[Opening visual of slide with text saying ‘National Allied Health Virtual Research Forum’, ’30 April 2024’, ‘Australian Government with Crest (logo)’, ‘Department of Health and Aged Care’, ‘www.health.gov.au’]
[The visuals during this webinar are of each speaker presenting in turn via video, with reference to the content of a PowerPoint presentation being played on screen]
Amber Shuhyta:
Welcome everyone to the National Allied Health Virtual Research Forum. Thank you so much for joining us. I’d like to acknowledge the traditional custodians of the lands around Australia which people are joining us online from. I’d like to acknowledge and pay my respects to their Elders past and present of all of the countries around Australia. And I’m coming to you from lovely Ngunnawal country so I pay my respects to Ngunnawal people and other families and communities that have connection to the region. I’d like to extend that respect to any Aboriginal and Torres Strait Islander people who are joining us in the forum today.
My name is Amber Shuhyta and I’m the Assistant Secretary of the Allied Health and Service Integration Branch here in the Department of Health and Aged Care. I lead the team that has been collaborating with the Australian Allied Health Professors to develop this event. I’ll be your Chair today. And listed on the screen are what we’re hoping this event will achieve. Facilitating better links, understanding and discussion between allied health research and policy worlds.
A few housekeeping points before we begin. We are recording the event and sharing the recording slides after the event. So feel free to share with your colleagues. There’s a closed caption function on your Webex screen should you require this. And we will also use Slido for any questions you would like to ask of our presenters.
Our program for the afternoon is on the screen. We will start with a keynote, move into six rapid abstract presentations before taking a short break. After the break we’ll have six more abstract presentations, our second keynote, and then to close we will bring things together in a panel discussion.
So let’s move right into it. It’s my pleasure to open the event with a keynote address from Professor Peter Bragge. Peter is an evidence-based policy and practice scholar specialising in evidence synthesis to support better decision making. He leads Monash Sustainable Development Institute’s Evidence Review Service which has delivered over 50 reviews to Government, philanthropic and industry organisations. Peter will speak to us today about the two-way policy pipeline between researchers and Governments. So welcome Peter.
Professor Peter Bragge:
[Visual of slide with text saying ‘Monash University’, ‘Monash Sustainable Development Institute’, ‘The Two-Way Policy Pipeline’, ‘Peter Bragge’, ‘National Allied Health Research Forum’, ‘April 30, 2024’]
Thanks very much Amber. And it’s a great pleasure to be joining you from Wurundjeri country here in Melbourne. I’m going to request control and I should be able to operate the slides from here. So I’m going to talk a little bit about where I come from in terms of my position at the University and then get straight into really three key messages about optimising evidence-based policy and practice which has been a focus of my research career for the last 15 years or so.
Okay. Let’s see if I can move the slides. I knew this would happen. Okay. Here we go. Right. So Monash Sustainable Development Institute is a non-faculty aligned institute at Monash University here in Melbourne. As our name suggests we are heavily committed to advancing action on the sustainable development goals. So that means obviously in health but also in other areas such as climate action and systems transformations. We’re now about 200 plus which makes us the size of at least a couple of faculties at Monash University. And one of the really exciting things about the way we work is that we deliver almost all of our work direct to Government, philanthropic and industry organisations. So the vast majority of our work is actually not through the research schemes that many other researchers do their work through. It’s direct to Government. And I’m going to talk about some insights of that approach.
I lead a small team within MSDI called very imaginatively the Evidence Review Service, and essentially we are methodological experts in delivering rapid evidence reviews to Governments, philanthropic and other organisations to help them make better decisions or more informed decisions that take account of research knowledge. We do a range of other activities including helping organisations to prioritise when they have multiple challenges and limited budgets. We do practice reviews alongside our evidence reviews which involve talking to experts in the field to contextualise global review knowledge for local audiences, and we also do teaching and training around all of those techniques and methods.
One of my favourite sayings, which is probably as good a summary of my career focus as any, is actually pretty old now but it is the idea that people who are taking action to address complex challenges in the world should be drawing upon the best available knowledge otherwise there is high potential that they’re wasting effort, money and resources and energy. Equally we now have such incredible access to research knowledge that we need to as a research community make sure that that knowledge is not a wasted resource sitting on the shelf. And that’s obviously the focus of all of the presentations this afternoon.
So I really want to harness this small talk around three key insights from delivering reviews and other research to Government over a period of over a decade. The first is to contextualise your research and understand I guess what it is you’re bringing to a Government or other client. The second which is really critical is to meet people where they are in terms of the problems that they are trying to solve and try and find shared agendas that allow you to collaborate and maximise the potential of the knowledge that you hold.
And the third is to begin to build an understanding of the bigger policy making picture. People often talk about the policy sausage and we don’t know what the ingredients are and it’s all very chaotic and time pressured, but we do know fundamentally what the inputs into policy are. There’s a whole raft of policy making research and models of policy making that talk about the process of identifying problems that can be addressed through better policy and moving through consultation and policy development and implementation processes.
So first I’m going to talk about contextualising research.
For my sins I wrote a paper a few years ago now where I tried to work out just how many research articles there are in the world. And I came up with this set of numbers and this pyramid which is sort of a reflection of how research knowledge is generally used. On the bottom of the pyramid – and this estimate obviously changes a lot – there’s about five billion pages on the open internet. So if you just go into an internet browser and type a question or a problem that you want solved you’re accessing a very, very large pool of content but we know that that’s not a credible pool of content.
Further up the pyramid – and again these estimates are probably a little bit out of date but let’s say there’s 70 million published peer reviewed research articles that exist in the world, and that’s exponentially a smaller number of things to think about compared with the open internet. And then at the top of the pyramid which is where I specialise, again an estimate, roughly 200,000 reviews of research evidence that have brought together the findings of some of those 65 million research articles.
So the arrows on the side are really about the disconnect between the use of evidence and the value of evidence. So at the top of the pyramid where we have the highest level of confidence in knowledge we tend to have the lowest level of use. And a lot of people, not just in policy making settings but in other time pressured environments, do default to just looking it up on the internet to see whether they can find knowledge.
So when you’re producing research it’s important to understand, and I’m sure everyone does understand, that when people say ‘Tell us about your research’ they really know nothing about where your research sits in that big pile of 65 million research articles. And this is where researchers have a responsibility to be pretty honest about where their research is. And it was really interesting to read the abstracts of the presentations we’re going to hear this afternoon and see that some of them were review-based findings that have brought together knowledge from around the world, some of them were early stage findings that need validation. And so when you’re bringing a research value proposition to a Government or another decision making organisation you need to have your own understanding of where it fits in the research landscape. So is this potential breakthrough but you need some more funding to validate and maybe do some research in larger samples? Is it a game changing trial that’s a multicentre trial that has really accelerated understanding of the effectiveness of a particular intervention? Is an outlier? Is it a study that actually suggests that perhaps some of the knowledge we have is potentially out of date or could be flawed in some way?
And so understanding where the global evidence-base is in your area of expertise is important. And it’s something that researchers do all the time but it needs to be made explicit when you’re talking about the importance of your research. It’s also important to understand that policy makers trust researchers fundamentally and they can sometimes be swept up in an outlying trial or something that is very aggressively sold to them. And so that gets back to the responsibility to be honest about where your research sits in related knowledge.
The second principle is about meeting people where they are. And there’s a whole body of research about policy windows and windows of opportunity, events that happen in society that make particular areas very salient to Government. So we would take obviously domestic violence at the moment. There’s definitely a window of opportunity because of the crisis that we’re seeing. There’s a recent announcement about made in Australia which sort of leans into perhaps med tech or manufacturing. And so these opportunities are really opportunities for impact.
But before we meet people where they are in terms of the problems we’re solving we also need to recognise that – and I learnt this after a surprising number of years, that I realised that when I was talking about research I was talking about university research that’s peer reviewed, published in journals, subject to ethical standards. And when industry and Government and others talk about research they have a much wider definition which is actually the definition of the National Health and Medical Research Council which is any investigation that produces new knowledge. It doesn’t have to be peer reviewed. It can be internal audits. It can be data insights. It can be things that people call business intelligence. When you put pieces of information together and create new information you’re doing research even if you’re not in a university.
So when I talk about evidence I mean evidence from university research which has all of those things around it like peer review and ethical guidelines. And as an academic I argue that that’s the knowledge that we can most rely on. But when Governments and other actors talk about evidence they might be talking about data, they might be talking about expert testimony, they might be talking about anecdotal evidence or findings of an audit. And so we need to be very clear when we’re talking about what it is that we’re presenting to Government.
And grey literature is another very important term and that encompasses Government reports, working papers, white papers, and a lot of knowledge in particular sectors, for example the circular economy, exists in grey literature and it doesn’t exist necessarily in peer reviewed literature. So those languages and conceptualisations are very important.
But the most important thing is whether your answer that you’re bringing to Government is matching the question that Government is grappling with at a moment in time. And it is far easier to have research impact when there is a good match between what you’re researching and what is occupying the mind of decision makers.
We have a whole taxonomy of question development that really basically means that we spend a lot of time talking to people about what exactly is the problem that you’re trying to solve and what type of research review in our case is going to be the most appropriate. And here’s a selection of some of the questions I would ask when I’m consulting with Government. I like to know who wants to know the answer to this question that you have? What do they want to do with the information that we’re going to give them? Is it going to be a standalone important piece of work? Is it going to be bundled up with other inputs? And what decisions are we potentially influencing versus decisions that have already been made, and what are the other inputs that go into that? And that helps me to contextualise what piece of the puzzle I am contributing to the decision.
I want to give one really simple example of meeting a Government where they are to solve a problem. And this is quite an old one but it’s one of my favourite projects that I’ve done in my previous role at Behaviour Works Australia which is also within Monash Sustainable Development Institute. Some years ago now – and we’re seeing this problem in different ways – ambulance calls were rising and some of the calls were not necessary.
We did some research to underpin a major media campaign that really helped to position the ambulance service as something that needed to be saved for emergencies. And to cut a long story short that campaign was successful. We measured the outcomes. We had reduced calls to the ambulance service. We published it in peer reviewed literature and the CEO of the ambulance service said that that work had helped reserve ambulances for genuine emergencies.
And finally – and I am going to get to some getting to know the audience questions which I haven’t forgotten about but I should have done it at the start – I’m going to finish off with the third one which is to consider the bigger policy making picture. And there’s been some great work trying to unpack policy making processes and this infographic really does help to get an understanding of the things that policy makers have on their desk that are not just research evidence. So you can see they’re pretty straightforward. They’re pretty self-explanatory. We saw a lot of modelling in the COVID era. We see a lot of data analytics. We see evaluation of previous Government initiatives. We get a lot of qualitative inputs. Governments get a lot of qualitative inputs about the acceptability and feasibility of particular policy possibilities. And you can see that evidence synthesis and other research are only part of that picture. And there’s whole reports like the Evidence Commission Report which are dedicated to unpacking that connection between evidence and policy.
And so if you want to land something with Government where you know that there are a lot of other inputs there’s a couple of really simple guidelines that can help. So it’s partly about getting to know your audience which I’m going to do shortly. But can you present findings that aren’t a peer reviewed paper? Because let’s face it. They’re not overly exciting to look at usually. We’ve used infographic techniques to summarise research with some success but it does require effort.
You can also obviously present your findings in a forum like this where there’s a question and answer session. And I often do that with Government which means I’m not investing lots of energy in a written report. It might be that the whole report is a slide deck, and that’s a lot how consultants do their work.
There are some areas of Governments and other clients that really do want to know what is the research that you’ve published on this, because they understand that that is a marker of the quality of your research. And we’ve co-published with people from Government on some of the bigger trials that we’ve done and that has been a very successful model of engagement. That is truly working collaboratively on a problem.
I think that might be the end of my slides. Let me just see. Yes. That’s it from me but I did have some questions which I forgot to do at the start which I’m going to do as an introduction to our question and answer. So there’s a couple of polling questions which will tell us a little bit about the audience here. And I see that there are over 150 people on the line which is fantastic. And I apologise for not doing this earlier but they have been very kindly turned into polls by the good people who are hosting this conference. And I can see we’re getting lots of responses through those Slido polls and soon we are going to present them. And at the same time now that I’ve finished the presentation part I’m happy to take some questions and maybe we can look at those poll results as we go.
[Visual of slide with text saying ‘Thank you’, ‘Further information’, ‘E: peter.bragge@monash.edu’, ‘T: +61 403 197 275’, ‘Monash University’]
Amber Shuhyta:
Thank you Peter. I am just waiting to see what Slido questions might come through but I do have a question of my own while that’s all happening in the works. I really liked the four questions you had in terms of who wants to know this and what decision this is going to help. And I just wanted you to speak a little bit more in terms of when a researcher should be really unpacking that. Do we need to move people to be really clear about that earlier in their research process rather than how do I now engage policy makers on the research that I’ve conducted and then engaging in that kind of exercise?
Professor Peter Bragge:
It’s a great question. And just with the poll I think we can only do one question at a time so we’ll have a look at who’s in the room while I’m answering that question. So maybe we’ll close that first question about who you are and I’ll answer your question. Maybe we can do one answer of the question and one poll at a time.
So there’s a whole lot of talk about codesign and it’s a really interesting discussion. Because obviously researchers are independently working on particular lines of enquiry. They might be working on something that is a very long term project around outcomes and it’s not always possible to sort of have a chat to Government every time you’re doing a research project. So I guess there are sort of two broad categories. The first is the scenario I described earlier where you have a research finding that seems to resonate with something that’s going on but the research has already been done. So in those situations you want to create awareness of that research and the relevance of that research to that particular issue.
