Abstract:PurposeDesign, implementation, and evaluation are all important for integrated care. However, they miss one critical factor: education. The authors define “integrated care education” as meaningful learning that purposefully supports collaboration and the development of adaptive expertise in integrated care. The ECHO (Extensions for Community Health Outcomes) model is a novel digital health solution that uses technology-enabled learning (TEL) to facilitate, support, and model integrated care education. Using EC… Show more
“…An opportunity exists to optimise multidisciplinary concussion care. At the microlevel, namely the patient-therapist interface, physiotherapists are already informally making diagnoses of suspected concussions and initiate person-centred care while waiting for a GP appointment, particularly at a community sports level (Poloai et al, 2023;Zhao et al, 2022). Instead of registering non-concussion related codes for secondary injuries such as neck pain, their ability to use the concussion or a "suspected" or provisional concussion code may improve timely access to specific concussion care (Poloai et al, 2023).…”
Section: Discussionmentioning
confidence: 99%
“…An accreditation process for physiotherapists providing concussion care could be developed, similar to physiotherapists' training for management of birthing injuries (Accident Compensation Corporation, 2024). Support for such a triaging role for physiotherapists would need to be approved at the macro-level, under the auspices of ACC, and potentially with the national sports organisations (Zhao et al, 2022). This would enable a whole systems approach for physiotherapists, GPs, and other providers to work towards a model of care for people with concussion to access appropriate care at the right place, at the right time, and by the right team.…”
Concussions (mild traumatic head injury) have received increasing attention in clinical practice, research, and the public press. A range of healthcare providers engage with patients presenting with concussion, and physiotherapists are often at the front line of these consultations, especially on the sports field. We explored physiotherapists’ perspectives of their scope of practice and actual clinical practice within the sports-related concussion diagnosis and return-to-sport context. A qualitative approach with interviews and focus groups was used, including 18 physiotherapists. Three themes were derived: (a) delayed access to concussiontrained general practitioners; (b) navigating concussion care in a strained healthcare system; and (c) proposed expanded role for physiotherapists. Delayed patient access to medical doctors often delayed a formal concussion diagnosis, initiation of specific concussion care, or medical sports clearance. Yet the participants were regularly identifying and managing concussions, and most felt confident to do so. Some participants, particularly those working with high-performance athletes or in multidisciplinary teams, suggested that concussion diagnosis and clearance for return to work or play should remain the medical doctors’ responsibilities. Yet participants working at community level suggested that, with relevant training and mentored experience, diagnosis, triaging, and clearance for sport could be within their scope of practice.
“…An opportunity exists to optimise multidisciplinary concussion care. At the microlevel, namely the patient-therapist interface, physiotherapists are already informally making diagnoses of suspected concussions and initiate person-centred care while waiting for a GP appointment, particularly at a community sports level (Poloai et al, 2023;Zhao et al, 2022). Instead of registering non-concussion related codes for secondary injuries such as neck pain, their ability to use the concussion or a "suspected" or provisional concussion code may improve timely access to specific concussion care (Poloai et al, 2023).…”
Section: Discussionmentioning
confidence: 99%
“…An accreditation process for physiotherapists providing concussion care could be developed, similar to physiotherapists' training for management of birthing injuries (Accident Compensation Corporation, 2024). Support for such a triaging role for physiotherapists would need to be approved at the macro-level, under the auspices of ACC, and potentially with the national sports organisations (Zhao et al, 2022). This would enable a whole systems approach for physiotherapists, GPs, and other providers to work towards a model of care for people with concussion to access appropriate care at the right place, at the right time, and by the right team.…”
Concussions (mild traumatic head injury) have received increasing attention in clinical practice, research, and the public press. A range of healthcare providers engage with patients presenting with concussion, and physiotherapists are often at the front line of these consultations, especially on the sports field. We explored physiotherapists’ perspectives of their scope of practice and actual clinical practice within the sports-related concussion diagnosis and return-to-sport context. A qualitative approach with interviews and focus groups was used, including 18 physiotherapists. Three themes were derived: (a) delayed access to concussiontrained general practitioners; (b) navigating concussion care in a strained healthcare system; and (c) proposed expanded role for physiotherapists. Delayed patient access to medical doctors often delayed a formal concussion diagnosis, initiation of specific concussion care, or medical sports clearance. Yet the participants were regularly identifying and managing concussions, and most felt confident to do so. Some participants, particularly those working with high-performance athletes or in multidisciplinary teams, suggested that concussion diagnosis and clearance for return to work or play should remain the medical doctors’ responsibilities. Yet participants working at community level suggested that, with relevant training and mentored experience, diagnosis, triaging, and clearance for sport could be within their scope of practice.
“…Recognizing that resources for educational programming are scarce, our objective was to develop sustainable virtual education with expanded reach that emphasizes the learning mechanisms previously demonstrated through a Project Extension for Community Healthcare Outcomes (ECHO) aimed at CHWs in the HIV sector. ECHO has been shown to improve access to education and impact learners significantly (Komaromy et al, 2016;Sockalingam et al, 2018Sockalingam et al, , 2021Zhao et al, 2022). To our knowledge, this is the only ECHO that is specifically aimed at CHWs.…”
PurposeCare of complex patients requires collaboration across hospital and community settings. Yet there is little recognition of the capabilities that healthcare workers need to effectively implement integrated care. An adaptive expertise theoretical framework can inform educational efforts that aim to give providers the abilities to navigate complexity and ambiguity in the healthcare system, including across hospital and community settings. Prior education research in the HIV sector has demonstrated that adaptive expert skills can be cultivated through education that emphasizes perspective exchange, inviting uncertainty in practice and integration of diverse perspectives on care.Design/methodology/approachThese principles informed the creation of an Extension for Community Healthcare Outcomes (ECHO) in HIV Psychiatry – the first ECHO directed at a non-clinical, community health worker (CHW) audience. The goal was to improve informal collaborations across hospitals and communities.FindingsParticipation in the ECHO was robust, with significant on-camera engagement. Participants attributed success of the ECHO to key themes: explicit value placed on all kinds of knowledge (not simply clinical knowledge), emphasis on approaches for navigating ambiguity and complexity and engagement in perspective exchange for provision of integrated, team-based care. Future cycles of ECHO HIV Psychiatry are being pursued, with a focus on the development of adaptive expert capabilities and the impact on integration of care between community and hospital services.Originality/valueTo our knowledge, this is the only ECHO that is specifically aimed at frontline CHWs.
“… Box 1: IPE for integrated care delivery—elements required High level support and sustained funding models for care delivery and training required 5 IPE along the continuum from pre‐qualification to continuing professional development The patient voice in planning and delivering education Case‐based learning Longitudinal clinical placements to enable integrated team membership IPE across pre‐qualification health and social care training Education about the importance of partnership working 6 Integration of learning across sectors through support of communities of practice 7 Technology‐enhanced learning 6 In‐service team‐based education with students as observers/participants Understanding/awareness of roles, responsibilities, scope of practice and boundaries Knowledge‐sharing culture 5 Workplace integrated learning for teams: informal and formal …”
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