The impact of a Calderdale Framework designed advanced pharmacy assistant role on inpatient pharmacy services.

Background Pharmacists in Australian hospitals do not see all inpatients. Effectively utilising pharmacy assistants in non-traditional roles may provide an opportunity to increase the number of patients seen by pharmacists. Objective To implement a Calderdale Framework designed advanced pharmacy assistant role on an inpatient unit and evaluate the impact of the role on the provision of clinical pharmacy services provided by the pharmacist in an Australian University hospital. Setting The study was conducted in a single 24-bed medical IPU at a tertiary hospital in Queensland, Australia. Method A quasi-experimental two-cohort comparison design, completed over three phases from 30/5/2016 to 30/9/2016 was employed. To evaluate the impact of the advanced pharmacy assistant on an inpatient unit an 8-week period of usual care was compared to the same time period on the same unit where the pharmacist provided usual care with the support of an advanced assistant. Pharmacist and assistant satisfaction was also surveyed. A training and lead-in phase was completed to ensure the advanced pharmay assistant was competent in completing the delegated tasks. Main outcome measure The primary outcome was percentage change of medication management plans documented by the pharmacist with an advanced assistant comparative to the pharmacist without. Results The number of documented medication management plans significantly increased by 9.5% (p = 0.019; CI 1.86-17.14). Plans documented within 24 h and time to documentation remained unchanged. Completeness increased in community pharmacy documentation. The percentage of completed discharge medication records rose by 15.6%, (p < 0.001; CI 7.78-23.16). Interventions documented increased by 55 and the percentage of patients with clinical reviews documented increased by 35%. There were fewer missed doses recorded and pharmacists spent more time on clinically based tasks. Pharmacist and assistant satisfaction also improved. Conclusion The use of the Calderdale Framework enabled structured pharmacy assistant role redesign that impacted significantly on the provision of clinical pharmacy services on an inpatient unit.

The effectiveness and feasibility of TREAT (Tailoring Research Evidence and Theory) journal clubs in allied health: a randomised controlled trial.

BACKGROUND: Journal clubs (JC) may increase clinicians' evidence-based practice (EBP) skills and facilitate evidence uptake in clinical practice, however there is a lack of research into their effectiveness in allied health. We investigated the effectiveness of a structured JC that is Tailored According to Research Evidence And Theory (TREAT) in improving EBP skills and practice compared to a standard JC format for allied health professionals. Concurrently, we explored the feasibility of implementing TREAT JCs in a healthcare setting, by evaluating participating clinicians' perceptions and satisfaction. METHODS: We conducted an explanatory mixed methods study involving a cluster randomised controlled trial with a nested focus group for the intervention participants. Nine JCs with 126 allied health participants were randomly allocated to receive either the TREAT or standard JC format for 1 h/month for 6 months. We conducted pre-post measures of EBP skills and attitudes using the EBP questionnaire and Assessing Competence in Evidence-Based Medicine tool and a tailored satisfaction and practice change questionnaire. Post-intervention, we also conducted a focus group with TREAT participants to explore their perceptions of the format. RESULTS: There were no significant differences between JC formats in EBP skills, knowledge or attitudes or influence on clinical practice, with participants maintaining intermediate level skills across time points. Participants reported significantly greater satisfaction with the organisation of the TREAT format. Participants in both groups reported positive changes to clinical practice. Perceived outcomes to the TREAT format and facilitating mechanisms were identified including the use of an academic facilitator, group appraisal approach and consistent appraisal tools which assisted skill development and engagement. CONCLUSIONS: It is feasible to implement an evidence-based JC for allied health clinicians. While clinicians were more satisfied with the TREAT format, it did not significantly improve their EBP skills, attitudes, knowledge and/or practice, when compared to the standard format. The use of an academic facilitator, group based critical appraisal, and the consistent use of appraisal tools were perceived as useful components of the JC format. A structured JC may maintain EBP skills in allied health clinicians and facilitate engagement, however additional training may be required to further enhance EBP skills. TRIAL REGISTRATION: ACTRN12616000811404 Retrospectively registered 21 June 2016.

Effects and mechanisms of an allied health research position in a Queensland regional and rural health service: a descriptive case study.

The aim of the present case study is to illustrate the outcomes of a dedicated allied health (AH) research position within a large Queensland regional and rural health service. The secondary aim of the case study is to describe the enabling and hindering mechanisms to the success of the role. Semistructured interviews were conducted with the Executive Director of Allied Health and the current AH research fellow incumbent within the health service. A focus group was also undertaken with six stakeholders (e.g. clinicians, team leaders) who had engaged with the research position. Outcomes of the AH research fellow included clinical and service improvements, enhanced research culture and staff up-skilling, development of research infrastructure and the formation of strategic research collaborations. Despite being a sole position in a geographically expansive health service with constrained resources, key enabling mechanisms to the success of the role were identified, including strong advocacy and regular communication with the Executive. In conclusion, the case study highlights the potential value of an AH research position in building research capacity within a large non-metropolitan health service. Factors to facilitate ongoing success could include additional research and administrative funding, as well as increased use of technology and team-based research.