In the second more ideal scenario which is less probable but has much bigger payoff you have a conversation about something that you’re an expert in and you are commissioned to research that. Now in my case because I’m a review researcher we can hit the ground pretty quickly with things like that. But there are lots of areas of Government where they need to understand lots of things that could be the subject of primary research and there are actually opportunities through tender portals and other requests for quotation where they do actually go out to market and say ‘We want someone to gather some information’. So they’re the two broad categories. And I think we need to be realistic that we’re not going to be talking to Government every time we’re initiating research particularly if it’s funded elsewhere or if it’s an ongoing project, but we do need to think about the match between our answers and their questions.
Now I’m wondering if we can look at one poll result while we’re waiting for another question. Can we view the results of the who you are poll possibly?
I’m not sure how we go about viewing the results. Okay. Can we see what the audience responded to that first question about who they are? Is there a way that we can visualise that?
Lindsey:
If you just click on the poll button Peter in Slido it should have the first question results there.
Professor Peter Bragge:
Is it the Slido button down – no. It’s polls. Okay. Here we go. I don’t seem to be able to control that but that’s okay.
Here we go. We’ve got some percentages down there. I’m just not sure how to display them.
Lindsey:
I think everyone should be able to see those results.
Professor Peter Bragge:
Great. Maybe I can’t see them because I haven’t voted. That’s probably what’s happened. All right. Let me do that. Send. Let’s see if I can see the results from that. Okay. So that’s fantastic. So we’ve got allied health professionals about 22%. We’ve got researchers, we’ve got a lot of physios. Good to see. OTs, clinician researchers, policy makers, people who I described as difficult to classify who maybe cross a few boundaries. Now how do we go to the next one? Because it would be worth just going through the rest of them but I’m not sure how to advance to the next one. Let me see. Okay.
How many years since you qualified? All right. Let me have a look at that. And we’ve got a lot of people with a lot of experience in the room. So really over 80% are over ten years since their first qualification. We’ve got some early career, about 3% of each of one to three and three to five, and about 15% between five and ten years. So that’s a really good spread of expertise.
Okay. We’re going to open the third question while I answer another question. So let’s have a look. So Jo has asked about good research taking time. And there’s another poll question there around how you classify yourself as a researcher. And we might finish with that one just for time reasons. So Jo asked a good question about:
Q: How do you resolve the tension between policy makers wanting quick answers to complex questions?
So I can answer this as a review scientist because there’s lots and lots of different ways of going about reviews. And I’m sure people have heard about rapid reviews and innovations in that space particularly through the COVID era. So it’s possible now with the technologies we have but also with the techniques that have evolved to do research reviews that are not full systematic reviews but can be undertaken in four to six weeks. And that comes with caveats. So we might only look for research from the last two or three years and we might take other steps to be able to manage the volume of research that we process.
When you’re in a primary research space it’s much more difficult. Because obviously you can’t stand up a trial and complete the trial in four weeks or six weeks or even a year. So when you’re consulting with Government as a clinical researcher that does primary research it’s probably more about drawing upon your expertise in the field more generally. And I would say that it does come back to knowing the literature and researching the literature. But Governments do make investments in long term research programs as well. For example the Medical Research Future Fund invested tens of millions of dollars in diabetes and cardiovascular disease research a few years ago. So it’s a combination of being realistic about what can be done in those short timeframes, adding your expertise to the table and advocating for the research that needs to happen to be able to fill those gaps.
There are other forums that are convened by Government, Senate Committees, Royal Commissions, where they actually take submissions. And you can make a submission as an expert to reflect your expertise in a particular area.
Sandy has asked how you can get Government interested in your question if it’s not already on the radar. That is really tricky because obviously Governments are lobbied by lots of people all the time. And so I think that selling research to Government where it’s not something that’s at the forefront of their mind – and when I looked at some of the presentations there’s some people that have done some great stuff on sort of return on investment and how much money you’re going to save by doing this. So you need to catch their attention with compelling metrics and also try and connect with known agendas which is something that a number of the presentations will do.
Now I’ve been asked to wrap up because we’re over time. So I’m very sorry. I will try and get an answer to that other question in written form. And we might just quickly look at the last poll.
And let’s have a look. So there are actually about a third of the audience who are not actively researchers which means they might be research users or people with an interest in research. And then there are people, probably about 20% each, doing implementation of health systems or clinical research. And 6% of people are like me and people who are in more specialised areas. So I will finish there. I apologise for going over time. I will get a written response to that last question while the next sessions are unfolding. Thanks very much for your attention.
Amber Shuhyta:
Thank you Peter. That was really insightful. And yes we are needing to rapidly move through a long list of speakers today so potentially we’ll only have time for the top question on the Slido bar. So please while the next speakers are presenting type your questions in there and vote. We’ll pick the most popular question and then we’ll work with the presenters to potentially as Peter said answer the questions at a different time as we move through the presenters.
I’ll now hand over to a presentation from Narelle Cox. It was going to be a presentation from Angela Burge but Angela has unfortunately been unable to present today. So her colleague Narelle is stepping in to deliver the presentation. So welcome Narelle and over to you.
Narelle Cox:
[Visual of slide with text saying ‘National Allied Health Virtual Research Forum 2024’, ‘Transforming pulmonary rehabilitation to enhance patient and health system outcomes’, ‘Dr Angela Burge’, ‘Physiotherapist, The Alfred’, ‘Research Fellow, School of Translational Medicine, Monash University’]
Thank you very much for having me and allowing me to present this work as you said on behalf of Angela. So today I’m speaking to you from the lands and the waters of the Boonwurrung and Wurundjeri clans of the eastern Kulin nation and I pay my respects to their Elders past and present.
So this particular presentation is going to describe a body of work which collectively sets out to enhance patient and health system outcomes for people living with chronic respiratory disease.
So one in three Australians live with a chronic respiratory condition and these individuals are particularly vulnerable to poor outcomes. For people living with lung disease symptom relief and avoiding hospitalisations are the treatment outcomes that they ascribe the highest value to. Pulmonary rehabilitation is a program of exercise and education that is a core component of care for people with chronic respiratory disease and is recommended in international treatment guidelines.
The program comprises a personalised assessment and individually prescribed and progressed exercise training and is proven to improve symptoms and quality of life and reduce the need for hospitalisation. In Australia pulmonary rehabilitation is by and large conducted on an outpatient basis at a hospital or other healthcare centre requiring participants to travel to the centre twice a week for the eight week program. And currently there are no funding models that support the delivery of pulmonary rehabilitation in primary care.
The evidence for pulmonary rehabilitation particularly in people with stable COPD is so comprehensive that almost ten years ago now the Cochrane Library made the decision to close the systematic review as they felt that additional randomised controlled trials comparing pulmonary rehabilitation to usual care were unlikely to change our confidence in the estimate of the effect. So instead our challenge is not whether pulmonary rehabilitation works but how best to deliver it to people who could benefit.
So access to pulmonary rehabilitation is a significant challenge both in Australia and globally. There is limited program availability which is a particular challenge in rural areas. There are also well established patient and system level barriers to attending pulmonary rehabilitation including very low referral rates and issues associated with travel and transport to attend the centre.
Despite the compelling benefits and consistent identification of access barriers until relatively recently the model of delivery of pulmonary rehabilitation has been relatively unchanged and as a result the program has been delivered to fewer than 10% of Australians who would benefit.
So our group has undertaken two randomised controlled equivalence trials to assess alternative models of pulmonary rehabilitation for safety, efficacy and program completion. The first of these was a home-based model with an initial home visit and the remainder of the eight week program delivered via telephone. And the second was a tele-rehabilitation program with an initial home visit followed by twice weekly virtual group-based exercise training that was supervised in real time via videoconferencing. And each of these was compared to the conventional centre-based model of rehabilitation.
And what these trials found was that the models were certainly safe, they demonstrated clinically meaningful improvements in patient outcomes and completion rates were higher.
So if we consider the results from these trials in the context of the primary care plan reform streams there is comprehensive evidence to support improvements in healthcare delivery. There has been an increased access to care when these programs have been implemented into usual clinical practice with the implementation of the telephone-based home-based model revealing that 93% of participants would have been unable to undertake pulmonary rehabilitation if a centre‑based program was their only option for attendance.
We know that these models of program delivery are safe particularly when appropriate processes are in place. And this is confirmed by the recent Cochrane Review on tele-rehabilitation which found no intervention related adverse events for these remote models of care. We also know that this is healthcare that is valuable to our patients with improvements in clinical outcomes translating into everyday life.
In considering reform stream two if we start with payments to incentivise quality and outcomes these programs are person-centred by definition and are certainly not expensive. A course of centre-based pulmonary rehabilitation costs less than one medical bed day here in Victoria. Trial based economic analyses have demonstrated that the home-based telephone model and tele‑rehabilitation don’t just produce similar clinical outcomes but they also provide cost effective alternatives to centre-based rehabilitation.
And finally pulmonary rehabilitation participation actually facilitates cost savings in other areas of the health system with reduced hospitalisations over the 12 months following rehabilitation as well as lower overall health system costs irrespective of where someone undertook their program of rehabilitation.
In considering access to quality care in areas of market failure barriers to program access would form a clear example of market failure. So if we consider the example of travel and transport, in our trial of tele-rehabilitation one of our recruitment sites was based in Horsham in western Victoria which is just over 300 kilometres from Melbourne. And their centre-based pulmonary rehabilitation program serves a community in a radius that exceeds more than 100 kilometres. So if like one of our participants you happen to live in a little town called Rainbow the only way for you to be able to attend a centre-based rehabilitation program is to drive up to three hours twice a week or around 230 kilometres for every single rehabilitation session that you attend.
However areas of market failure are not confined to just regional areas with travel related barriers also a significant issue in metropolitan locations. So the availability of alternative models of rehabilitation could ensure access to evidence-based care delivered by allied health at all levels.
This leads us to reform stream three. And through this particular program of work we have successfully delivered pulmonary rehabilitation in a number of different settings including home‑based programs for patients who have been identified through primary care. However there remain gaps in our ability to achieve widespread service delivery including limited resources, a lack of formalised training in alternative program delivery models for healthcare professionals and a need to adapt programs to local context and resources. Without any dedicated funding we’ve been able to support the introduction of clinical programs following clinical trials in some settings and provide some support to centres who have expressed an interest in adopting these alternative models.
To address international standards that healthcare professionals running pulmonary rehabilitation should have model specific training, we’ve developed two freely available education website resources but again across the board there remain clear gaps in this particular area.
So in summary pulmonary rehabilitation is supported by robust evidence and has important benefits for patients and the health system. In Australia pulmonary rehabilitation can be provided in a wide range of settings but funding is ad hoc and there are currently no funding pathways for delivery in primary care. So certainly if there was able to be establishment of sustainable funding mechanisms for pulmonary rehabilitation from primary care this might help us to address the disconnect between research knowledge and clinical practice in order to better drive patient and system level outcomes.
And with that I’d just like to thank our team and also on behalf of Dr Burge say thank you very much.
[Visual of slide with text saying ‘Our team’, with photograph of team, ‘Respiratory Research@Alfred’, ‘School of Translational Medicine’, ‘Monash University, Melbourne’, ‘Monash University’, ‘Alfred Health’]
Amber Shuhyta:
Thank you so much Narelle and thank you for coming in at short notice to do that. That’s great. Just in the spirit of time we’ll move to the next speaker. And if there’s questions that have come up in Slido our secretariat behind the scenes will let you know and if you could address them in the chat as Peter did. Thank you very much.
I’ll now hand over to Simone De Morgan. And I think you’re ready to go Simone so without any more ado over to you.
Dr Simone De Morgan:
[Visual of slide with text saying ‘Community-based allied health led model of care to better manage chronic pain’, ‘Australian Government with Crest (logo)’, ‘Department of Health’, ‘Primary Health Networks’, Presented by Dr Simone De Morgan’, ‘Senior Research Fellow’, ‘Menzies Centre for Health Policy and Economics’, ‘University of Sydney, Gadigal Country’, ‘The University of Sydney’]
So thank you for the opportunity to talk to you about a community-based allied health led model of care to better manage chronic pain. And sorry that my video isn’t being shown at the moment. And I’d just like to acknowledge that I’m speaking to you on the land of the Gadigal people of the Eora nation in Sydney.
So just as a bit of context chronic pain as you’re probably aware is a major public health issue. It affects one in five Australians. It leads to disability, mental health problems, loss of income and early retirement and isolation.
And there’s also a reliance on opioids, other medications and alcohol to help people cope with their pain in the absence of non-pharmacological options.
The current model of care is unsustainable and not fit for purpose. Tertiary pain services have long waiting times and this is compounded by limited reach to regional and remote areas.
It’s also associated with high healthcare utilisation. So it’s a common reason for a GP visit impacting on their workload and it’s a common reason for an ED presentation although it’s a non‑urgent condition.
And there’s a lack of access to non-pharmacological strategies and I’m sure you’re aware of the reasons for this. Cost is a barrier to access allied healthcare. There’s also allied healthcare workforce shortages particularly in the regions and also GPs lack the time in their consultations to go through the self-management strategies and help people set goals.
So over the last few years we’ve conducted a project through the Australian Prevention Partnership Centre and our directive from Government was to find evidence-based models of care currently implemented by primary health networks that help people better manage their pain, that also support opioid alternatives and that are also suitable for scale up across primary health networks in Australia. And we had a high level of engagement with primary health networks consulting with almost all of the primary health networks across Australia using a variety of methods.
