Role, implementation, and effectiveness of advanced allied health assistants: a systematic review

Abstract

BackgroundThe purpose of this systematic review was to determine the effectiveness and implementation of advanced allied health assistant roles.MethodsA systematic search of seven databases and Google Scholar was conducted to identify studies published in English peer-reviewed journals from 2003 to 2013 and reporting on the effectiveness and implementation of advanced allied health assistant (A/AHA) roles. Reference lists were also screened to identify additional studies, and the authors’ personal collections of studies were searched. Studies were allocated to the National Health and Medical Research Council hierarchy of evidence, and appraisal of higher-level studies (III-1 and above) conducted using the Centre for Evidence Based Medicine Systematic Review Critical Appraisal Sheet for included systematic reviews or the PEDro scale for level II and III-1 studies. Data regarding country, A/AHA title, disciplines, competencies, tasks, level of autonomy, clients, training, and issues regarding the implementation of these roles were extracted, as were outcomes used and key findings for studies investigating their effectiveness.ResultsFifty-three studies were included, and most because they reported background information rather than investigating A/AHA roles, this representing low-level information. A/AHAs work in a range of disciplines, with a variety of client groups, and in a number of different settings. Little was reported regarding the training available for A/AHAs. Four studies investigated the effectiveness of these roles, finding that they were generally well accepted by clients, and provided more therapy time. Issues in integrating these new roles into existing health systems were also reported.ConclusionA/AHA roles are being implemented in a range of settings, and appear to be effective in terms of process measures and stakeholder perceptions. Few studies have investigated these roles, indicating a need for research to be conducted in this area to enable policy-makers to consider the value of these positions and how they can best be utilized.

Advanced allied health assistants: an emerging workforce

“…ACT Health's Advanced Allied Health Assistants: an Emerging Workforce project aimed to scope the role of the advanced AHA in its potential to contribute to the delivery of quality allied health service and to outline an education pathway that provides skills escalation and career development to a diploma or equivalent qualification. The literature review involved a systematic search of key databases using a comprehensive list of search terms (see Stanhope and Pearce 7 for further details). The project officer (CP) also undertook an informal consultation via telephone and email with a selection of services in other states that are working with the advanced role, as identified by the National Allied Health Assistant Working Group, a subgroup of the National Allied Health Advisory Committee.…”

“…Examples of tasks within these broad skill sets could include undertaking risk assessments, developing and leading therapeutic groups, making recommendations to other agencies regarding client care needs, supervising junior AHAs and undertaking clinical screens that have some element of clinical decision making involved. 7 The AHAs surveyed for this project were asked what they considered to be advanced skills or roles. Their responses are summarised in Table 1.…”

“…There are several issues reported in the literature regarding how advanced AHA roles may fit traditional healthcare models. 7 Uncertainty about the scope of practice of advanced AHAs, concerns among allied health professionals regarding how they should be best used, as well as concerns around responsibility and accountability, may all be potential barriers to implementation. The importance of implementing a well-defined supervision framework within healthcare, supported by competent, trained supervisors has been well established.…”

“…5,6 The drivers for advanced role development are a combination of local need, the skill of the post holder and the willingness of the supervising allied health professional to delegate. 7…”

The Queensland Health Ministerial Taskforce on health practitioners’ expanded scope of practice: consultation findings

“…4 Despite this situation, there is evidence of improvements in patient flow, waiting times, waiting lists and patient satisfaction without increased risks. 5,6 A recent systematic review on workforce reform 7 9 These bodies of work involved 59 demonstration projects examining new models of care incorporating advanced practitioner roles and allied health assistants across 14 allied health disciplines in a range of clinical contexts and geographic areas. Policies and tools were developed to support extended and advanced scope roles and delegation of tasks.…”