A cross sectional observational study of research activity of allied health teams: is there a link with self-reported success, motivators and barriers to undertaking research?

BACKGROUND: Team-based approaches to research capacity building (RCB) may be an efficient means to promote allied health research participation and activity. In order to tailor such interventions, a clearer understanding of current patterns of research participation within allied health teams is needed. Different self-report measures exist which evaluate a team's research capacity and participation, as well as associated barriers and motivators. However, it remains unclear how such measures are associated with a team's actual research activity (e.g., journal publications, funding received). In response, this observational study aimed to identify the research activity, self-reported success, and motivations and barriers to undertaking research of eight allied health professional (AHP) teams and to explore whether any relationships exist between the self-reported measures and actual research activity within each team. METHODS: A total of 95 AHPs from eight teams completed the research capacity and culture survey to evaluate team success, barriers and motivators to undertaking research, and an audit of research activity from January 2013 to August 2014 was undertaken within each team. Kendell's correlation coefficients were used to determine the association between research activity (i.e., number of journal publications, ethically approved projects and funding received) and the self-reported measures. RESULTS: Seven out of eight teams rated their teams as having average success in research and demonstrated some form of research activity including at least two ethically approved projects. Research activity varied between teams, with funding received ranging from $0 to over $100,000, and half the teams not producing any journal publications. Team motivators demonstrated a stronger association with research activity compared to barriers, with the motivator "enhancing team credibility" being significantly associated with funding received. No significant association between self-reported research success and actual research activity was identified. CONCLUSIONS: Preliminary findings suggest that self-report measures of research success may not always correspond to actual research activity, and a combination of both these measures may be useful when planning RCB interventions. Variation in activity between teams and organisations should also be considered when tailoring RCB interventions. Reinforcing intrinsically motivating rewards of research may also be useful in promoting research participation for some teams.

Allied health research positions: a qualitative evaluation of their impact.

BACKGROUND: Research positions embedded within healthcare settings have been identified as an enabler to allied health professional (AHP) research capacity; however, there is currently limited research formally evaluating their impact. In 2008, a Health Practitioner industrial agreement funded a research capacity building initiative within Queensland Health, Australia, which included 15 new allied health research positions. The present project used a qualitative and realist approach to explore the impact of these research positions, as well as the mechanisms which facilitated or hindered their success within their respective organisations. METHODS: Forty-four AHP employees from six governmental health services in Queensland, Australia, participated in the study. Individual interviews were undertaken, with individuals in research positions (n = 8) and their reporting line managers (n = 8). Four stakeholder focus groups were also conducted with clinicians, team leaders and professional heads who had engaged with the research positions. RESULTS: Nine key outcomes of the research positions were identified across individual, team/service and organisational/community levels. These outcomes included clinician skill development, increased research activity, clinical and service changes, increased research outputs and collaborations, enhanced research and workplace culture, improved profile of allied health, development of research infrastructure, and professional development of individuals in the research positions. Different mechanisms that influenced these outcomes were identified. These mechanisms were grouped by those related to the (1) research position itself, (2) organisational factors and (3) implementation factors. CONCLUSIONS: The present findings highlight the potential value of the research positions for individuals, teams and clinical services across different governmental healthcare services, and demonstrate the impact of the roles on building the internal and external profile of allied health. Results build upon the emerging evidence base for allied health research positions and have important implications for a number of stakeholders (i.e. individuals in the research positions, AHPs and their managers, university partners and state-wide executives). Key recommendations are provided for all stakeholders to enhance the ongoing impact of these roles and the potential advocacy for additional positions and resources to support them.

Is more intensive better? Client and service provider outcomes for intensive versus standard therapy schedules for functional voice disorders.

BACKGROUND: Functional dysphonias are commonly associated with reduced treatment attendance leading to variable treatment outcomes. Preliminary research has proposed that intensive treatment may improve client adherence and outcomes; however, further research into the application of intensive models in functional dysphonia in comparison with standard intensity models is warranted. AIMS: The present study evaluated the impact of intensive and standard treatments on functional, well-being, and service outcome measures in clients with functional dysphonia. METHODS: Participants with a functional dysphonia were randomly allocated to one of two treatment groups: (1) intensive treatment (n = 7) or (2) standard treatment (n = 9). Participants completed the voice handicap index (VHI) and the Australian therapy outcome measures voice assessment (conducted by a blinded assessor) before and after treatment and 4 weeks after treatment. Satisfaction questionnaires were completed after treatment and data pertaining to attendance and duration of intervention were collected throughout treatment. In addition to a vocal hygiene education session, all participants received a total of 8 hours of treatment; intensive treatment consisted of four 1-hour treatment sessions per week over 2 weeks, whereas the standard group received one 1-hour treatment session per week over 8 weeks. RESULTS: High satisfaction and statistically significant improvements on the VHI ratings were found after treatment in the intensive group. Significantly greater attendance rates were found in the intensive group. Intensive treatment is a potentially viable service delivery option for functional dysphonia and warrants further larger scale investigation.