So out of this project we identified a community-based allied health led model of care as a feasible and effective model of care. And it’s also supported by the National Strategic Action Plan for pain management and by the consumer pain organisations.
So I’m just going to go through some of the key elements of the model of care. Firstly it’s allied health led. There is a group program plus or minus individual consultations and allied health are upskilled to deliver the group program. And this is an example in New South Wales. Sydney Uni offers training to upskill allied health to deliver the program.
It also focuses on self-management strategies, supporting patient activation. There’s no cost to consumers to ensure equitable access. And it ensures connected and coordinated care and partnership with GPs. So GPs are at the centre. So the GPs refer into the group program, then there’s communication back to the GPs. The GPs also link to tertiary hospital services for complex chronic pain patients or they link to other appropriate services such as mental health.
There’s also refresher follow up group programs and links to consumer led support groups.
And the model of care is promoted by primary health networks via health pathways and also the networks.
So seven primary health networks are currently commissioning this model of care across different jurisdictions. And so within each jurisdiction the group program is usually conducted within multiple locations and the model of care is adapted to the local PHN context.
So the model of care has been demonstrated to be effective and acceptable to clinicians and patients. It improves self-efficacy. So that’s confidence in daily activities and work. It improves functional capacity and quality of life and it enables people to get on with their lives. It reduces opioid usage. It also reduces hospitalisations and it reduces pain related GP visits. So that decreases the workload on GPs.
So the model of care can be adapted to ensure equitable access. So firstly it can be digitally enabled. And this is really important to overcome the allied health workforce shortages particularly in the region. Also some people may not be able to travel to a group program so it extends the reach of the program and this was particularly successful in the pandemic. There’s also currently a program being adapted to Aboriginal and Torres Strait Islander people to be culturally appropriate in south-east New South Wales PHN. And also the model of care has been adapted and is currently being adapted to different multicultural groups in New South Wales and South Australia.
And also we often think about the management but we also need to think about intervening in the secondary prevention phase. So the model of care can be adapted in the secondary prevention phase in high risk individuals post-surgery or post-injury. So they’re the details but I won’t go into those now. I’d just like to also say that the model of care can be adapted to other chronic conditions and/or multiple comorbidities because there’s only a very small aspect of the group program that is condition specific. So this may be a good way to scale up the program and be efficient and to have a large reach.
So what does it cost? So the cost per consumer for a primary health network with no pre‑existing model of care – this cost modelling comes from the Gold Coast PHN. So the start up costs are $2-2.5K per consumer. So that’s to implement the program, to evaluate the program and to upskill healthcare professionals to deliver the program. And then this reduces at about 18 months to $800 to $1K per consumer. And this is the phase that we suggest a co-commissioning model perhaps with the local hospital networks.
And so also to note if we upscale the model across PHNs in Australia this would further reduce the costs per consumer due to resource sharing. And also if you compare the cost of one episode in ED for lower back pain it’s $3,000. So these are small figures.
So primary health networks are well placed to deliver this model of care and it’s aligned to the priorities of the Strengthening Medicare Taskforce. We recommend that the Australian Government invests in supporting every primary health network to commission or co-commission with local hospital networks this model of care for chronic pain with adaptations for other chronic diseases and multiple comorbidities.
So to scale up the model of care nationally it will require establishing commissioning and governance arrangements. We also need mechanisms for collaboration and sharing of resources amongst primary health networks. And of course we need ongoing monitoring and evaluation not only for quality improvement but to establish the value of the model of care ongoing. Thank you.
[Visual of slide with text saying ‘Connect with me’, ‘Dr Simone De Morgan’, ‘Senior Research Fellow’, ‘Menzies Centre for Health Policy and Economics’, ‘University of Sydney’, ‘simone.demorgan@sydney.edu.au’, ‘The University of Sydney’]
Amber Shuhyta:
Thank you so much Simone. And sorry we didn’t get to see you and we couldn’t sort that out for you with the video. But it was so great to hear your summary there.
Dr Simone De Morgan:
I think what it is is that you need to put your video and unmute before you take control of the slides.
Amber Shuhyta:
Well we can see you now so thank you so much for presenting. And if there’s questions the team will help direct them to you and we’ll answer them in the chat as we move through the rest of the presentation. So thank you again.
Dr Simone De Morgan:
Thanks so much.
Amber Shuhyta:
We’ll now hear from Megan Tremlett. And I’m hoping Megan can take some of those tips from Simone in terms of turning the video on before taking control of the slides. And I’ll hand over to Megan.
Megan Tremlett:
[Visual of slide with text saying ‘Pharmaceutical Society of Australia’, ‘The IPAC Trial’, ‘Integrating Pharmacists within Aboriginal Community Controlled Health Services to improve Chronic Disease Management’, ‘National Allied Health Virtual Research Forum 2024’, ’30 April 2024’]
Thank you very much Amber. Can you hear me okay?
Amber Shuhyta:
Yes. Thank you.
Megan Tremlett:
Wonderful. So my challenge is I have audio and video but I can’t drive my slides. So I will be relying on the team to do that. So we’ll go from there. But thank you very much Amber and thank you to the Department of Health and Aged Care for the opportunity to present today. I’m a senior pharmacist working with the Pharmaceutical Society of Australia which is the national peak body for all 37,000-ish pharmacists nationally regardless of practice setting. And my presentation relates to the Integrating Pharmacists within Aboriginal Community Controlled Health Services to improve Chronic Disease Management. It’s a super long title so we’ll just know it as the IPAC Trial.
So the IPAC Trial came about with the support and funding of the Australian Government Department of Health under the Pharmacy Trial Program of the 6th Community Pharmacy Agreement. So just for the reference the 7th Community Pharmacy Agreement is just wrapping up now and we’re about to head into the 8th.
The aim of the IPAC Trial was to explore whether quality of care outcomes for Aboriginal and Torres Strait Islander adult patients with chronic disease could be improved by integrating a practice pharmacist into the primary care team of the Aboriginal Community Controlled Health Service when compared to prior care. So I’ll refer to that as either an ACCHS or an ACCHO. The terms tend to get used a little bit interchangeably. The trial was a tripartite partnership with the Pharmaceutical Society of Australia, or PSA being the lead agency. Our role was to recruit and train and support pharmacists through the trial. The National Aboriginal Community Controlled Health Organisation or NACCHO was there to recruit ACCHOs as trial sites and to support those trial sites throughout the trial. And we had James Cook University College of Medicine and Dentistry as the sort of research and evaluation arm of the trial.
So just at the very end of 2017 and through the first half of 2018 was our establishment phase where we identified ACCHOs that would like to participate and recruited pharmacists and developed the training for those pharmacists to get them on board and ready for the implementation phase. So the implementation phase was around about a 15 month period between August 2018 and October 2019. That then led into the analysis and reporting phase with the trial wrapping up mid-2020.
And in terms of – I’ll speak about this early – the alignment with national priorities, we know that there’s a higher burden of chronic disease experienced by Aboriginal and Torres Strait Islander Australians when compared with other Australians and that there is poorer access to the medicines necessary to help manage those chronic conditions. So this does align with the National Agreement on Closing the Gap priority reform two which is building the community controlled sector. Also aligns with the National Allied Health Workforce Strategy which is really looking at innovative models of care that increase equitable access to allied health professionals including of course the pharmacist workforce and it also aligns with the National Strategic Framework for Rural and Remote Health which explores opportunities to better meet the needs of people living in rural and remote Australia.
So in terms of where the trial was conducted you’ll see there each one of those little Google dots on the map there is a trial site. There were 18 ACCHOs involved, some of which had multiple trial sites. And we had those in some pretty remote places. So we were looking at remoteness categories everywhere from Monash Medical Model category one in suburban Melbourne right through to some very remote places. You can see in the very top tip of the Cape there up at Bamaga which was serviced by a pharmacist from Thursday Island, some pretty remote parts of Arnhem Land there. The aim of this was by operating the trial across two states and a territory and that geographic spread that the results would be generalisable across the entirety of the country. And in the 15 month implementation phase we recruited 26 pharmacists with an overall FTE of 12.3 across the implementation phase of the trial.
So in terms of what the pharmacists did and part of their training as well which I must say did have a strong reinforcement on cultural training as well, but ten pharmacists’ core roles were identified as part of the trial protocol all well within the skillset of pharmacists. So team-based collaboration, medication management reviews and follow up from those reviews, medication appropriateness audits which were looking at sort of prescribing quality medicines appropriateness indices, looking at areas of under-use of necessary medicines as well. We looked at medication adherence, preventative healthcare activities, looking at medicines use evaluations, sometimes known as drug use evaluations, education and training for staff as well as for patient groups as well, medicines information services, looking at stakeholder liaison in terms of sort of external stakeholders involved in an individual’s care, and transitions of care when individuals move between health service settings. So all within the pharmacist skillset and tailored to the individual needs of each specific ACCHO.
So I won’t go through each one of those numbers in detail other than to say that there was a great amount of activity across the 15 month implementation phase of the trial. A total of 1,733 patients gave their consent to participate in the trial and we know this to be the largest interventional clinical study involving pharmacists and their impact on chronic disease measures for Aboriginal and Torres Strait Islander Australians. So lots of activity there. A lot of collaboration within the team of the ACCHO which is specifically what we were hoping to achieve. Lots of stakeholder liaison, so external communication between the pharmacists and other people involved in an individual client’s care. We saw 639 home medicine reviews and following up to those. Each one of those had a couple of reviews as well. Lots of incidences of medicines information sessions whether they were formalised or the corridor conversations that we know work quite well in team-based care settings. Lots of transitional care conversations and interactions as clients move between care settings. 358 education and training sessions delivered. Each pharmacist did deliver a medicine use review during their implementation time. We saw lots of application of our self-reported medication adherence survey which was customised for this particular trial. And 789 applications of a medicines appropriateness index along with assessments of under-utilisation of necessary medicines. So the activity summary really demonstrates the extent that the pharmacists worked to in their 15 month period.
So in terms of the outcomes, just as a super high level summary there, the quality of care measures you’ll see on the left there. Albeit small changes in quality of care measures we did see a reduction in HbA1c for patients with diabetes. We saw a reduction in diastolic blood pressure as well as total cholesterol, LDL and triglycerides, a reduction in cardiovascular disease five year risk and a slowing of the decline of eGFR as a measure of kidney function. So the quality of care measures are summarised there.
Our secondary measures involved and saw a fourfold increase in uptake of home medicines reviews as a formal referral process between GPs and the pharmacist. We saw improvements in prescribing quality, adherence to medicines and self-reported health status. We used a short form 1, an SF1 adapted version of the self-reported health status survey questions.
And the qualitative measures again from the patient perspective, patients felt empowered, understood their medicines better. The education sessions were valued by staff and community pharmacy relationships between the ACCHO were improved as well. I know I’m getting very close to time there so I will just speed up on the next one.
At the end of the trial period the final report was submitted to the Department of Health. There followed a health technology assessment process. And the final report was handed down by the Medical Services Advisory Committee in March last year in support of public funding of this model of care. You can read the quote there as well and if you would like to look that up online you can search ‘MSAC application 1678’.
In terms of what happens next I’ll just quickly step through the following slide. A positive MSAC recommendation does not equate to the actual funding. It’s a positive recommendation. So in PSA’s federal budget submission for the forward financial year we have recommended a sustainable funding stream to support pharmacists working in ACCHOs and we continue to advocate through our position statement on that. And to help prepare a greater workforce of pharmacists to work in this space we worked in codesign with NACCHO a Deadly Pharmacist Foundation Training course. Deadly of course meaning fantastic and wonderful in this context. And as of yesterday we had 1,500 pharmacists enrolled in that course. So our aim is to prepare the workforce moving forward so we’re ready for a funding stream.
And that’s probably enough from me so I’ll just stop there. And if we have time for questions I’m happy to answer them as and when I can.
Amber Shuhyta:
Thank you Megan. It would have been really wonderful to have a bit more time to delve into what you were saying. It was very interesting. Thanks for that presentation. I think the team will send you the questions in the background for you to respond to in the chat.
And we’ll move to our next presenter Aleysha Martin. Thank you Aleysha.
Aleysha Martin:
[Visual of slide with text saying ‘Mater’, ‘Transdisciplinary assessment models: Making the most of the allied health workforce’, ‘Aleysha Martin’, ‘aleysha.martin@mater.org.au’, ‘mater.org.au’]
Hi everyone. Thank you for having me today. So today I’ll be talking to you about transdisciplinary assessment models, making the most of the allied health workforce.
I would like to start by acknowledging the clinical team at the Mater Hospital Brisbane and as well as Active Rehabilitation Physiotherapy, my doctoral research team and the support I’ve received from the funding bodies on the slide.
So I’ll start with defining what I actually mean by transdisciplinary assessment models. Transdisciplinary assessment models involve redesigning roles of allied health professionals around patient needs as opposed to around the priorities of the allied health professional themselves. It involves blending perspectives, exchanging our knowledge and skills as well as integrating elements of our assessments. All of this enables one team member to assess across multiple domains of a patient’s function.
I will give a clinical example of the study that we did at the Mater Hospital. A transdisciplinary stroke assessment was developed, implemented and evaluated using a 22 month pre/post-study. In this study we compared profession specific usual allied health stroke assessment to our new transdisciplinary stroke assessment. We used many different measures. Some of the key ones were assessment time where we manually timed the assessments we completed and later compared pre and post using a two-sample t-test. We also looked at the amount of assessment duplication through an audit of allied health assessments as well as the number of OTs and physios who were involved in patient care. We looked at this through an audit of the medical records and compared pre and post using Pearson’s chi-squared test.
