Enhancing the quality of allied health clinical supervision in a regional setting: An action research study.

OBJECTIVE: To explore and describe strategies to enhance the implementation of an organisational clinical supervision framework and subsequently inform the development of a model of implementation of clinical supervision for allied health professionals in a regional health care setting. SETTING: A large regional health service in Victoria, providing hospital, rehabilitation, community, mental health and aged care services. PARTICIPANTS: Allied health managers employed at the health service were members of an action research group. DESIGN: This longitudinal study used an action research approach. The action research group informed the repeated cycles of planning, action and reflection. Data from recorded action research meetings were analysed using content analysis. RESULTS: The action research group met 11 times over a 5-year period informing four action research cycles. Six main themes relating to factors that enhanced the quality of clinical supervision emerged from the analysis of the action research group data: purpose and value of clinical supervision; clinical supervision characteristics; differences between disciplines; framework development; training and support and implementation of clinical supervision. CONCLUSION: The findings from this comprehensive longitudinal study provide evidence-based approaches to the implementation of allied health clinical supervision. The action research approach used ensures that the strategies described are realistic and sustainable. A model has been developed to inform the implementation of clinical supervision for allied health.

Effectiveness of allied health clinical supervision following the implementation of an organisational framework.

BACKGROUND: Clinical supervision makes an important contribution to high quality patient care and professional wellbeing for the allied health workforce. However, there is limited research examining the longitudinal implementation of clinical supervision for allied health. The aim of this study was to determine the effectiveness of clinical supervision for allied health at a regional health service and clinicians' perceptions of the implementation of an organisational clinical supervision framework. METHODS: A cross-sectional study was conducted as a phase of an overarching participatory action research study. The Manchester Clinical Supervision Scale (MCSS-26) tool was used to measure clinical supervision effectiveness with additional open-ended questions included to explore the implementation of the clinical supervision framework. MCSS-26 findings were compared with an initial administration of the MCSS-26 5 years earlier. MCSS-26 data (total scores, summed domain and sub-scale scores) were analysed descriptively and reported as mean and standard deviation values. Differences between groups were analysed with independent-samples t-test (t) and one-way between groups ANOVA. RESULTS: There were 125 responses to the survey (response rate 50%). The total MCSS-26 score was 78.5 (S.D. 14.5). The total MCSS-26 score was unchanged compared with the initial administration. There was a statistically significant difference in clinical supervision effectiveness between speech pathology and physiotherapy (F = 2.9, p = 0.03) and higher MCSS-26 scores for participants whose clinical supervisor was a senior clinician and those who chose their clinical supervisor. Seventy percent of participants perceived that the organisation's clinical supervision framework was useful and provided structure and consistent expectations for clinical supervision. CONCLUSIONS: Clinical supervision was effective for allied health in this regional setting and clinical supervision effectiveness was maintained over a 5 year period. The implementation of an organisational clinical supervision framework may have a positive effect on clinical supervision for some professions.

The foot-health of people with diabetes in regional and rural Australia: baseline results from an observational cohort study.

BACKGROUND: There is limited Australian epidemiological research that reports on the foot-health characteristics of people with diabetes, especially within rural and regional settings. The objective of this study was to explore the associations between demographic, socio-economic and diabetes-related variables with diabetes-related foot morbidity in people residing in regional and rural Australia. METHODS: Adults with diabetes were recruited from non-metropolitan Australian publicly-funded podiatry services. The primary variable of interest was the University of Texas diabetic foot risk classification designated to each participant at baseline. Independent risk factors for diabetes-related foot morbidity were identified using multivariable analysis. RESULTS: Eight-hundred and ninety-nine participants enrolled, 443 (49.3%) in Tasmania and 456 (50.7%) in Victoria. Mean age was 67 years (SD 12.7), 9.2% had type 1 diabetes, 506 (56.3%) were male, 498 (55.4%) had diabetes for longer than 10 years and 550 (61.2%) either did not know the ideal HbA1c target or reported that it was ≥7.0. A majority had peripheral neuropathy or worse foot morbidity (61.0%). Foot morbidity was associated with male sex (OR 2.42, 95% CI 1.82-3.22), duration of diabetes > 20 years (OR 3.25, 95% CI 2.22-4.75), and Tasmanian residence (OR 3.38, 95% CI 2.35-4.86). CONCLUSIONS: A high proportion of the regional Australian clinical population with diabetes seen by the publicly-funded podiatric services in this study were at high risk of future limb threatening foot morbidity, and participants residing in Northern Tasmania are more likely to have worse diabetes-related foot morbidity than those from regional Victoria. Service models should be reviewed to ensure that diabetes-related foot services are appropriately developed and resourced to deliver interdisciplinary evidence-based care.

