficiencies addressed and the intervention strategies used. Potential synergies and trade-offs among interventions are discussed. Little evidence exists regarding the synergistic and antagonistic interactions of alternative intervention strategies.ConclusionThe categorization acts as an aid in identifying why the primary-specialty care interface may be failing and which interventions may produce improvements. Overlap and interconnectedness between interventions creates potential synergies and conflicts among co-implemented interventions.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3745-y) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

A categorisation of problems and solutions to improve patient referrals from primary to specialty care

Greenwood-Lee

Jewett

Woodhouse

et al. 2018

BMC Health Serv Res

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“…HWNZ is also introducing more qualitative intelligence through scope of practice analysis. Scope overlap or plasticity analysis investigates the possible substitution of professionals at some stages of care [61, 62]. For example, Suter et al [62] reviewed centralised intake processes and the roles, types and scopes of health care providers, physicians and support staff associated with the various steps to identify potential alternative providers.…”

Section: Discussion and Evaluationmentioning

confidence: 99%

“…Scope overlap or plasticity analysis investigates the possible substitution of professionals at some stages of care [61, 62]. For example, Suter et al [62] reviewed centralised intake processes and the roles, types and scopes of health care providers, physicians and support staff associated with the various steps to identify potential alternative providers. Likewise, HWNZ has reviewed plasticity for assessing general practice workloads as a means to have GPs concentrating on more complex cases in a scenario of comprehensive primary care delivered by integrated, multi-disciplinary teams [38].…”

Section: Discussion and Evaluationmentioning

confidence: 99%

The evolution of New Zealand’s health workforce policy and planning system: a study of workforce governance and health reform

Rees

2019

Hum Resour Health

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Introduction While considerable attention has been given to improving health workforce planning practice, few articles focus on the relationship between health workforce governance and health reform. By outlining a sequence of health reforms, we reveal how New Zealand’s health workforce governance and practices came under pressure, leading to a rethink and the introduction of innovative approaches and initiatives. Case description New Zealand’s health system was quite stable up to the late 1980s, after which 30 years of structural and system reform was undertaken. This had the effect of replacing the centralised medically led health workforce policy and planning system with a market-driven and short-run employer-led planning approach. The increasing pressures and inconsistencies this approach produced ultimately led to the re-centralisation of some governance functions and brought with it a new vision of how to better prepare for future health needs. While significant gain has been made implementing this new vision, issues remain for achieving more effective innovation diffusion and improved integrated care orientations. Discussion and evaluation The case reveals that there was a failure to consider the health workforce in almost all of the reforms. Health and workforce policy became increasingly disconnected at the central and regional levels, leading to fragmentation, duplication and widening gaps. New Zealand’s more recent workforce policy and planning approach has adopted new tools and techniques to overcome these weaknesses that have implications for the workforce and service delivery, workforce governance and planning methodologies. However, further strengthening of workforce governance is required to embed the changes in policy and planning and to improve organisational capabilities to diffuse innovation and respond to evolving roles and team-based models of care. Conclusion The case reveals that disconnecting the workforce from reform policy leads to a range of debilitating effects. By addressing how it approaches workforce planning and policy, New Zealand is now better placed to plan for a future of integrated and team-based health care. The case provides cues for other countries considering reform agendas, the most important being to include and consider the health workforce in health reform processes.

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“…The purpose of the document analysis was to identify providers who are able to perform some or all of the different tasks associated with assessment and triaging of patients. 16 These include performing musculoskeletal assessments, reviewing medical histories, screening for comorbidities, and making referrals to or receiving referrals from other providers. It was also important to establish if providers are authorized to perform the following restricted activities: order or apply X-rays and magnetic resonance imaging; administer diagnostic imaging contrast agents; prescribe medication, dispense or compound medication or sell a drug within the meaning of the provincial Pharmacy and Drug Act.…”

Section: Methodsmentioning

confidence: 99%

Scope of practice review: providers for triage and assessment of spine-related disorders

Boakye¹,

Birney²,

Suter³

et al. 2016

JMDH

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PurposeThis study explored which health care providers could be involved in centralized intake for patients with nonspecific low back pain to enhance access, continuity, and appropriateness of care.MethodsWe reviewed the scope of practice regulations for a range of health care providers. We also conducted telephone interviews with 17 individuals representing ten provincial colleges and regulatory bodies to further understand providers’ legislated scopes of practice. Activities relevant to triaging and assessing patients with low back pain were mapped against professionals’ scope of practice.ResultsFamily physicians and nurse practitioners have the most comprehensive scopes and can complete all restricted activities for spine assessment and triage, while the scope of registered nurses and licensed practical nurses are progressively narrower. Chiropractors, occupational therapists, physiotherapists, and athletic therapists are considered experts in musculoskeletal assessments and appear best suited for musculoskeletal specific assessment and triage. Other providers may play a complementary role depending on the individual patient needs.ConclusionThese findings indicate that an interprofessional assessment and triage team that includes allied health professionals would be a feasible option to create a centralized intake model. Implementation of such teams would require removing barriers that currently prevent providers from delivering on their full scope of practice.

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Optimizing the interprofessional workforce for centralized intake of patients with osteoarthritis and rheumatoid disease: case study

Cited by 17 publications

References 27 publications

A categorisation of problems and solutions to improve patient referrals from primary to specialty care

A categorisation of problems and solutions to improve patient referrals from primary to specialty care

The evolution of New Zealand’s health workforce policy and planning system: a study of workforce governance and health reform

Scope of practice review: providers for triage and assessment of spine-related disorders

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