In our study there were three key outcomes with workforce implications. First we found on average 65 minutes of time was saved per patient assessment. And this is largely due to the reduction of duplicated assessment questions and tasks as 54.6% of questions and tasks appeared in more than two of our profession specific eye health assessments. Also we found that our physios and occupational therapists went from being involved in 100% of patient cases down to 84.5% for physios and 87.1% of patient cases for OTs. So there was a change in which we were providing our service.
Overall you can see that using the transdisciplinary stroke assessment helped our existing workforce to provide more efficient stroke assessment which then freed us up with more time to provide additional occasions of service such as assessing another patient or commencing rehabilitation earlier.
Our transdisciplinary stroke assessment is supported by current policy which supports innovative models of care to make better use of the allied health workforce. For example the vision of the Queensland Health Allied Health Workforce Plan 2022-2026 is to optimise allied health workforce to provide high value, efficient and person-centred care.
Our study proves the value of transdisciplinary assessment models. While we tested in a stroke service our work could be translated into electronic document templates for other settings such as medical objects and primary care. To translate the transdisciplinary model local health professionals should identify patient groups within their network who might benefit from a model like this or where a lot of assessment duplication occurs. They should codesign the transdisciplinary model alongside stakeholders who will use the model. They should complete formal competency training to upskill clinicians involved, as well as making use of available technology in the setting such as electronic health records, and making use of available resources such as the transdisciplinary assessment model we developed at the Mater. In addition the Australian Commission on Safety and Quality in Healthcare published a guide in 2015 and that can be used by healthcare managers and professionals to define and monitor usual and transdisciplinary scopes of practice across their settings. The guide is called Credentialling Health Practitioners and Defining their Scope of Clinical Practice. And for example Part 6 discusses changes to scope and the roles of the health practitioner, the organisation and a credentialling committee to ensure our consumer safety.
If transdisciplinary models are successfully implemented and evaluated across other healthcare settings like primary care future policy could stipulate transdisciplinary models as a valid solution to provide high value efficient and person-centred care. By naming and endorsing transdisciplinary models in policy this could support and encourage uptake to make better use of our allied health workforce.
I would like to finish with a brief hypothetical case example to showcase how our transdisciplinary stroke assessment could be adapted and used in other settings like primary care. So in our example we have a patient who is a 70 year old woman. She has osteoporosis and back pain and that is impacting on her daily activities. She visits her GP and her GP is in a collocated clinic with allied health services including physiotherapy. After she sees the GP the physiotherapist completes a transdisciplinary screening assessment which asks across multiple domains of function including social supports, exercise routines and the impact of back pain on daily activities.
So there’s a few outcomes from using this transdisciplinary model. While the GP prescribes some pain medication the physio can teach exercises and non-pharmacological pain management strategies. The physio has also recognised that the back pain is impacting on daily activities like heavy cleaning and that the back pain and osteoporosis put the patient at a high risk of falls and a high risk of injury. So therefore they decide to refer to social work and occupational therapy for intervention through the My Aged Care portal.
Later the referred practitioners can then go and view the electronic transdisciplinary screening assessment so that these questions asked by the physio in the initial assessment don’t need to be repeated. So this is a fairly high level example but I think it does demonstrate that when assessing across multiple domains of function more comprehensive care can be provided more efficiently and in that initial occasion of service.
And I would like to say thank you for listening.
[Visual of slide with text saying ‘Mater’, ‘Thank you’, ‘aleysha.martin@mater.org.au’, ‘mater.org.au’]
Amber Shuhyta:
Thank you so much Aleysha. That was great. Like with the other presenters I can see some questions there if you wouldn’t mind responding in the chat when we move to our next presenter. Thank you.
And our next presenter is Katelyn Dyason. And I’ll just see if Katelyn’s online.
Dr Katelyn Dyason:
[Visual of slide with text saying ‘UNSW’, ‘The Sydney Children’s Hospitals Network’, ‘SCHF’, ‘Sydney Children’s Hospitals Foundation’, ‘Mindgardens Neuroscience Network’, ‘Griffith University’, ‘Queensland, Australia’, ‘Intensive Exposure with Response Prevention for Paediatric OCD:’, ‘A Community alternative to Inpatient Admission’, ‘Dr Katelyn Dyason, PhD (Clinical Psychology)’, ‘SCHN Clinical Psychologist (Registrar) & UNSW Conjoint Lecturer’, ‘katelyn.dyason@health.nsw.gov.au’, ‘OCD Bounce’]
Yes I am.
Amber Shuhyta:
Thank you. Over to you.
Dr Katelyn Dyason:
Okay. Thank you. My name is Katelyn Dyason. I’m coming to you from Gadigal land today. I’m a clinical psychologist registrar working for the Sydney Children’s Hospital and a conjoint lecturer with the University of New South Wales. Today I’ll be talking about a community alternative to an inpatient admission for children and young people with obsessive compulsive disorder.
I am paralysed by uncontrollable thoughts. Some days they are so loud I can’t get off the floor. I’m miserable and I’m making my family miserable. This is a quote shared with permission from a 16 year old young man we saw who’s currently almost unable to leave the house due to his severe OCD.
OCD or obsessive compulsive disorder is an often debilitating mental health condition characterised by obsessions which are intrusive, distressing and repetitive thoughts and images or compulsions which are repetitive actions or avoidance taken to reduce distress associated with these obsessions.
OCD affects two to three percent of children and young people. In Australia that’s around 200,000 young people living with OCD. Between 65% to 75% of people who develop OCD will do so in their childhood or youth and they’ll often live with OCD throughout their childhood and well into adulthood with an average illness duration of between seven to 20 years. OCD also has the second longest duration of untreated illness of all mental illnesses behind bipolar too.
OCD is not only relatively prevalent and long lasting but it’s also associated with a significant functional impairment. Children with OCD are absent from school on average 14 days per year attributable solely to their OCD. Children and their families can spend hours per day accommodating to OCD reducing time available for daily living, recreation and socialisation. At an economic level OCD is associated with a $3.4 billion annual loss to the Australian economy. Yet OCD receives a tiny fraction of the clinical research funding awarded to dementia, psychosis, autism and eating disorders despite higher prevalence rates, longer duration of untreated illness and significant functional impact. This restricts us from researching prevention of OCD, reducing the substantial duration of untreated illness, finding better ways to train clinicians to deliver evidence‑based treatment, developing or adapting treatments for those who are yet to see benefit and developing new service models to improve access to treatments.
Highly effective treatments exist for OCD like a type of cognitive behavioural therapy called Exposure with Response Prevention or ERP for short. And a range of medications including selective serotonin reuptake inhibitors or SSRIs. The first line treatment for OCD is ERP which achieves response rates of up to 70% in children. But few children receive this treatment with only 20% to 30% of clinicians offering ERP. Even with manualised treatment protocols exposure components have the lowest adherence rates and the highest departures from protocol. 95% of clinicians report a lack of training opportunities to upskill and offer this treatment. Longer durations of untreated illness are associated with poorer response to treatment and for children also associated with delayed developmental milestones being met and impacts on their developing identity. Better and earlier intervention is imperative to give children their childhoods back and prevent decades of illness.
Last year we looked at inpatient admissions characteristics for OCD at the Sydney Children’s Hospital Network, the largest provider of children’s health services in Australia. We found that around 9% of admissions had a primary or comorbid diagnosis of OCD but they disproportionately occupied 15% of bed days. Patients with a primary diagnosis of OCD were compliant with hospitalisation recommendations with over 95% voluntarily hospitalised rather than admitted involuntarily under the Mental Health Act. This was the highest proportion of all diagnoses.
Behind developmental disorders patients with OCD had the highest rate of referrals from community teams, meaning that they were frequently connected with and treated by community teams rather than being new referrals into the system. However they also had the longest length of stay behind psychotic disorders and the difference between OCD and psychosis was not statistically significant. Correspondingly OCD and psychosis also had the most costly admissions.
Looking only at primary diagnosis of OCD, OCD cost the hospital $4 million over six years to treat at an inpatient level. When we include OCD as a comorbid diagnosis this shoots up to $11 million. That’s almost $2 million per year. Yet despite being young, compliant, engaged with community teams and staying a long time in hospital these children also had the second highest readmission rate within 28 days behind trauma disorders. This suggests that in a number of cases a costly inpatient admission did not help their symptoms improve substantially enough for continued care in the community. These admissions patterns demonstrate the severity and complexity of OCD and help us to understand how to plan services that enhance clinical care overcoming barriers within existing structures.
As a response to these complexities a wraparound model of care was developed in consultation with consumers and clinicians at the Child and Adolescent Mental Health Services covering the full spectrum of severity, treating severe OCD at one end of the model with an intensive community-based program and preventing deterioration of symptoms by treating mild OCD in CAMHS and Headspace services.
Today I’ll just be focusing on the community-based intensive program for children with severe and complex OCD as an alternative to an inpatient admission. By treating children in the community we can work with families, completing home visits and tackling obsessions and compulsions in the child’s normal environment. We can better integrate with community treating teams and avoid risks associated with hospital admissions such as vicarious trauma.
Using a multiple baseline design you can see here the symptom scores for eight clients who completed the program for two weeks before starting the intensive program, two weeks of intensive ERP and then four weeks of maintenance sessions. All eight improved substantially with significant large effects from treatment on both symptom severity and family accommodation. Importantly there have been no readmissions to the inpatient unit. As a result of the wraparound model of care patients can remain with their families in the community receiving specialised evidence-based treatment to reduce instances of inpatient admission and significantly improve symptoms of OCD. This is a more cost effective and values driven treatment for health services reducing risks of inpatient admission.
The model of care is scalable. A small multidisciplinary team can build capacity across existing health services to ensure high quality, evidence-based care for mild to moderate OCD, while reserving specialised [1:13:50] services for the most severe and complex cases. The pilot implementation of the model of care has demonstrated significant cost reductions relative to inpatient admission while enhancing clinical care and treatment outcomes.
Moving forwards though the team is soft funded with a low FTE. Permanent funding and an increase in FTE and staffing would enable the model to be rolled out across the state. OCD is recognised internationally as a specialty area and clinical care for paediatric OCD is often not delivered to evidence-based standards. A dedicated treatment team and a hub for accessing specialised resources, training and clinical support would enable a coordinated statewide approach for paediatric OCD particularly those most severely affected to reduce inpatient admissions and continue high quality, value-based care.
[Visual of slide with text saying ‘Questions?’, ‘OCD Bounce’, ‘SCHN-SCH-OCD@health.nsw.gov.au’, ‘www.OCD.org.au’]
So happy to take questions now. I think we’re doing them at the end. And I’ll just throw the references up there as well if anyone’s interested.
Amber Shuhyta:
Thank you Katelyn. That was great. Yes. I wish we had time for interactive questions but we’re doing that interactively on the chat. So thank you very much for your presentation today. And we’ll move to our final presentation before a bit of a break. And our final presentation is from Janet Sluggett. I’ll hand over to Janet.
Janet Sluggett:
[Visual of slide with text saying ‘University of South Australia’, ‘@JanetSluggett’, ‘Janet.Sluggett@unisa.edu.au’, ‘Improving care by simplifying medications and streamlining medication rounds in aged care services’, ‘A/Prof Janet Sluggett’, ‘Associate Professor in Pharmacy and Pharmacoepidemiology, University of South Australia’, ‘Affiliate Postdoctoral Researcher, South Australian Health and Medical Research Institute’]
Thanks very much and thank you for the opportunity to speak today. So I’m an Associate Professor and a pharmacist based at the University of South Australia and today I’ll be presenting the results of a body of work that we’ve been undertaking over the last seven or eight years around simplifying medication administration in aged care homes. So we’ve developed a tool to be able to achieve this as well as implemented it in a randomised controlled trial and also conducted a series of knowledge translation projects as well which I’ll touch on.
So why are we looking at this particular issue? Well we know that complex medication regimens are really common among older people and particularly those in aged care settings. So residents of aged care facilities take an average of ten different medicines every day with additional as needed medicines on top of that. And they’re administered medicines an average of four times per day. And so obviously that can be quite a burden for the resident and it is an issue because we know that people with more complex medication regimens have a higher risk of poorer health outcomes like adverse events and hospitalisations.
So it could be beneficial to simplify things for residents. We also know that medication administration in aged care homes is a very time consuming activity for staff. Sometimes for example the medication round in the morning can take an average of two and a half hours to complete and so if we could streamline the way that medicines are given that could also have benefits for staff in terms of enabling them to redistribute their time to other types of medicines related activities or just other types of care in aged care homes.
And so for this reason there’s been increasing focus on ways to simplify medication management in aged care homes. And so one way of course is to deprescribe or stop unnecessary medications. Another complementary approach that we’ve been focusing on in our work is medication simplification. And so it doesn’t focus on starting or stopping medicines. Rather it focuses on reducing the number of administration times per day and consolidating things and also looking for opportunities to use slow release or a combination of products to reduce the total number of tablets per day.
So our research team has developed the Mrs Grace tool. It’s a five step tool that a pharmacist or a health professional can use to identify ways to streamline medication management and make recommendations to optimise the use of this. This tool has been validated amongst pharmacists and as part of our knowledge translation work we’ve also validated the tool for use amongst GPs and geriatricians as well.
