'The big value of it is getting the patient seen by the right person at the right time': clinician perceptions of the value of allied health primary contact models of care.

Allied health primary contact clinic models of care have increasingly been used as a strategy to increase public health service capacity. A recent systematic review found little consistency or agreement on how primary contact clinics are evaluated. The concept of value of primary contact clinics, which has important implications for evaluation, has not yet been explored in-depth. To explore allied health clinicians' perceptions of the value of allied health primary contact clinics, with the goal of informing an evaluation framework, a descriptive qualitative approach utilizing semi-structured interviews was employed. Participants included allied health staff embedded in clinical lead roles within primary contact clinics across four acute care hospitals in a metropolitan health service located in South-East Queensland, Australia. Lead staff from 30 identified primary contact clinic models in the health service were approached to take part via email. All eligible participants who provided consent were included. An inductive thematic analysis approach was used. A total of 23 clinicians (n = 23) representing 22 diverse models of primary contact clinics participated. Most participants were physiotherapists, dietitians, or occupational therapists, although speech pathology, audiology, and podiatry were also represented. Participant perceptions of the 'value' of PCCs were a highly complex phenomenon, comprising five intersecting domains: (i) patient satisfaction; (ii) clinical outcomes; (iii) care pathway and resource use; (iv) health service performance; and (v) staff satisfaction and professional standing. These five core value domains were positively or negatively influenced by 12 perceived benefits and 8 perceived drawbacks, respectively. Value domains were also highly interrelated and impacted upon each other. The concept of 'value' relating to primary contact clinics involves multiple intersecting domains encompassing different perspectives. This study highlighted potential benefits and drawbacks of primary contact clinics that have not yet been measured or explored in the literature, and as such may be useful for healthcare administrators to consider. The findings of this study will inform an evaluation framework including health economics calculator for primary contact clinics.

Dysphagia Management in the Emergency Department: Using Concept Mapping to Identify Actionable Change to Improve Services.

BACKGROUND: Integrated speech-language pathology (SLP) services within the emergency department (ED) may facilitate timely dysphagia management. However, there are multiple patient and logistical factors specific to the ED that challenge the delivery of optimal dysphagia referral and management practices within this setting. The aim of the current study was to engage a stakeholder group to identify prioritised, actionable goals that could help enhance dysphagia management within the ED. METHODS AND PROCEDURES: Applying concept mapping methodology, 16 ED stakeholders from SLP, medical, nursing, and leadership participated in semi-structured interviews to develop action statements which were sorted and ranked for importance and changeability. Multidimensional scaling and hierarchical cluster analysis were used to organise data in clusters with unifying themes before statements were ranked by importance and changeability. OUTCOMES AND RESULTS: Stakeholders identified 53 unique statements, grouped into 8 clusters. Review of the 8 clusters identified 3 overarching aspects for change: (a) Improving processes related to identification and referral of patients as well as communication; (b) Teamwork and collaboration amongst the ED multidisciplinary team and SLP; and (c) Improving staffing and access to training resources for SLP and nursing teams. Seventeen statements were within the Go-zone rated highest for importance and changeability) with the highest rated statement being: Clear documentation by SLP re: recommendations. CONCLUSION: The current data identified multiple aspects of service provision that require change to facilitate improved dysphagia referral and management services in the ED. Collaborative actions are required by both SLP and the ED multidisciplinary team to help optimise dysphagia services.