Effectiveness of Allied Health Clinical Supervision: A Cross-Sectional Survey of Supervisees.

OBJECTIVE: Clinical supervision (CS) is widely used by allied health (AH) professionals, although with limited supporting research evidence. The aim of this study was to evaluate the effectiveness of CS for AH professionals in a regional health setting and to investigate differences in CS perceptions between AH disciplines. METHODS: Within a participatory action research project, a quantitative cross-sectional survey was distributed to AH professionals at a regional Australian health service. Data were collected using the Manchester Clinical Supervision Scale (MCSS-26), and differences between disciplines were analysed with independent-samples t-tests and one-way between-groups ANOVA. Of a possible 258 participants, 106 responded to the survey (response rate 41%). The action research group assisted with the interpretation of findings. RESULTS: The total mean for MCSS-26 scores across AH was 78.5 ± 13.9 (SD), which is above the recommended threshold score for effective CS (73). There were statistically significant differences in total scores between occupational therapy (82.8 ± 14.4) and physiotherapy (70.9 ± 11.3) and in the formative and restorative domains. CONCLUSIONS: While CS was perceived to be effective, there were significant differences between some disciplines. The findings demonstrate that CS is effective when it is practised within a structured framework; however, flexible models of CS across disciplines need to be explored.

An organised approach to the podiatric care of people with diabetes in regional Australia.

OBJECTIVE: To ensure an efficient publicly funded podiatric service for people with diabetes in regional Victoria, a Podiatry Diabetes Model (PDM) of care was developed. The aim of this study was to determine if people with diabetes attended the most appropriate podiatric service as depicted by the model. METHODS: A 3-month prospective clinical audit of the PDM was undertaken. Primary variables of interest were the podiatric service where the patients were seen and the patients' risk of future foot morbidity. Chi-square analyses for each service category were undertaken to compare the expected number of patients seen according to foot-health risk as predicted by the model, with what was observed. RESULTS: Five hundred and seventy-six people with diabetes were seen in the 3-month period. There was no statistically significant difference between the proportion of patients seen by each podiatric service according to risk status, with what was expected (community: χ(2)=3.3, P=0.4; subacute: χ(2)=8.0, P=0.05; acute: χ(2)=6.6, P=0.09). CONCLUSIONS: The Podiatry Diabetes Model is a sound podiatric model of care and is an example of cross-organisational collaboration that could be implemented in other areas of Australia.

The foot-health of people with diabetes in a regional Australian population: a prospective clinical audit.

BACKGROUND: There is limited understanding of the foot-health of people with diabetes in Australian regional areas. The aim of this study was to document the foot-health of people with diabetes who attend publically funded podiatric services in a regional Australian population. METHODS: A three month prospective clinical audit was undertaken by the publically-funded podiatric services of a large regional area of Victoria, Australia. The primary variables of interest were the University of Texas (UT) diabetic foot risk classification of each patient and the incidence of new foot ulceration during the study period. Age, gender, diabetes type, duration of diabetes and the podiatric service the patients attended were the other variables of interest. RESULTS: Five hundred and seventy six patients were seen during the three month period. Over 49% had a UT risk classification at a level at least peripheral neuropathy or more serious diabetes-related foot morbidity. Higher risk at baseline was associated with longer duration of diabetes (F = 31.7, p < 0.001), male gender (χ2 = 40.3, p <0.001) and type 1 diabetes (χ2 = 37.3, p <0.001). A prior history of foot pathology was the overwhelming predictor for incident ulceration during the time period (OR 8.1 (95% CI 3.6 to 18.2), p < 0.001). CONCLUSIONS: The publically funded podiatric services of this large regional area of Australia deal with a disproportionally large number of people with diabetes at high risk of future diabetes-related foot complications. These findings may be useful in ensuring appropriate allocation of resources for future public health services involved in diabetic foot health service delivery in regional areas.

Charcot osteoarthropathy of the foot.

BACKGROUND: One of the most devastating complications of diabetes is Charcot osteoarthropathy. It can lead to gross structural deformities of the foot and ankle, and subsequent skin ulceration and lower limb amputation from soft tissue or bony infection. However, it is often unrecognised, with deleterious consequences. OBJECTIVE: This article describes the case of a man with type 1 diabetes who presented with Charcot osteoarthropathy of both feet, with a 3 month delay in diagnosis between the two presentations. DISCUSSION: Treatment, patient comorbidities and risk management were similar for both feet, with a marked difference in outcome, demonstrating the importance of the timely diagnosis of Charcot osteoarthropathy.