So we’ve gone on to implement the Mrs Grace tool as part of a cluster randomised controlled trial called the SIMPLER study. So this trial really centred around an intervention from a pharmacist where the pharmacist visited an aged care home, reviewed the residents’ medication charts and then used the Mrs Grace tool to make a series of recommendations to simplify medication management. And these recommendations were then communicated back to the aged care provider as well as the GP for that resident. So we had four facilities participating in the trial who received the intervention and four of the facilities received usual care.
So in terms of the main outcomes from this trial at our four months follow up what we found was that the pharmacist was able to make recommendations to simplify medication schedules for two thirds of residents in the aged care homes and at least one of their recommendations was implemented for three quarters of the residents where they were made. Our main outcome from this trial was to see if there was a reduction in the number of medication administration times at four month follow up which we did see a significant reduction in. There were no negative impacts on resident satisfaction or quality of life which was a positive finding. But what we also found was that there was an opportunity for nursing staff to redistribute a meaningful amount of time to other types of care activities. So approximately 40 hours per 100 residents per month that could be shifted to other types of care activities in the sites that received the intervention.
So these were the results at four months follow up and what we found was that even from this once off visit from the pharmacist the impact on fewer administration times was sustained at eight and 12 months follow up as well.
So we’ve gone on to implement this work in a series of knowledge translation projects and one of these was implementing medication simplification in community aged care services. And we know that the number of people receiving home care packages is growing and so this is going to be an important area for pharmacists to be working in and targeting. So as part of this intervention we had a pharmacist visit people receiving community aged care services in their home and I guess conduct a bundle of interventions. So they first took an accurate medication history and compared what the person was taking to what their GP and pharmacist thought they were taking. They did an adherence assessment and also assessed the person’s ability to self‑manage their medicines at home. They conducted a simplification using Mrs Grace. They communicated with the GP and the aged care provider and they offered all of the participants the option to have a medication list with their up to date medicines.
So this was a pilot and feasibility study. We included 25 individuals and we followed them up at four months to see their outcomes. And what we found was that again simplification was possible for 56% of people participating in this study. And I think one of the other important findings was that by the pharmacist taking a medication history as well as part of this bundle of interventions it identified there was lots of opportunity to I guess reconcile differences between what the GP and pharmacist thought they were taking and also what the person was actually taking. So there was a median of six discrepancies from what the person was taking and the GP list on average. And so the pharmacist was able to do some work to try and resolve those discrepancies during the home visit as well.
Everybody that participated wanted a medication list and we conducted interviews as part of this program as well and found that the intervention overall was generally well received and that it was thought to be feasible for a wider rollout.
We’ve also gone on to undertake a knowledge translation project where we’ve implemented medication simplification for hospital inpatients who are being discharged to an aged care home. We felt this was an important area to target because we know that around one third of all residents of aged care homes are hospitalised at least once a year and sometimes when a person’s in hospital their medication schedules can become more complex. So we implemented simplification working with hospital clinical pharmacists in three South Australian hospitals including two rural sites, and we found consistent results again, that 48% of those inpatients could take their medicines in a simpler way.
I won’t spend too much time on this slide but it was really looking at the results of validating the Mrs Grace tool among GPs and geriatricians. And so I think importantly it’s found that when GPs and geriatricians have a good understanding of simplification they’re able to implement it at their point of care when they’re reviewing charts or also when they’re prescribing medicines for the first time in aged care homes.
So I guess what are the key outcomes for patients and services arising from this work? Well we know that two thirds of residents of aged care homes can take their medicines in a simpler way. A lot of the medication complexity that they have is unnecessary complexity and things can be simpler for them. We know that simplification is low risk. It’s an evidence-based process. It can be applied in community services, aged care homes and also hospital settings. And it can release staff to provide other types of care activities for a meaningful period of time. So in the aged care home setting we found that it enabled staff to redistribute half an FTE per 100 beds to other types of care activities and to support resident care and wellbeing.
So in terms of the possible policy implications arising from this work we think there’s a number of settings where simplification could be added on to existing services to extend those. So it could be provided by an onsite pharmacist who will work in aged care homes as part of a new Government funded program from July 2024 onwards. It could also be part of an added bundle with an expanded medication review service which is an existing service provided in aged care homes. In the community setting the bundled service which included medication reconciliation, adherence assessment, simplification and self-administration assessments could be provided in community pharmacies. It could also be provided by pharmacists working in GP practices or providing home medicines reviews. And we’ve also highlighted that simplification could be provided on hospital admission by clinical pharmacists working in hospitals or also at discharge.
So I’d just like to finish by acknowledging our researchers and collaborators and the funding for this work. And I’d also like to point out that we have links to the resources available with the slides for this work. Thank you.
Amber Shuhyta:
Thank you Janet. That concludes our first session of abstract presentations. I just wanted to thank again Narelle, Simone, Megan, Aleysha, Katelyn and Janet.
We’ll now hear from our second group of abstract presentations. And as before please type your questions into Slido. And given we’re really trying to hear the amount of really wonderful information that’s coming from our speakers as per the first session there’s not really a lot of time to have the interactive questions so those will be addressed in the chat.
And so I’d like to move to our first presentation of this next session Jennifer Alison. Thank you Jennifer.
Jennifer Alison:
Thanks Amber. I’m just waiting for the slides to come up.
[Visual of slide with text saying ‘National Allied Health Research Forum 2024’, ‘Improving Lung Health for Aboriginal and Torres Strait Islander Peoples: the Breathe Easy, Walk Easy Lungs for Life (BE WELL) project’, ‘Jennifer Alison’, Professor of Respiratory & Professor Allied Health’, ‘David Meharg, PhD candidate, Project Manager’, ‘The University of Sydney’]
Okay. Can you see that? Yep.
Thanks very much for the opportunity to present our work on improving lung health for Aboriginal and Torres Strait Islander peoples. We call it the Breathe Easy, Walk Easy Lungs for Life project, or BE WELL. And I’m Jenny Alison as you said. I’m a Professor of Respiratory and Physiotherapy and a Professor of Allied Health in Sydney Local Health District and Sydney University. And David Meharg was the PhD candidate, the Aboriginal PhD candidate on this project which was funded by NH&MRC and David was pivotal to the success of this project.
I’d just like to acknowledge the traditional owners of the lands on which I work, the Gadigal people of the Eora nation and pay my respects to Elders past, present and emerging and any Aboriginal people joining us today. And this is a painting from one of our partner sites with the lungs as a centrepiece which I could explain to you if we had more time.
Sorry. I’m just having a bit of trouble with the slides. I think everyone would be aware that COPD or Chronic Obstructive Pulmonary Disease is a major problem for us in Australia but for Aboriginal people the prevalence of COPD is 2.5 times greater than that of other Australians with mortality rate three times the national average and hospitalisation rates for COPD five times that of other Australians. And COPD is the most common cause of potentially preventable hospitalisations in Indigenous Australians and that means hospitalisations that could be prevented if there was evidence-based care earlier in the disease in primary settings.
And you can see here from this figure from the 4th Atlas of Australian Clinical Variation in Healthcare that Indigenous Australians not only have a much higher rate of hospitalisation per 100,000 but also that that gap is growing between Indigenous Australians and other Australians.
So pulmonary rehabilitation as we heard actually in the very first presentation today is a program of supervised exercise training and health education recommended as best practice management in COPD guidelines nationally and internationally. And the Australian Commission on Safety and Quality in Healthcare think that this is a very important area and later this year they’ll be publishing clinical standards for COPD one of which will be around pulmonary rehabilitation and the need for referral to pulmonary rehabilitation.
And this is because pulmonary rehabilitation has high level evidence of efficacy in increasing exercise capacity, reducing symptoms of dyspnoea and fatigue, improving quality of life, importantly reducing hospitalisations and length of stay, decreasing mortality and decreasing healthcare costs.
The problem is that there’s lack of culturally safe pulmonary rehabilitation programs for Aboriginal and Torres Strait Islander people. Most programs are offered in mainstream hospital settings or community outpatient departments and these are not considered culturally safe environments by many Aboriginal people who feel that going to hospital they may experience racism. And this means that there’s a lower attendance of Aboriginal and Torres Strait Islander peoples at these programs.
This has also been called out again by the 4th Atlas of Healthcare Variation which highlighted the high rates of hospitalisation as unacceptable for Indigenous Australians and also talked about the priority is to improve access to culturally safe pulmonary rehabilitation.
So our project we aimed to partner with New South Wales based Aboriginal Community Controlled Health Services or ACCHS to implement evidence-based culturally safe pulmonary rehabilitation for Indigenous people with COPD. We used implementation science methodology, the knowledge to action cycle, and that is where we just highlighted the knowledge that we have that pulmonary rehabilitation has high evidence and we’re trying to implement it and evaluate the implementation of that evidence into a new context, and the new context being the Aboriginal Community Controlled Health Services.
We partnered with four ACCHS in the BE WELL project. We also did interviews with Aboriginal people who had COPD to understand their experience of care and we did a survey of New South Wales based ACCHS to try and understand what respiratory services were available from their services.
So what did we do? We did capacity building. We did a two day workshop talking about patient assessment, exercise prescription and training with a lot of hands on practical skills, and provided also for the education part of pulmonary rehab the upskilling of Aboriginal health workers to provide yarning education for the patients that would attend the pulmonary rehab BE WELL program. We used Aboriginal pedagogy and the eight ways of learning using symbols like this for meeting place and also analogies like upside down lungs being like a tree. These were the seven yarning topics that we covered but also most importantly Aboriginal health workers were involved in all aspects of pulmonary rehabilitation. Often Aboriginal health workers are considered as the cultural brokers but not necessarily engaged in service delivery.
We also funded Aboriginal health workers to undertake a Certificate IV in allied health assistants and we developed the research skills of staff in terms of assessment and measurement and data management. We did provide some infrastructure such as exercise equipment if it was needed and spirometers as well as a small amount of funding.
Three of the ACCHS as an outcome provided pulmonary rehabilitation programs which are ongoing with good improvements for the participants. And the Aboriginal health workers and the local physiotherapists or exercise physiologists who were involved in the program increased knowledge, confidence and skills in providing the exercise and education components of pulmonary rehabilitation and this was measured by questionnaires and objective tests.
When we interviewed 20 Aboriginal people with COPD about their experience of care what we learnt importantly was did they understand what COPD was and unfortunately this is what we got. They did not. It was like a blank. Did they know what pulmonary rehab was and what its benefits were? And certainly that was not the case. And really most people had a relative or somebody that they knew who had been diagnosed with COPD or emphysema as they called it and had died. And so when they got the diagnosis there was a lot of fear about dying.
So we also tried to raise community awareness while we were doing this project and we partnered with the ACCHS to run COPD awareness days where we did case finding and building the awareness around COPD, and importantly that there were things that could be done to help people with COPD live well with this condition. We also ran an art competition and these are three of the beautiful winners of that competition in each site and each of those has a lovely story behind it. And this was also a very important community awareness raising exercise.
When we surveyed the New South Wales ACCHS we had a 44% completion rate of the survey to find out what respiratory services were available. Then we could see that the top two were smoking cessation and spirometry, and that’s not surprising because both these are funded, this smoking cessation through tackling Indigenous smoking and spirometry through MBS item numbers. Unfortunately before we started no services were providing pulmonary rehabilitation and the main reasons were no staff available or trained, not adequate financial resources and inadequate space for providing the program.
So the conclusion for policy is that pulmonary rehab is a key recommendation in guidelines to reduce preventable hospitalisations and improve health related quality of life. Extremely limited opportunities for Indigenous Australians to access culturally safe pulmonary rehabilitation. But we did show that the provision of pulmonary rehab in culturally safe environments of the ACCHS is achievable and staff can be upskilled and this is possible.
I think the policy decisions to overcome the barriers requires funding to support service provision of pulmonary rehabilitation, maybe specific MBS item numbers for this, improved infrastructure and increased staffing. And this fits with the recommendation of the Strengthening Medicare Taskforce report to enable ACCHS to commission primary care services that are appropriate and needed by their communities.
This is a project summary. And I’m not going to spend time on this. Just to say that this is our journey so far and we really want to advocate for funding for pulmonary rehabilitation provided by ACCHS that could be accessible to more Aboriginal and Torres Strait Islander people with COPD.
I’d just like to acknowledge the funding bodies, the ACCHS that partnered with us and the clients and their families and the investigating team. Thanks very much.
Amber Shuhyta:
Thank you so much Jennifer. And thank you also for sharing that wonderful artwork with us as part of your presentation. Thank you.
Up next we have Jonathan Foo and Marie-Claire O’Shea. And I will see if they are on and ready.
Dr Jonathan Foo:
[Visual of slide with text saying ‘Development of an automatable malnutrition screening indicator using routinely collected data for older adults in long-term care: the AutoMal’, ‘Dr Jonathan Foo, Monash University’, ‘Dr Marie-Claire O’Shea, Griffith University’, ’30 April 2024’, ‘National Allied Health Virtual Research Forum’, ‘Funding disclosure: project partially supported by Aged Care Research & Industry Innovation Australia grant’, ‘ariia’, ‘Aged Care Research & Industry Innovation Australia’, ‘Griffith University’, ‘Monash University’]
Thank you. Yes. Am I coming through okay?
Perfect.
Amber Shuhyta:
Hi. Jonathan over to you.
Dr Jonathan Foo:
All right. Thank you. So look thank you for the invitation to present. My name’s Jon and I’m presenting with my colleague Marie-Claire. Our work seeks to address the problem of malnutrition in aged care through the development of an automated screening indicator. And I’ll hand over to Marie-Claire to provide an introduction to this topic.