Changes to articulation following LSVT(R) and traditional dysarthria therapy in non-progressive dysarthria.

The present study aimed to evaluate the effects of the Lee Silverman Voice Treatment (LSVT(R)) on acoustic and perceptual measures of articulation in non-progressive dysarthria in comparison to traditional dysarthria therapy. The study involved 26 individuals with non-progressive dysarthria who were randomly allocated to receive either LSVT(R) or traditional dysarthria therapy (TRAD), both of which were administered for 16 hourly sessions over 4 weeks. Participants' speech samples were collected over a total of six testing sessions during three assessment phases: (1) prior to treatment, (2) immediately post-treatment, and (3) 6 months post-treatment (FU). Speech samples were analysed perceptually to determine articulatory precision and intelligibility as well as acoustically using vowel space (and vowel formant measures) and first moment differences. Results revealed short and long-term significant increases in vowel space area following LSVT(R). Significantly increased intelligibility was also found at FU in the LSVT(R) group. No significant differences between groups for any variables were found. The study reveals that LSVT(R) may be a suitable treatment option for improving vowel articulation and subsequent intelligibility in some individuals with non-progressive dysarthria.

Effectiveness of Lee Silverman Voice Treatment (LSVT) on hypernasality in non-progressive dysarthria: the need for further research.

BACKGROUND: Hypernasality is a common feature of non-progressive dysarthria. However, limited research has investigated the effectiveness of treatments for this impairment. Preliminary research has revealed positive effects on nasalance when using increased loudness in certain non-progressive dysarthric speakers. However, the long-term effects of loud speech on nasalance as part of a structured intervention such as Lee Silverman Voice Treatment (LSVT) are yet to be investigated in this population. AIMS: The study aimed to investigate the short- and long-term effects of LSVT on hypernasality (perceptual ratings and degree of nasalance) in non-progressive dysarthria; and secondly, to evaluate the effects of traditional dysarthria therapy on these same measures, in comparison with the effects of LSVT. METHODS & PROCEDURES: Ten non-progressive dysarthric speakers with varying levels of hypernasality (taken from a larger research study) were randomly allocated to receive LSVT((R)) (n = 5) or individually tailored traditional dysarthria therapy (n = 5). Both treatments were administered four times weekly for 4 weeks (that is, 16 x 1-hour sessions). Participants were assessed twice before treatment, twice immediately post-treatment, and twice at follow-up 6 months post-treatment using a perceptual rating task performed by two independent speech pathologists, and the Nasometer. Changes to individual mean nasalance scores were compared against clinically significant criterion and perceptual ratings were analysed descriptively. OUTCOMES & RESULTS: Three out of five participants demonstrated reductions in perceived hypernasality immediately following LSVT, but these changes were maintained at follow-up for only one participant. Two of these three participants demonstrated a corresponding reduction in mean nasalance. Limited changes in perceived hypernasality and nasalance scores were found following traditional dysarthria therapy, with only one participant exhibiting reduced nasalance at follow-up. CONCLUSIONS & IMPLICATIONS: Due to the small sample size in the present research and variability between participants, further exploration into the effects of LSVT on nasality with a larger population with different dysarthria types is essential.

The short- and long-term effectiveness of the LSVT for dysarthria following TBI and stroke.

OBJECTIVES: To examine the effectiveness of Lee Silverman Voice Treatment (LSVT) for the treatment of 10 individuals with dysarthria following TBI and stroke. RESEARCH DESIGN: ABAA experimental research design. METHODS: Participants received 4 weeks of the standard LSVT programme. To measure the effects of intervention, participants were assessed using perceptual and acoustic speech measures and everyday communication outcome measures prior to, immediately post and 6 months post-treatment. RESULTS: Following treatment, participants demonstrated statistically and clinically significant improvements to several acoustic and perceptual parameters. This included increased vocal loudness in sustained phonation and connected speech, increased vocal frequency range and improved word and sentence intelligibility. Improved ratings of communication initiation and participation and well-being were also found on the AusTOMs and items on participant questionnaires post-LSVT. The majority of treatment effects were maintained 6 months following treatment. CONCLUSIONS: LSVT has the potential to be a viable treatment option for individuals with dysarthria featuring respiratory-phonatory impairments following TBI and stroke.