Beyond the big smoke: No discipline is an island
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1 Beyond the big smoke: No discipline is an island Robyn Adams James Cook University
2 geography.about.com/.../blank/blxaustralia.htm
3 Dispersed health Professionals linked Common issues identified Action to address identified issues Evaluation and dissemination This could not have been achieved without joining in the bigger picture Rural Health Movement Advocacy and Lobbying Programs developed to support rural health professionals Replication of successful initiatives Critical success factors Networks and Partnerships Organisations and united voices Funding Product, Policy and politics
4 Dispersed health Professionals linked Common issues identified Action to address identified issues Evaluation and dissemination Rural allied health professional associations committed individuals networking Hodgson 1991 Nihill st R&R AH conf 1993 Hodgson &Berry 1993 Taylor 1994 Millsteed 1995 Bishop 1998 SARRAH 2000 Recommendations Projects/initiatives addressing workforce and service issues Project reports published articles and recommendations for long term structural change
5 Rural training Clinician Support Innovations in service delivery models Benchmarks
6 Rural training Rural background and undergraduate clinical experience remain predictors of rural work Scholarships and Clinical placement grants Rural universities providing AH courses University Departments of Rural Health Rural Health Training Units
7 Rural training Scholarships and Clinical placement grants Commonwealth Rural Allied Health Undergraduate Scholarship (RAHUS) Scheme State Rural Health Scholarships Schemes Rural Health training Units University Departments of Rural Health RDA NSW website Physio-15 Speech-16 OT-17 SW-24 Psychology-28
8 Clinician support Scholarship Schemes (national, state and local) Support for specific study and research Mentoring Career path options Locums Organisations, networks and advocacy Resources and literature
9 Clinician support National Australian Rural and Remote Health Professional Scholarship Scheme (ARRHPSS) QLD Graduate Certificate in Health (Remote Health Practice - Allied Health) Allied Health Research Scholarships The Study and Research Scheme (SARAS) Rural Connect Allied Health Conditional Clinical Advancement Scheme
10 Clinician support Victoria Mentorlink Locum optometrist support Country Education Program Victorian Allied Health Postgraduate Rural Retention Bonus Rural Professional Improvement Assistance Fund Continuing Professional Education Program for Rural Allied Health Practitioners Podiatry self-care demand management strategy Allied Health Workforce Enhancement Physiotherapy Locum Pilot
11 Clinician support NSW the Rural Health Taskforce has recently funded an Allied Health Locum trial across three areas Health services IRCST-Rural Rural Allied Health Project The NSW Rural Allied Health Project Officer The NSW Rural Allied Health Conference 2007 CW Mentoring trial
12 Organisations, networks and advocacy Senior State Allied Health officers Services for Australian Rural and Remote Allied Health (SARRAH( SARRAH) National Rural Health Alliance (NRHA( NRHA) Allied Health Professions Australia (AHPA) Rural committees of professional associations
13 Resources Improved access to computers Improves access to internet to support EBP eg CIAP Websites, relevant to rural practice eg NRHA and SARRAH Data SARRAH report AIHW workforce reports State Workforce reports ABS data analysis
14 Literature Peer review journals eg AJRH Conference proceedings Rural allied health conferences Rural Health Conferences State based rural allied health conferences Project reports RHSET funded projects and Regional Health Services funded projects
15 Innovations in funding and service delivery More Allied Health Services Program The Regional Health Services Program NWQAHS Katherine West Rural Private Access Program Medicare access through EPC WA Allied Health Assistants project Community rehabilitation project QLD
16 Allied health benchmarks a number of approaches focussed on specific clinical areas predominantly inpatient workloads Relevance to rural too specific for many rural settings lack the concentration of services, particularly inpatient services Rural and remote examples Rural Physiotherapy Remote AH services
17 allied health benchmarks approaches individual staff member to a number of patients in specific clinical areas. Eg Rehabilitation guidelines Victorian Allied Health in Rehabilitation Consultative Committee and Christie (which both include outpatients) clinical time as a percentage of an FTE eg use of the NAHCC workload distribution categories
18 Benchmarking examples Langhorne and Dennis 1998 study Staffing in British acute stroke units (ASU s) Stroke Units: an Evidence Based approach recommendations for average Allied Health Staffing per 10 beds. Heather Christie recommendations based on the number of patients to FTE for specific caseloads. Eg general medical inpatients per FTE; Paediatric outpatients per FTE.