Dr Marie-Claire O’Shea:
Hi everyone. So let’s remind ourselves why we are here. And for Jon and I it’s very simple. Older people in our communities and residential care facilities deserve good health and good food. And this is the foundation of our passion as clinicians and researchers in aged care.
In 2021 the Australian Royal Commission into Aged Care Quality and Safety reported, and I quote, ‘Too often providers fail to meet the nutritional needs of older people in their care’. The Commission cited studies from 2017 where up to 68% of aged care residents were reported to be malnourished or at risk of malnutrition. So malnutrition is defined as two or more of the following characteristics. Insufficient energy intake, weight loss, loss of muscle mass, loss of subcutaneous fat, localised or generalised fluid accumulation and diminished functional status. Malnutrition has wide reaching impacts for our residents. It’s associated with poorer health, increased health service utilisation, increased falls and fracture rates, wound healing time, infection risks, and hastens mortality.
But within residential aged care settings and in our communities how do we identify who is malnourished? Or even harder, how do we identify who might be at risk of malnutrition in the future? We have undertaken research within residential aged care facility staff who report little understanding of malnutrition risk factors and limited skills in assessing or diagnosing malnutrition. Audits of aged care facilities indicate there is no single or regular malnutrition screening or assessment and if it is undertaken the diagnosis can be overruled by the clinical judgment applied by a nurse. You can see it’s this subjectivity surrounding malnutrition diagnosis that’s problematic.
In short we have identified four key challenges with addressing malnutrition within aged care facilities. Malnutrition is under-identified. Malnutrition screening in any form is not routinely conducted. It is likely that the lack of staff time, training and organisational policies are contributing to the lack of malnutrition screening. And lastly validated tools are not used in this setting but rather BMI or weight loss are used.
Dr Jonathan Foo:
So in this study we aimed to develop an approach to detecting malnutrition using automation in the residential aged care setting. To do this we conducted a review of existing literature and tools that are being used, we spoke to a number of expert clinicians and researchers, and through this process we identified eight variables that are routinely collected in aged care that we thought might predict malnutrition. We then looked for these variables in ten aged care facilities across Australia and collected data on 539 residents of whom 37% were malnourished.
The process that we used is called logistic regression and this was to develop the automated malnutrition screening tool that we’re calling AutoMal. Essentially this process takes two pieces of information. First we need to know who is actually malnourished and we did this using the subjective global assessment which is a clinician conducted examination that includes both the history and physical assessment. We then compare this against the information from the routinely collected variables and try to create a prediction model that best predicts what we found using the gold standard subjective global assessment.
And through this logistic regression process we ended up eliminating eight of the variables and developed a final model based only on body mass index and weight change over six months. Thus the risk of malnutrition is calculated based on the equation provided here on the screen and this results in a probability between 0 and 1. So we’re calling this equation AutoMal.
Now I personally was quite surprised by this result as I thought we would have more variables in this equation. And quite frankly I like to see a complicated equation. It makes me feel like the research was robust. But look at the end of the day I think having a simple model that demonstrates I guess excellent prediction ability means that it is simple to implement and to understand. And so this statistic down below, the area under the curve of 0.84 really just indicates that it has an excellent ability to discriminate between malnutrition status and it’s quite well accepted as a threshold across other areas of prediction.
Now it can be helpful to understand how the AutoMal works by looking at some specific numbers. So this chart shows all of our 500 plus participants separated based on their malnutrition rating into SGA-A which is normal, SGA-B which is moderately malnourished, and SGA-C which is severely malnourished. So you can remember this through the traffic light system where green is good and red is bad.
Now if we look across the chart you can see the probability calculated on AutoMal which as I mentioned earlier runs from 0 to 1, with the left side being less risk of malnutrition and right side being more risk of malnutrition. So the AutoMal calculates a probability that is continuous but we want to also have a classification into simply are they malnourished or are they not. So we can do this step by inserting a threshold, where anyone who is on one side of the threshold on the left will be not malnourished and right would be malnourished. We can see that over here.
So on this slide I put in three possible thresholds that we could use and on the left hand side you can see one that is really sensitive. So that means that we will be picking up a lot of people who are malnourished but we might also incorrectly identify some people. And the same goes for when you sit on the other side of the scale where you are really specific but again you are incorrectly classifying some individuals.
Without going too much into the details of these statistics what I want to emphasise is the benefit of the AutoMal is we can put this threshold wherever we want based on how you want to use it. So if you really want to pick up everyone who might be malnourished you can set it as really sensitive. But if you want to make sure you’re not accidentally identifying people who are healthy as malnourished we could be really specific. So this gives it flexibility for a range of uses.
So Marie-Claire it’s over to you.
Dr Marie-Claire O’Shea:
So let’s look at the implications for policy and practice. So the AutoMal is recommended for the inclusion in the National Aged Care Mandatory Quality Indicator Program as an indicator for malnutrition and we’re currently working with facilities to test the automation of this algorithm. We see facilities completing routine data collection as they currently do. The AutoMal algorithm is then applied to particular columns in their already collecting data spreadsheet, and that is the BMI and the weight change. The AutoMal then indicates who is malnourished or who is at risk of malnutrition. The data is then reported as part of NQIP and the facility can act promptly to provide nutritional care for those identified residents.
So as previously explained malnutrition screening and diagnosis is not routinely undertaken and when it is completed it can be overruled at the discretion of a clinician who may not be skilled enough in this area. AutoMal uses routinely collected data. It reduces subjectivity and bias and does not require additional workload for an already stretched workforce. AutoMal is a cost‑effective way to treat a national and systemic problem. AutoMal is currently being trialled with older people in the community and the in-home care setting to test its feasibility. And this is yet another setting where malnutrition screening is not routinely undertaken.
We believe a nationwide adoption of AutoMal within NQIP standards should be accompanied by resources to support the nutritional management of malnutrition and we recommend offering a malnutrition clinical pathway that includes a range of options including food fortification with additional nutrients, oral supplements and a dietician referral if required.
Dr Jonathan Foo:
Thank you.
[Visual of slide with text saying ‘Contact us: ‘Jonathan Foo’, ‘jon.foo@monash.edu’, with an image of Jonathan Foo, ‘Marie-Claire O’Shea’, ‘m.oshea@griffith.edu.au’, with an image of Marie-Claire O’Shea, ‘*Content from this presentation is currently under peer review’, ‘ariia’, ‘Aged Care Research & Industry Innovation Australia’, ‘Griffith University’, ‘Monash University’]
Amber Shuhyta:
I’d like to now welcome Sandi Hayes our next presenter. Sandi are you with us?
Professor Sandi Hayes:
[Visual of slide with text saying ‘Cancer Council Australia’, ‘A Cost-Consequences Analysis of the SAFE trial: a comparative, effectiveness trial evaluating low versus high level of exercise supervision over a 12-week intervention period for women with breast cancer’, ‘Presented by Prof Sandi Hayes’, ‘Director of Research’, ‘Cancer Council Queensland’, ‘ihop’, ‘improving health outcomes for people’, ‘improvinghealth.com.au’, ‘Griffith University’, ‘Queensland Australia’, ‘Menzies Health Institute Queensland’]
I am. Can you hear me?
Amber Shuhyta:
Yeah. Thanks. Over to you.
Professor Sandi Hayes:
Great. Thank you. Good afternoon everyone and thanks for having me here today. I’m the Director of Research at Cancer Council Queensland and would just like to present results from a consequence analysis of a trial called the SAFE study.
I am speaking from the lands of the Turrbal and Jagera people and would just like to pay my respect to Elders past, present and emerging.
I think it’s important just to begin with some context. Breast cancer is the disease that I’m specifically talking about today. It’s the most common cancer among Australian women. It has an overall survival rate of over 90%. Sorry. I’m just trying to find the animation.
There we go. Can’t quite see it. So over 90% of women who are diagnosed with breast cancer will go on to survive the disease. The survival rate is much higher than the five year survival rate that we see with all cancers combined. But of course it’s really quite dependent on the stage of the disease at the point of diagnosis.
While advancements in treatment have certainly contributed to the improvements in survival rates that we’ve seen over the last couple of decades survival rates do not of course represent the burden that is imposed on an individual as a consequence of that treatment. The higher the stage of disease at diagnosis the more invasive and intensive the treatment. And along with that comes an increased risk of the frequency and the severity of treatment-related burden.
There’s a compelling and consistent evidence-base that continues to show or to grow that shows exercise as an effective supportive care strategy that can be used to manage the burden associated with cancer. In 2019 there was an international round table that was convened to discuss this evidence-base and as you can see on the table to the right of the slide there is a list of 16 common treatment related side effects that can present as a consequence of cancer and its treatment that have been evaluated in exercise oncology trials over the past 30 years.
Now the strength of the evidence that supports exercise as being beneficial for any given outcome is also shown on the slide and you can see that the strength of the evidence ranges from insufficient to strong. But I think what is particularly noteworthy is that of any outcome that has been assessed in these exercise oncology trials we’re yet to see an outcome be adversely affected through the incorporation of exercise as part of care and at worst there will be no change. But alongside that no change will be benefits in a whole host of other outcomes. Despite this evidence-base the vast majority of people who are diagnosed with any kind of cancer but including breast cancer are insufficiently active at diagnosis. They experience declines in their physical activity during the treatment process and physical activity levels rarely decline following the cessation of treatment.
I’m having real troubles finding the forward slide button. To assist individuals with a chronic disease such as cancer to access supportive care such as exercise therapy Medicare offer up to five reimbursable sessions with an allied health professional in any calendar year. As I’m sure most if not all of you on this meeting are aware this funding model allows sessions to be directed towards one particular allied health professional or more commonly the sessions are shared between multiple allied health disciplines. The distribution of these sessions may be a bit dependent on the individual’s multidisciplinary needs, their personal choice or their doctor’s advice. And so this means that exercise therapy could receive anywhere between zero sessions up to five sessions in a calendar year under this model. Interestingly enough the safety feasibility and effective delivery of exercise therapy under this five session model has not been evaluated in any cancer setting.
Which brings me to the SAFE trial. The SAFE trial was a comparative effectiveness trial which was designed to evaluate the safety, feasibility and effect of exercise when delivered under the Medicare model versus a more typical research model to women with stage two or higher breast cancer.
What I’m showing you today is the comparison of the cost and the health consequences associated with the 12 week individualised evidence-based exercise intervention and comparing when it was delivered under five sessions with an accredited exercise physiologist versus 20 sessions with an accredited exercise physiologist.
The intervention spanned a 12 week period versus a 12 month period. So just to flag that. The eligibility criteria was purposely designed to ensure that we were targeting women who were less likely to participate in an exercise intervention trial but would benefit the most from participating in that trial. So eligibility was restricted to women with stage two or higher disease at diagnosis. They needed to have at least one persistent treatment related side effect such as fatigue, nausea, peripheral neuropathy, or an additional comorbidity such as obesity, diabetes, hypertension. And they needed to be insufficiently physically active.
We delivered the intervention via face to face delivery with an accredited exercise physiologist at a location of the participant’s choice which was usually their home.
So into our economic analyses. To create our cost consequence analyses firstly the consequences of the intervention needed to be defined. The 12 outcome measures collected during the SAFE trial are listed on the slide and these represent our intervention consequences that were then combined into a composite variable using what’s called a standardised Z score and we reported this as an effectiveness score.
We then categorised this effectiveness score into whether someone showed evidence of being a clinically relevant improver, decliner or whether they were stable in the overall health outcome or health consequence of the intervention.
After identifying our intervention consequences, the costs of the intervention delivered under both supervision levels needed to be defined and costs were grouped into four broad categories, including design and development, initial and ongoing training, intervention delivery and equipment required to deliver the intervention.
So to our results. Our intervention consequences are represented by the effectiveness score displayed on the right and you can see that both groups experienced improvements from baseline to post intervention and these improvements were maintained at the 12 week follow up. And when we categorised people in the five versus the 20 session group as being an improver or not you can see that one in two women in the five exercise group were considered improvers versus three in four women in the 20 session group.
Okay. So this slide demonstrates the distribution of costs to deliver the intervention over both supervision levels. And as you can see the costs are constant between both groups for the design, development and training phases. However costs begin to differ when taking intervention delivery into account. The five session group delivery costs reached approximately $14,000 whereas the 20 session group is almost four times this. And when we look at the cost per improver in the five session group we had 14 improvers that came at a cost of about $2,500 per improver and in the 20 session group we had 21 improvers which came at a cost of about $3,000 per improver. So you can see that the differences between both groups begin to minimise with a difference of about only $500 per person.
So what happens to these results when we apply them to a real world context? And if we assume that the same percentage of improvers are seen in both groups when delivered to a large number of survivors we can see greater cost efficiencies occur. This slide shows eight of Queensland’s hospital and health services with approximate numbers of breast cancer cases recorded at each health service in 2016 listed next to their names. And as you can see the greatest cost efficiencies for both groups are obtained when the intervention is delivered to a greater number of survivors like in our Metro South hospital and health service group.
The other thing that we see emerging is within our remote and very remote regions whereby costs start to equalise between both supervision levels when delivered to smaller populations with less than a $600 difference between our two groups per person.
So to summarise both of our groups experienced positive health consequences over the course of the 12 week intervention but certainly there were more women in the 20 session group who experienced clinically relevant improvement. We now need to extend this work to look at five versus 20 sessions over a 12 month period rather than a 12 week period which takes it fully in line with the Medicare model. But I think overall the key point is that we get greater cost efficiencies when the intervention is delivered to a larger number of participants as well as when we go into very remote areas where there’s a lower cost difference between either of the two models.
