Allied health primary contact services: results of a 2-year follow-up study of clinical effectiveness, safety, wait times and impact on medical specialist out-patient waitlists

Abstract

ObjectiveLong specialist out-patient waitlists are common in public health facilities, but not all patients require consultation with a medical specialist. Studies of single allied health primary contact services have shown they provide timely, appropriate care and reduce demand on medical specialist out-patient waitlists. This study evaluated the collective benefits across multiple allied health primary contact services and models to determine their clinical effectiveness, safety, timeliness of care and impact on medical specialist out-patient waitlists. MethodUsing a prospective observational study design, data were collected and analysed for patients attending 47 allied health primary contact services in Queensland public hospitals over a 2-year period. Outcomes reported are global status, adverse events, wait times and impact on medical specialist out-patient waitlists. ResultsIn all, 10634 patients were managed in and discharged from the allied health services. Most adult patients (80%) who attended at least two consultations reported an improvement in health status. No adverse events were attributed to the model of care. Approximately 68%, 44% and 90% of urgent, semi-urgent and non-urgent out-patients respectively were seen within clinically recommended time frames. Between 35% and 89% of patients were removed from out-patient waitlists without medical specialist consultation across the service models. ConclusionsAllied health primary contact services provide safe, effective and timely care. The impact on medical specialist out-patient waitlists varied depending on service model and pathway characteristics. What is known about this topic?Most studies of allied health primary contact services have focused on the management of patients on orthopaedic specialist out-patient waitlists by a physiotherapist. These studies of either individual services or groups of services with the same model cite benefits, including reduced waiting times, high levels of patient and referrer satisfaction, improved conversion to surgery, cost-effectiveness and more effective utilisation of medical specialists. What does this paper add?This paper highlights that, collectively, allied health primary contact services are safe, effective and provide timely care. The proportion of patients independently managed and removed from various medical specialist out-patient waitlists and the services involved are reported, demonstrating the variety of service models. This study reports outcomes for primary contact services for which there is a dearth of published literature, including dietician services for patients on gastroenterology waitlists, speech pathology and audiology services for patients on ear, nose and throat waitlists, occupational therapy hand services for patients on orthopaedic waitlists and physiotherapy led pelvic-health services for patients on gynaecology waitlists. Possibilities for efficiency gains are identified and discussed. What are the implications for practitioners?Health service managers should consider allied health primary contact services as a viable option to increase specialist out-patient capacity. Service model characteristics that maximise impact on medical specialist out-patient waitlist management are highlighted to inform resource allocation.

Cost Analysis of Orthoptist-Led Neurofibromatosis Type 1 Screening Clinics

“…Our findings demonstrate a gain in technical efficiency and reveal an opportunity to screen a greater number of patients. Consultant-led clinic appointments previously allocated to screening for an OPG in patients with NF1 can now be utilised by other patients, reducing delays between appointments (Stute et al 2021). The benefits of surveillance and screening clinics in facilitating earlier detection of pathology while simultaneously reducing the costs associated is well understood (Watts et al 2015).…”

Primary contact physiotherapy for patients with suggested vestibulopathy for an Australian ENT clinic: a retrospective cohort study

“…[11][12][13][14] Over the last decade, there has been a growing interest in the development of physiotherapy-led models of care; in these models, the physiotherapist conducts the initial appointment, with the objective of reducing unnecessary appointments with the ENT specialist. [15][16][17][18][19] In the UK, Kasbekar et al 16 and Burrows et al 17 demonstrated the effectiveness of physiotherapy-based models of care, where 22 per cent and 3 per cent of patients, respectively, avoided the need to see an ENT specialist.…”

“…The effectiveness of the multidisciplinary team (MDT) primary contact approach on ENT specialist review waitlist times was further improved when speech pathology and audiology were also included. Stute et al 15 and Távora-Vieira et al 20 demonstrated that speech pathology and audiology services can reduce the need to see an ENT specialist. Barnes 18 further confirmed the benefits of this MDT approach, reporting that ultimately only 10 per cent of patients required a consultation with an ENT specialist or neurologist for vestibular symptoms.…”

The lactation skill gaps of multidisciplinary paediatric healthcare professionals in the United Kingdom

“…However, several studies have found that breastfeeding training for physicians and nurses is inadequate, 4–6 lacks clarity regarding the optimal educational approach, 7 and many healthcare professionals default to their own experiences of breastfeeding 8–10 . Moreover, training for staff such as those working in dietetics and speech and language therapy, who often support medically complex feeding, is patchy and may be formula industry‐funded 11–16 …”