19 Relevance to rural too specific for many rural settings lack the concentration of services, particularly inpatient services reduces their applicability beyond metropolitan and perhaps major regional areas
20 One approach Public sector NSW ARIA levels HA, MA, A P+R+I+O = recommended minimum Physiotherapy staffing level P=Population (1:5000) R=number of Rehab (1:10) I= number of ICU beds (1:6) O=the number of Orthopods (1:2) P/5000+R/10+I/6+O/2= recommended FTE
21 Remote area recommendations have been developed and reviewed for ARIA levels R and VR and recommend the capacity for a minimum of monthly visits from a physiotherapist to all remote communities with a population of over 100 residents
22 New and ongoing challenges Workforce Supply Staffing level recommendations Distribution Critical mass Education and training Recruitment and retention in rural and remote areas
23 New and ongoing challenges Service delivery Ageing population Chronic diseases Workforce changes Data -workforce planning Service planning
24 .there are many ways forward.. all will require the consistent and collaborative effort that has produced the results described during this conference
25 Dispersed health Professionals linked Common issues identified Action to address identified issues Evaluation and dissemination This could not have been achieved without joining in the bigger picture Rural Health Movement Advocacy and Lobbying Programs developed to support rural health professionals Replication of successful initiatives Critical success factors Networks and Partnerships Organisations and united voices Funding Product, Policy and politics
26 The progress to date reflects the gains made by the collaborative work of many, and that within rural and remote areas, No discipline is an island in allied health ".
27 Thank you
28 References 1. Adams, R. Distribution and Utilisation of Physiotherapy Services in Rural NSW: Preliminary findings 1997 National Rural Health Conference Proceedings 2. Adams R, (Unpublished) The development of recommended physiotherapy FTE s : feasible or fantasy? Workshop presentation at 2002 International Physiotherapy Congress Sydney 3. Adams, R Is it possible to develop recommended staffing levels for rural allied health services? 1st NSW Rural Allied Health Conference proceedings December NSW Health Services Comparison Data Book 1998/1999 Volume 1 5. Department of Health and Aged Care, October 2001 Measuring Remoteness: Accessibility/Remoteness Index of Australia (ARIA) Revised Edition Occasional Papers: New Series Number 14 (Also available on the Department of Health and Ageing website 6. Australasian Faculty of Rehabilitation Medicine of the Royal College of Physicians Rehabilitation unit Guidelines Standards For Rehabilitation Service in Public and Private Hospitals, Australian Institute of Health and Welfare (AIHW) 2001 Physiotherapy Labour Force Report 8. Curry, R (unpublished).conference( Workshop Summary Minimums standards for remote allied health workforce 7th International Physiotherapy congress: Sydney, May 27, Aspinall B, (unpublished) Allied Health Workload Distribution Benchmarking Project Oct 2003 Compiled by for Children s Hospitals Australasia 10. Heather J Christie Physiotherapy Caseload Guidelines 1999 Physiotherapy Canada: : Summer GMTT Stroke Working party Recommendations (unpublished) Minimum Staffing levels for Rehab Medicine for general Neurological cal-stroke Langhorne, P and Dennis, M (ed( ed) ) Staffing in British acute stroke units (ASU s( ASU s). Stroke Units: and Evidence Based approach BMJ Books, GMTT Care of the acutely ill older person in Greater Metropolitan Hospitals (unpublished) Dec 2003 Consensus Statement on Allied Health Staffing for a 20 bed Acute Aged Care Ward 14. Allied Health in Rehabilitation Consultative Committee (unpublished) Guidelines for Allied Health: Resources required for the provision on of Quality Rehabilitation Version 8 Mar strategic-directions Images /.../AUST-social-general.htm
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