Hay Physiotherapy Service implemented a telehealth model of care for appropriate patients, to better manage its waiting list and allow patients across vast geographical regions to access physiotherapy services in a timely and convenient way, particularly during service interruptions.
Aim
To ensure physiotherapy services in Hay are available 80% of the time over a 12-month period, by 31 March 2016.
Benefits
- Improves access to clinical services across vast geographical distances, addressing service gaps in rural and remote areas.
- Improves health outcomes and provides seamless, integrated care.
- Reduces waiting lists and delays in providing face-to-face care.
- Reduces the risk of complications, avoidable emergency department presentations and hospital admissions.
- Enhances collaboration between clinicians and patients.
- Empowers patients and their carers to manage their own health.
- Supports the efficient transfer of care.
- Maximises the allied health workforce and increases competency through the innovative use of technology.
- Increases productivity in rural physiotherapy clinics, by streamlining time spent in patient consultations.
- Reduces travel time and costs for patients.
- Aligns to NSW Health Strategic Directions 1 (Providing healthcare in ways that meets the needs of rural communities), 2 (Building a skilled sustainable workforce) and 3 (Improving clinician and community engagement), as well as its CORE values of collaboration, openness, respect and empowerment.
Background
Hay Physiotherapy Service has traditionally relied on a sole therapist to provide outreach services to patients one day a week from Griffith. Prior to the project, there were long periods of time where no physiotherapist was available to deliver these services, which led to long waiting lists. By March 2016, there were five sites in Murrumbidgee Local Health District (MLHD) with staff vacancies in physiotherapy. This is a common problem in rural areas of NSW . In 2011, there were 98.8 physiotherapists per 100,000 people in urban areas of NSW , compared to 37 physiotherapists per 100,000 people in rural and remote areas.1
The lack of access to physiotherapists in MLHD was also a result of the vast geographical distance between patients’ homes and physiotherapy services. A community survey conducted in July 2015 showed that only 40% of people were prepared to travel to attend physiotherapy services elsewhere if there was no service available in Hay.
Hay Physiotherapy Service has used telehealth for meetings, staff education and clinician communication with patients across MLHD . It has proven to be a valid, reliable and effective form of clinical care. As a result, it was suggested that delivering physiotherapy services via telehealth would provide care to the patient when it is needed and as close to their home as possible.
A cost analysis conducted by Hay Physiotherapy Service compared the costs of attending one physiotherapy appointment in Griffith, to the costs of attending the appointment locally via telehealth. Results showed significant cost savings when delivering care via telehealth. However, not all care can be delivered this way and other factors must be considered before giving patients the option to attend appointments locally using the telehealth model.
Implementation
- A project team was established, comprising local clinicians, medical staff, community representatives, physiotherapists, managers and district advisors.
- The following factors were identified as contributing to service accessibility:
- a lack of guidelines in Hay Physiotherapy Service
- no back-fill for remote part-time positions, when they are on leave or there is a vacancy
- the remote location of Hay.
- Contributing factors were analysed and an action plan developed to deliver consistent access to physiotherapy services.
- Community consultation was undertaken to measure satisfaction levels with the existing service and alternative options when no physiotherapy service was available. Results showed that 57% of participants were generally satisfied with Hay Physiotherapy Service, while 60% chose other local options or managed without physiotherapy when there was no service available – i.e. they chose not to travel to access this service somewhere else (n=26).
- Patients and staff involved in the pilot project provided feedback on their experiences. Patients were receptive to using technology for clinical care, while staff and management supported the use of telehealth for clinical care in appropriate patient groups, using existing resources.
- A telehealth model of care was developed for Hay Physiotherapy Service. It was explained to patients as an option to access physiotherapy services when the alternative was to wait for the service to resume in two weeks.
- In this telehealth model, a consultation is scheduled into the outpatient physiotherapist’s appointment book as per usual. Relevant documentation is shared by the allied health assistant (AHA), after which the physiotherapist connects via telehealth to the AHA and patient at the other site, where the patient and their carer have been shown into the treatment room from the waiting area. This method can also be used for preliminary assessments, to determine the need for a face-to-face consultation, so high-priority patients can be seen and escalated without delay.
- Procedures and patient criteria for using telehealth were developed and implemented within Hay Physiotherapy Service.
- Role plays were conducted to test equipment and procedures, train staff and improve competency and confidence across the service.
- Two physiotherapy patients volunteered to test the telehealth model, including follow-up care. Following the successful pilot, the project was made available for use according to patient need and staff availability.
- A barrier identified by physiotherapists was their confidence in the AHA to competently manage patient care. AHA competency needs were identified. A proposal for assessment of these competencies was drafted for TAFE NSW that would allow AHAs to learn how to facilitate telehealth consultations as part of their training. This solution is still in progress.