Thank you very much and hopefully this was useful to everyone.
[Visual of slide with text saying ‘Professor Sandi Hayes’, ‘sandihayes@cancerqld.org.au’, ‘www.linkedin.com/in/sandihayes/’, ‘@_SandiHayes’, ‘icanmoveit’, ‘ihop’, ‘improving health outcomes for people’, ‘Co-authors: Dr Rosa Spence, Ms Jess Watzek, Dr Carolina Sandler, Dr Louisa Collins, Dr Chris Pyke, Dr Dimitrios Vagenas’, ‘improvinghealth.com.au’, ‘Cancer Council Queensland’, ‘Griffith University’, ‘Queensland Australia’, ‘Menzies Health Institute Queensland’]
Amber Shuhyta:
Thank you Sandi. That was great.
I’ll now pass over to Alex Bahar-Fuchs who will be speaking next. Alex do we have you online?
Dr Alex Bahar-Fuchs:
[Visual of slide with text saying ‘Deakin University’, ‘Australian Dementia Network’, ‘Registry. Clinics. Trials’, ‘Cognition-oriented treatments for older people with mild cognitive impairment presenting at Australian Memory Clinics: A case for implementation’, ‘Alex Bahar-Fuchs, PhD’, ‘School of Psychology; Deakin University’, ‘On behalf of the Australian Dementia Network Cognitive Interventions Working Party’, ‘National Allied Health Virtual Research Forum 2024’, ’30 April 2024’, ‘1:00pm – 4:30pm AEST’, ‘a.baharfuchs@deakin.edu.au’, ‘@AlexBaharFuchs’]
Hello. Good afternoon. I hope you can hear me.
Amber Shuhyta:
Yes. Thank you. Over to you.
Dr Alex Bahar-Fuchs:
I’m just requesting control of the slides. Good afternoon everyone. It’s a pleasure to be given the opportunity to speak to you today. I’m speaking on behalf of the Australian Dementia Network working group on cognitive interventions and I’ll be talking about our work towards implementation of cognitive interventions for people with mild cognitive impairment in Australian memory clinics. I’m a clinical and research neuropsychologist based at Deakin University in Melbourne and I’m speaking to you today from Wurundjeri land.
I’ve got no relevant conflicts of interest and my sources of funding support are listed on this slide. Just by way of quick context I’m sure I don’t have to convince the audience regarding the importance of the global burden associated with dementia and the importance of implementing urgently effective evidence-based treatments to support people with or at risk for dementia. In the field of the cognitive intervention class of approaches we’ve been distinguishing over the past 20 years between three broad approaches that we term cognitive stimulation, rehabilitation and training. I’m not going to go into the details of these different approaches but they have all been subjected to a lot of research and they are backed by a very, very strong body of evidence.
In fact our team published in 2020 a very large systematic overview which is a meta-analytic study of meta-analysis where as you can see on the screen here – I know that it’s hard to see the details – but we produced very robust evidence showing the positive effects of cognitive stimulation, rehabilitation and training for people along the continuum of ageing, cognitively healthy people, people with mild cognitive impairment and people with dementia, and this is a reproduction of our [2:07:21] from that review which was used by the Lancet Dementia Commission report in 2020.
And in fact clinical practice guidelines both in the US and in Canada now make recommendations to offer people with MCI and people with dementia cognitive interventions. Unfortunately in Australia we are lagging a little bit behind in this respect and we’re still relying or our clinicians are still largely relying on the Clinical Practice Guidelines for GPs published by the NHMRC Cognitive Decline Partnership Centre in 2016, anecdotally largely based on evidence that my team produced some ten years ago which was very inconclusive but was misinterpreted as evidence against cognitive training and rehabilitation for people with dementia. Likewise the Australian Royal Commission into Aged Care Quality and Safety also made recommendations against cognitive training and rehabilitation.
So it’s been a slow process translating the most recent and very strong evidence-base in the Australian context and to that end we’ve established in 2021 as part of the Australian Dementia Network the Cognitive Intervention Working Group championed by Professor Sharon Naismith and co-chaired by myself and Associate Professor Kerryn Pike from Griffith University, formerly also by Dr Loren Mowszowski from the University of Sydney.
Our work has been divided broadly into three I guess broad phases which you see on this slide. We started off from kind of a mapping phase as part of which we conducted a large scoping review and a national survey of stakeholders, a capacity building phase as part of which we’ve developed and delivered a comprehensive clinician training toolkit as part of our attempt to build capacity, and a third phase which is our translation phase as part of which we’re currently conducting a pilot implementation study across the country.
And I’m going to take you quickly through the key findings from the different stages of the work that we have actually already completed. So our scoping review which is currently in revision and is led by Associate Professor Kerryn Pike, 29 implementation efforts from around the world. We were really interested in understanding these implementation efforts in different parts of the world, which approaches were used as part of these implementation efforts and what were some of the barriers that were found in implementing these types of interventions.
You can see that we found that interventions came from several parts of the world but primarily from the UK, the US and several Asian countries. Cognitive stimulation was the most represented approach in these implementation studies as a very mature form of intervention but there were also other studies that looked at cognitive training and rehabilitation. Only a small number, in fact three of these studies used a formal implementation framework, and mostly it was the RE-AIM framework. And among the barriers that were identified these were divided into stakeholder factors, service factors, intervention factors and reach related factors. So this paper is currently in revision and we hope that it will be available soon.
On this slide you can see the components of the RE-AIM implementation framework that were most commonly reported and least commonly reported in the 29 studies that we included. The three most commonly reported implementation components were the efficiency, feasibility, and the least commonly reported were cost and cost effectiveness as well as maintenance.
The next phase of the work involved a multi stakeholder survey led by PhD student Alessandra Lee from the University of Sydney. She interviewed clinical neuropsychologists and trainee clinical neuropsychologists and very briefly she found very strong support for some of these statements including the fact that neuropsychologists felt that it was very important or extremely important for them to be able to offer cognitive interventions as part of routine clinical practice, that they would be very interested in receiving additional formal training in the delivery of cognitive interventions, and that in terms of the way this training would be delivered it should ideally be a combination of online and in person forms of delivery.
So in the second phase of our work we’ve developed a comprehensive clinician training package which was delivered through the CogTale evidence synthesis platform. It included six online modules that clinicians completed once a week and you can see the broad sort of topics of those modules here. The modules included a range of topic areas, quizzes, video material and lots of interactive content. And here are just some examples of some of the content that was included in one of those modules. There was lecture material by members of our team and an evaluation of understanding as part of each module as well.
We then conducted a full one day training workshop held at Deakin downtown mid last year and this is the packed agenda of that day and the members, I think 17 or 18 clinical neuropsychologists from across the country who took part in this one day workshop. And we collected some feedback on the satisfaction of our participants from this additional training we offered and you can see here that most of our participants were either very or slightly satisfied with the quality of the toolkit as a whole as well as with individual components of the toolkit.
They’ve also given us some very useful feedback on the strengths and areas of improvement associated with the training package that we developed and we are currently in the process of revising this training package supported by some additional funding we received from the Department of Health.
Finally we are currently I guess midway through the implementation study we’re running in initially six memory clinics from across the country. Since then one of the memory clinics had to drop out. This involves a clinician training which we did last year, then a six month implementation period and a six month observation period. The components of the RE-AIM framework were all reflected in our assessments. And we are currently just at the beginning of the six month outcome assessment for all the participating clinics and you can see some of the statistics around some of the patients that have been offered and accepted an intervention, and we are in the middle of collecting all the relevant outcome data at this point.
Just to wrap up I think cognition oriented treatment is an excellent case of a class of interventions which are policy ready. There’s plenty of evidence supporting their efficacy for a range of outcomes for people with dementia or at risk of dementia. The group of us behind this work are very passionate and strongly believe that patients deserve access to post-diagnostic support services, evidence-based, and that it’s really time to translate this into policy. We are in the process of revising the clinician training package and under the leadership of Associate Professor Kerryn Pike we’re waiting for the outcomes of a large MRFF to conduct the larger implementation study.
And I think I’m going to leave it there and thank the wonderful people of the ADNET Cognitive Intervention working party without whom all of this amazing work wouldn’t be possible. And I also thank you for your attention.
Amber Shuhyta:
Thank you Alex. Thanks a lot. We now have one more abstract presentation before our next keynote speaker. And so I’m going to now hand to Nadine Foster for her presentation.
Professor Nadine Foster:
[Visual of slide with text saying ‘Harnessing policy changing research from the UK to implement & evaluate new models of allied health-led primary care in Australia: time for change?’, ‘Prof Nadine Foster’, ‘National Allied Health Virtual Research Forum’, ‘30th April 2024’]
Thank you. Can you hear me and can you see my slide?
Amber Shuhyta:
Hear you and see your slide. Thanks.
Professor Nadine Foster:
Perfect. Okay. Well again thank you and thank you all for staying and listening to the last presentation from these abstracts. I’m going to talk about harnessing policy changing research from the UK to implement and evaluate new models of allied health-led primary care in Australia and ask the question is it time for a bit of a change here.
So the Strengthening Medicare Taskforce Report, I just want to link my talk to this as sort of a policy direction. And this is very much building on Australia’s primary care healthcare ten year plan. And this Taskforce made 21 recommendations and four are really relevant to this presentation. Firstly increasing access in primary care, encouraging multidisciplinary team‑based care, increasing commissioning of allied health services and then lastly for this learning from international and local best practice and investing in research.
So I’m not going to detail all of the differences and similarities between the primary care context in the UK and Australia but there are some really key similarities. And they are of course increasingly complex health needs of our populations, and a very similar number of appointments every day and a strikingly similar number of full time equivalent GPs.
Both of our systems could be viewed as primary care in crisis with retiring GPs and a small pipeline choosing general practice in new medical graduates. And certainly in the UK there’s been a direction of fewer and larger practices incorporating many other members of a multidisciplinary team. And that’s perhaps not just moving at quite the same pace here in Australia where accessing primary care is harder and there are disjointed services that are hard to navigate.
The big difference of course is in population size with 67 million in the UK versus 26 million here. That means that in reality with boots on the ground for GPs there are much fewer GPs per patient in the UK than there are here in Australia. And that’s perhaps one of the reasons for the at pace change or step change in really beginning to use other clinical disciplines to full scope and enhanced scope. And I’m just going to mention some of those that are relevant here which particularly is expanding self-referral or direct access pathways to allied healthcare-led pathways, and physiotherapists are now able to issue fit notes for time off work, models like Pharmacy First in the community and allied health first contact practitioner models or FCPs.
So what I’m going to do is just present some studies that my team led in the UK before I moved to Australia just a few years ago but I think could be real learning for Australian both research and policy directions.
My work focuses on musculoskeletal pain and of course it’s one of the most common conditions in the community. It accounts for between 14% and 25% of all GP consultations depending on the study that you access. And of course there’s real opportunity to get care and early care right. And part of the solution I believe is direct access to physiotherapy and other first contact practitioner models in primary care.
The three research studies are linked and therefore in the interests of time I’m just going to give you very high level information from these studies. One is a systematic review of the international evidence of non-medical musculoskeletal triage and direct access services. One is a cluster randomised controlled trial that my team led in the UK with just under 1,000 patients including full health economic analysis. And the final and more recent piece is an implementation evaluation study where we ran alongside the NHS England rollout of the first contact physiotherapist model of primary care embedded in general practice.
So that’s our systematic review. Of course we reviewed various databases, including 26 studies. Really interestingly most of those studies were from the US or the UK. None of the studies were from Australia. But there were plenty of patients in these studies in both non-medical practitioner models of care as well as GP led traditional care. The team were able to group the models into three main approaches. Open access, a combination or in fact the offer of a service pathway where patients were free to choose either GP led care as usual or directly accessing a non-medical practitioner. And in nearly all the studies, apart from one I think, those were physiotherapists.
The key results were that direct access patients had similar characteristics to those accessing usual GP led care, that patient outcomes in terms of pain and disability were not different depending on the access model, but the benefits were there was lower healthcare use and less time off work in patients directly accessing these non-medical practitioner models of care compared to those traditionally accessing GP led care.
And that led this team to conclude comparable clinical outcomes, lower healthcare consumption, 10% to 20% lower healthcare costs, all helping to manage that GP crisis and GP workload that I mentioned.
Moving on then to talk about the cluster randomised controlled trial that we led in the UK. So this was a pragmatic, non-inferiority cluster randomised trial working with general practices and physiotherapy services and then collecting data from patients at baseline two, six and 12 months. We randomised four general practices with a total patient population of 25,000 and those practices either continued to offer usual GP led care for adults with musculoskeletal conditions or they also added a pathway, this new direct access to physiotherapy pathway. And we marketed that new service to all adults registered at the intervention practices and gave physiotherapists brief training and mentoring in the model of care.
We showed that there were comparable patient characteristics across the two arms of this trial. There were no serious adverse events and no evidence of a missed serious pathology where we did a detailed review of the GP medical record for 12 months following the model of care’s introduction. Only 4% of self-referrers were deemed unsuitable at physiotherapy triage. 90% of the physiotherapy caseload in those intervention practices came via this self-referral model and there was no increase in waiting times for physiotherapy.
On this slide is just our primary outcome which was physical health and you can barely distinguish the blue and red lines. We saw similar physical health outcomes. We saw benefits however in healthcare utilisation. So on the left in usual GP led care there were more GP visits, more orthopaedic and rheumatology visits, more prescribed drugs, more surgery. And on the right in the direct access pathway we saw some more physiotherapy visits but fewer days off work and crucially lower NHS costs.
