Randomised controlled trial of a transprofessional healthcare role intervention in an acute medical setting.

As demand for health services increases, attention has turned to the development of alternate models of service delivery that maximise efficiency. These include skill sharing models, in which cross-professional skills are delivered by appropriately trained professionals. The usage of skill sharing models is increasing in some professions, but little evidence on efficacy currently exists. This article reports on an intervention of the use of a transprofessional role, which involved delivery of services from a range of health providers, including physiotherapy, occupational therapy, dietetics, speech pathology, podiatry, social work, and psychology, by a trained professional, developed and trialled in the acute medical setting in Toowoomba Hospital, Queensland, Australia. A single-blind randomised controlled trial examined the clinical efficacy of this skill shared service. Participants were allocated at random to either standard care (n = 29) or the new model of care (n = 29) groups and compared on a range of patient and service provision outcome measures. Descriptive outcomes indicated that patients receiving the new model of care underwent more comprehensive and prompt assessments in the health domains included than those in standard care, and demonstrated more positive health and functional outcomes at 1-, 3-, and 6-month follow-up. Given the paucity of research on skill sharing, this study provides preliminary evidence of the effectiveness of skill shared roles in acute settings.

Health needs of regional Australian children in out-of-home care.

AIM: This study aims to identify the health needs of children placed in out-of-home care in regional Queensland and to compare them with the needs of similar children in metropolitan Queensland. METHODS: Retrospective chart review and subsequent analysis of data from the first assessments of the children placed in care from January 2005 to April 2011. Health needs based on assessment recommendations were then compared with needs and recommendations from a similar clinic in metropolitan Brisbane. RESULTS: Two hundred thirty-nine first assessments were reviewed. The average number of health referrals arising out of each assessment was 2. 72% children were between 2 and 12 years of age and accounted for 76% of the health referrals made. The 10-13% of the children needed referrals for medical and surgical specialties, audiology, speech pathology, dental, and ophthalmology/optometry, each. A percentage of 30 needed ongoing paediatric care. The 15% needed immunisation catch up, 35% counselling and behaviour management, and 15% formal mental health referrals. These were comparable to the health needs identified in out-of-home care children residing in metropolitan Queensland. CONCLUSION: Children in care who live in a regional setting have similar health-care needs compared with urban children. Given restricted health services in regional settings, there is difficulty in accessing services to meet these needs.

Infant abusive head trauma incidence in Queensland, Australia.

This study describes the incidence of head injuries caused by abuse in an Australian infant sample. The frequency of abusive head trauma established by the study is comparable with that reported both internationally and for age-incidence peaks of alternate forms of childhood injury, highlighting the need for investment in prevention initiatives.

Infant abusive head trauma - incidence, outcomes and awareness.

BACKGROUND: Abusive head trauma of infants is a significant cause of morbidity and mortality. The incidence in Australia has been estimated at 29.6 cases of abusive head trauma for which hospital admission is required per 100 000 infants aged 0-24 months and under per year; more frequent than low speed runovers, drowning and childhood neoplasms. OBJECTIVE: This article provides a review of the significant incidence and outcomes of abusive head trauma and seeks to raise awareness of the potential of evidence based interventions to reduce infant injury and its consequences in the community. DISCUSSION: An evidence based program, the Period of PURPLE Crying®, has been shown to reduce infant injury. An evaluation of the suitability of program materials for different cultural groups in Australia needs to be assessed. Such a scoping project is proposed as a necessary prerequisite to a pilot clinical intervention.

Health of Australian children in out-of-home care: needs and carer recognition.

AIM: Following research highlighting high levels of health need in New South Wales children in out-of-home care, this study aimed to quantify health need in a sample of Queensland children in care based on multidisciplinary child health assessments. The study also sought to examine the concordance between foster carers' health concerns for children for whom they are providing care and health need as established through referrals made as a result of health assessment. METHODS: Children entering out-of-home care in the north Brisbane area within the previous month were referred for baseline child health assessment. Child health was assessed by paediatricians and clinical nurses utilising a pro forma-based methodology. Analysis of initial carer concerns, health referrals and immunisation status in the sample was undertaken. RESULTS: Of the 63 children assessed, 70% were found to require multiple referrals to various health services. The most frequently made referrals included paediatrician follow-up (41% of children), counselling services (30%) and audiology (26%). Only 68% of the sample was found to be fully immunised. A discrepancy was noted between foster carers' child health concerns and level of referral need established during assessment. CONCLUSIONS: Queensland children in care have high health needs similar to those evidenced by children in care in other areas of Australia. Foster carers appear to underestimate the health needs of children in their care, demonstrating the necessity of multidisciplinary health screens and foster carer training in order to detect child health problems in this population.

Effects of gender, indigenous status and remoteness to health services on the occurrence of assault-related injuries in children and adolescents.

BACKGROUND: Assault-related injury is a devastating consequence of violence and is a prominent cause of morbidity and mortality in young age. However, reliable data sources are scarce and there has been a paucity of studies examining possible predisposing factors on the incidence of assault-related injury. METHOD: Logistic regression analyses were conducted to examine the effect of gender, indigenous status and remoteness to health services on sustaining assault-related injuries in patients aged 17 years and under by using data from the state-wide trauma registry in Queensland, Australia from 2005 to 2008. RESULTS: A total of 282 assault-related injury cases were identified. Indigenous females were at the highest risk of sustaining assault-related injuries (odds ratio (OR): 15.3, 95% confidence interval (CI): 8.17-28.6), followed by indigenous males (OR: 6.55, 95% CI: 3.60-11.9) and non-indigenous males (OR: 2.82, 95% CI: 1.78-4.47). Males were at a significantly higher risk than females in the group aged 13-17 years (OR: 2.11, 95% CI: 1.34-3.31). Living in a regional area was associated with a lower risk compared to major cities for non-indigenous people (OR: 0.59, 95% CI: 0.44-0.78). Indigenous people were at higher risk of sustaining an assault-related injury than non-indigenous people in regional areas (OR: 4.8, 95% CI: 3.14-7.42) and in remote areas (OR: 10.1, 95% CI: 2.64-38.69). CONCLUSIONS: The current study provides evidence of interaction effects among the predisposing factors. Identifying these factors is important to conduct effective preventive measures and trauma management plans focussing on high-risk groups of assault-related injuries in young age.