- Other solutions were examined, such as increasing the flexibility of services across physiotherapy sites in MLHD , but were found not to be suitable.
Project status
Sustained - the initiative has been implemented and is sustained in standard business.
Key dates
March 2015 – March 2016
Implementation sites
Hay Physiotherapy Service, MLHD
Partnerships
- Wagga Wagga, Griffith and Hillston Physiotherapy Services
- TAFE NSW
- Health Education and Training Institute NSW
- NSW Agency for Clinical Innovation
Results
- Access to physiotherapy services in Hay increased from 40% in March 2015 to 81% in March 2016. This was measured by the number of weeks in which there was a physiotherapy service available on one or more days per week.
- Waiting lists were reduced from six months in February 2016 to one month in March 2016. However, the opening of a new private physiotherapy service in Hay had a significant impact on this result.
- Patient feedback was positive, with comments including: “I understood what I had to do” and “some help is better than none” and “we just wish this service had been available sooner”.
- Consultation time and skill was comparable for both modes of care delivery. The differences to usual practice included the need for:
- better verbal communication
- strong trust between the physiotherapist and AHA
- strong coordination skills by the AHA
- appropriate patient selection for telehealth services.
- Following a presentation to physiotherapists in Wagga Wagga in March 2016, a physiotherapy and Telehealth Action Working Group was formed to expand the implementation of telehealth services in physiotherapy services and develop policies to manage this implementation across MLHD .
- Project findings were shared at the MLHD Allied Health Forum in May 2016 and an abstract was accepted to the 2016 Services for Australian Rural and Remote Allied Health National Conference. A poster presentation was showcased at the NSW Rural Health Research Congress at Tweed Heads and the NSW Health and Biomedical Research Symposium in Wagga Wagga, both in November 2016.
- A new private physiotherapy service opened in Hay in March 2016. This increased the availability of physiotherapists in the area during implementation of the project. The combination of this new service and the telehealth model has improved the availability of physiotherapy services in Hay and now provides patients with a choice between public and private services in the local area.
Awards
- 2016 MLHD Innovation Awards Nominee – Local Solutions
- 2016 MLHD Innovation Awards Winner – Chief Executive’s Award
- 2016 MLHD ACI Innovation Award Winner
Lessons learnt
- The AHA position at Hay Physiotherapy Service was vacated, which temporarily halted the use of telehealth until a new AHA was recruited and trained. This highlights the importance of the AHA in this model of care.
- Having electronic medical records for all patients simplifies the management of information and procedures for this model of care.
- Using telehealth for outpatient care does involve a change in the way physiotherapists deliver patient care. Change takes time, practice, considerable effort in the initial stages and ongoing reflective practice.
- The project requires collaboration across sites, disciplines, external experts and staff, despite geographical barriers.
- Involving patients and their carers in healthcare decisions is important and empowers them to have a say in how the service is shaped to meet their needs.
- Being open to new ideas and trying new methods was sometimes done enthusiastically and on some occasions was met with conservative caution. It’s important to work collaboratively and be respectful of all team members’ opinions.
References
- Health Workforce Australia. Australia’s Health Workforce Series: Physiotherapists in Focus. Adelaide: Health Workforce Australia; 2014.
Further reading
- Australian Physiotherapy Association. Rural and Remote Australia: Position Statement. Camberwell, Victoria: Australian Physiotherapy Association; 2014.
- Nielsen I, Kirkpatrick J. Allied Health Telehealth Capacity Building: Scoping Project. Brisbane: Queensland Health; 2015.
- NSW Agency for Clinical Innovation (ACI). Guidelines for the Use of Telehealth for Clinical and Non Clinical Settings in NSW. Chatswood: ACI; 2015.
- NSW Agency for Clinical Innovation (ACI). Pain Management Network. Chronic Pain Telehealth Pilot Project: Evaluation Report 2016. Chatswood: ACI; 2016.
- Raven M, Bywood P. Allied Health Video Consultation Services. Primary Health Care Research & Information Service (PHCRIS) Policy Issue Review. Adelaide: PHCHRIS; 2013.
- Russell, TG. Goniometry via the internet. Australian Journal of Physiotherapy 2007; 53(2): 136.
- NSW Ministry of Health. Allied Health Assistant Framework, GL2013_005. Sydney: NSW Health; 2013.
- Australian Physiotherapy Association
- American Physical Therapy Association. Telehealth. 2017.
- Australian College of Rural and Remote Medicine. Telehealth Standards. 2016.
- Commonwealth Dept of Health. Telehealth: Specialist Video Consultations under Medicare. MBS Online. Commonwealth of Australia; 2014.
Contact
Ellen McMaster
Physiotherapist
Griffith Base Hospital
Murrumbidgee Local Health District
Phone: 0427 087 933
ellen.mcmaster@health.nsw.gov.au