Sorry. It’s a bit slow to move forward. And then finally the implementation study of the FCP model of care. So this is a primary care model where musculoskeletal physiotherapists undertake the first patient consultation in general practice that enhances musculoskeletal care and frees up GP capacity for other patients. In 2019 the NHS long term plan committed to rolling out this FCP model of care across NHS England and our team were commissioned to evaluate this new model of care. And that’s why I said we were kind of running alongside the rollout of this across the whole of England.
So this was a national mixed methods 24 month service evaluation and we collected data from high level sort of routine impacted service data but also we invited participants and patients to complete brief online questionnaires for PROMs and PREMs and we did various interviews with a whole range of stakeholders.
So what did we find? We worked with 240 first contact practitioners from 40 services. They saw more than 6,800 patients across the timeline of this evaluation and of those 2,400 were asked to complete our online survey and we had 680 responses. 98% reported having confidence in the FCP’s competency to assess them. 93% reported receiving sufficient information about their musculoskeletal condition. And 94% would recommend their FCP service to family and friends.
In terms of outcome we saw global improvement in symptoms across the three months of outcome data collection. We saw pain reduction at three months that exceeded the minimal important change. We saw better musculoskeletal health that also exceeded our minimal important change on that outcome. 80% of patients did not go on to see their GP after consulting the FCP. We saw reductions in orthopaedic referrals and fewer drug prescriptions. And the return on investment essentially concluded that for every one pound spent on implementing this service there was a return on investment of between £0.81 to £2.37.
So essentially these models of modernising access and expanding the GP team are safe, they don’t overload services nor increase waiting times, and they provide non-inferior clinical outcomes. They do yield high patient satisfaction and they are cost effective. And actually in the UK NICE now recommends both self-referral and FCP roles and NHS England is committing to ensure that all adults in England will be able to see a musculoskeletal FCP at their local GP practice without being referred by a GP.
So just to finish I guess the question that I’m asking, is it time for a change also here in Australia in primary care, to learn from this UK evidence, to develop, implement and evaluate these models of care here in Australia, and to provide high quality policy ready research here? And the final little picture is just to remind me to say that we’re currently working across a national team to try to obtain funding for a trial that will test this type of model of care here in Australian primary care. Thank you very much.
Amber Shuhyta:
Thank you so much Nadine. That was a great presentation.
And thanks to all the presenters for those excellent demonstrations of allied health policy ready research. It’s now my pleasure to hand over to Dr Masha Somi for our second keynote address. Masha has recently been appointed Assistant Secretary in the Primary Care Reform Branch within the Department of Health and Aged Care and she has over 20 years’ experience in the Australian Public Service, the last 13 as a senior executive in the Department working on national health programs in medical research, immunisation, Aboriginal and Torres Strait Islander health, preventative health and health reform. Over to you Masha.
Dr Masha Somi:
Thanks Amber. And I’m going to go rogue. I don’t have a slide deck so I’m happy for you to take the deck off and we can just sort of have as conversation. So I’d also just like to acknowledge that I’m joining on Ngunnawal and Ngambri country here in the Canberra region and acknowledge our Aboriginal and Torres Strait Islander colleagues who are here with us today.
So I do know a couple of people and I met a couple of people already but look forward to having a bit more of a conversation during the questions and answers and also in the panel discussion. So today I’m here to talk about aligning research with Government policy. And I’ll share some thoughts of what I’ve learned over that career that Amber just mentioned and I’ll particularly focus on some of the pressure points that I’ve experienced and I’ve kind of talked to researchers about when they’re engaging with policy makers, bureaucrats in particular. And I’ll also give some examples of where things have worked well and perhaps where they’ve been a little bit challenging. And really happy to take any questions on that either in the Q&A or in the panel discussion.
So I’ve taken Peter’s three ideas or three themes and I’ve got four key ideas that I’d like to talk through today. I’ve one upped him. And I’m hoping that the conversation will help demystify working with policy makers for you.
So my first idea is pretty obvious. It’s that you need to know each other. It’s obvious but I can’t emphasise it enough. So just to break it down this includes meeting all the relevant players, having a really good understanding of the issues and the concerns, learning to speak each other’s languages. I’m always surprised how similar words can have completely different meanings to different people. So it’s really important to make sure you actually mean the same things when you’re having these conversations.
And as Peter mentioned it’s really important to understand the operating environment that the people that you’re working with have to operate under. So whether that’s the political context, whether that’s actually the social licence that people or bureaucrats are having to work under, or even just the environment that they have within their organisation.
Sometimes people forget but it’s our day to day experience that as bureaucrats we operate under legislation and also Codes of Conduct that impact what we can or can’t do. So for the federal public servants we operate under the Australian Public Service Act and there’s actually a Code of Conduct which is summarised to a set of values which is ICARE, and that stands for impartial, committed to service, accountable, respectful and ethical.
So impartial means that we are apolitical. And what that means is we have to be able to hold a centre line on all matters that are political. So for people on the outside this can sometimes seem really frustrating because it can seem like maybe we’re sitting on the fence or that we don’t understand the issues or we don’t have a will to be able to address them. But from an inside perspective I guess the way I see it is it’s about discipline, it’s about being careful to make sure that in everything that we do that we’re really conscious that we’re able to maintain the faith that Governments and the public have in us and that we’re able to deliver the agenda for any Government that’s in power.
Another thing is that bureaucrats don’t know what it’s like to work in a university even though I did a PhD at the Australian National University. It wasn’t until I spent my time at the Medical Research Future Fund that I got a really good understanding of the experience of academics particularly sort of mid to senior academics and the challenges they have in being able to operate in that environment. So it’s unclear to us about your day to day experience of what’s important in terms of being promoted and having successful career progression and also what it takes to be successful in category one grant funding. And they’re your bread and butter in how you operate as an academic but they’re not sort of things that are very clear and transparent to a bureaucrat. And so your drivers around your own career and managing your grant funding and being able to get the grants and the funding that you need to do the research that you want to do or that you think is important, those drivers aren’t as apparent to bureaucrats.
So some of the pressure points I have seen over time, just to acknowledge, bureaucrats move a lot or we look to move a lot compared with academics. And I appreciate that’s really frustrating. Often I’ll meet with sort of a new set of stakeholders when I start in a new role and you can feel everyone saying okay, the next group’s here. But I guess just encourage you to lean into that and I guess take the time to bring the person up to speed and share your knowledge and understanding and that will help you build that relationship.
I encourage you to think about it as a respectful relationship. Again this seems obvious but it’s actually a really important part of building a strong relationship is having a foundation of respect. So you need to know each other and recognise each other’s strengths and that your roles are complementary. You’ll be the research expert and they’ll be the policy expert. And for example in my roles, in my work, my expertise is taking good ideas and being able to run them through Government processes and to get them into practice. So it’s about how you can work together as a partnership and having a truly respectful partnership that you’ll then be able to build and develop and be able to actually achieve the agenda that you have.
Another area where there’s a challenge is sort of the nexus between collaboration and advocacy. So be clear when you’re approaching policy makers whether you’re looking for a partnership or if you’re looking to advocate on a specific issue or topic that you’re interested in. If you do want to truly build a partnership just maybe manage the advocacy. Obviously that’s your role and you need to do that but often bureaucrats feel backed into sort of positions if they feel like someone’s coming to advocate a particular position and it means you often can’t have the truly open conversations that you might wish to have to be able to build that partnership.
So I’ll talk about two examples that are about knowing each other from my time in managing the National Immunisation Program. The first is that we did provide effectively block funding to the National Centre for Immunisation Research and Surveillance and through that block funding we were able to develop a work program together. We had really regular and routine engagement and meetings and we were able to partner together on research projects and I guess surveillance and other projects that were able to take the agenda for the National Immunisation Program forward. So over time we were able to build a really strong sense of shared purpose, trust and confidentiality. We could have really frank conversations about topical issues and know that those were in confidence. And through that partnership we were able to leverage each other’s strengths and over a relatively short period of time we were able to deliver quite a range of reforms in how the National Immunisation Program was delivered.
One that was a little bit more tricky was the work that we did in redesigning the Australian Immunisation Handbook. So it was basically a hard copy book. It was about six or seven centimetres thick and lots of small text and also some very long sentences. And we were a bit concerned because the harder it is to read a guideline the higher the risk that there could be misadministration of a vaccine. And also we needed to move to a digital model to get into the 2010s as it were.
To be able to deliver a digital handbook from scratch effectively we needed three different types of expertise. So this is really pulling together the idea of partnerships and complementarity. We needed the academic and the clinical input, and that’s the expertise of what vaccines were needed and when. And our National Research Centre provided this in partnership with other academics. We needed expertise in digital innovation and we needed expertise in how to kind of format and present and digitise our complex information in an accessible online format. And we actually ended up contracting a specialist digital provider to be able to do this for us.
And finally we needed project management skills. And so that was the capability the Department was able to bring to the project which covered the financial milestone and risk management that was required to deliver quite a complicated project. So it took a lot of meetings and a lot of conversations to be able to get alignment across all of the three different groups that meant we were able to meet all of those different components for sort of the clinical, the digital and the project management. And that was the first time I had learnt, and many of you will know this, is that academics really dislike bullets. I didn’t realise that until this project.
So the outcome of that really quite powerful collaboration was a really amazing product. It was delivered on time and on budget and it was really highly regarded by users. Still in train and doing really well including in supporting the COVID response.
My second idea to talk to you about is the importance of knowing the difference between a research gap and a policy problem. So researchers’ super skill is to identify research gaps. The issue is that policy makers have policy problems. Now in some instances those two things overlap however in a lot of cases they don’t. And this isn’t an issue that’s unique to policy makers. It’s also an issue that I think researchers experience when dealing with consumers and health professionals and health services.
I’m just going to pause for a minute because I’m not sure if I’ve frozen because I actually can’t see anyone.
Amber Shuhyta:
You’re fine Masha.
Dr Masha Somi:
Okay. Awesome. Thank you so much. Okay. So in terms of sort of the pressure points in the research gap versus the policy problem I guess the issue is that policy problems are often really, really complicated. Our world is messy and interlinked. It’s hard to translate these problems into a set of research questions. The issues are often not static. They’re constantly evolving particularly as there’s many confounders and there’s lots of activity that can happen in different parts of the system that will impact the overall outcomes.
And finally it’s really difficult to apply traditional methodologies to the types of issues and questions that policy makers are trying to address.
So it’s possible that you can have a great research project and a great outcome that you want to get into practice. This is a significant pressure point that I’ve experienced with researchers. And it can appear that policy makers may not be interested in this really important thing at this particular time. And I’ll come back to that because that sort of causes I know quite a bit of distress or disappointment amongst academics.
So in terms of two examples in this area of research gap versus policy problems I’ll talk about two examples from the Medical Research Future Fund. One is that there were often or regularly policy problems that had been identified by the community or by Government or by policy makers that we couldn’t engage researchers on. We couldn’t get sufficient, or sometimes any or sometimes sufficient competitive proposals to be able to conduct the research. And these examples in this area were things like pancreatic cancer and the management of chronic pain. Which is interesting there was a presentation earlier on it. But we’ve been looking at the issue of chronic pain and how it’s managed in primary care for a while and often struggle to get enough competitive applications through grant opportunities.
Also in the Medical Research Future Fund I guess a good news story is that we were able through some really I guess thorough and comprehensive work able to work with policy makers to be able to align the policy problem with the researchers and their interests. The example that I’ll talk through today is that we have a health technology assessment stream through the Medical Research Future Fund. It provides $10 million each year. And we worked with the chairs of health technology assessment committees, both reimbursement and regulation, to set research priorities. And that stream’s been incredibly successful over the last couple of years and we’ve been able to fund some great research that would help the committees manage complex applications to their committees in time.
So a really interesting one is we’ve been able to fund the development of a generalisable model for assessing the cost effectiveness of emerging high cost gene therapy. So these are brand new technologies, gene modification quite early on in life and really trying to work out how do you assess this in terms of a reimbursement strategy for the Australian public.
My third idea today is ideas have a time and a place. I talked a little bit earlier about context, that sometimes your great idea isn’t quite ready for policy consumption and you may need to be patient, to wait for the right time and the right place for the idea. As a public servant sometimes we feel a little bit like we’ve got a solution that’s looking for a problem that we don’t have yet. But from your perspective you’re seeing it as a problem and a solution. It’s just sometimes we don’t have a mechanism for getting your great idea into practice.
With a little bit of patience and building of the relationships though I do think that you can help sort of carve and create an opportunity to get the right environment for the idea. So some of the pressure points I’ve experienced is that it really can be frustrating for researchers to find something useful and important that you can’t get implemented and this is particularly challenging where I guess researchers and clinicians see that the alternative, either the thing that’s in train or in practice or the things that’s being implemented, is harmful. And another pressure point is sometimes you and the policy maker can agree however the political environment isn’t ready. And I’ve experienced that a lot working in preventive health in particular, that sometimes the Government of the day just hasn’t got that sort of specific focus at that time.
So my example for this is a good news one from when I was working in immunisation back in 2017 and we were rolling out an updated version of the Gardasil vaccine. It protected against nine types of human papillomavirus up from the four that were covered in the original vaccine. And the group that conducted – there was a group in Australia that conducted a sample of cervical cancer tissues and found that the old vaccine covered HPV types associated with 77% of cancers while the new vaccine covered HPV types associated with 93% of the cancers. And we were able to promote and share that evidence as part of all the dissemination for the new program, and that included communications through the Prime Minister and the Health Minister at the time.
So my final idea is be pragmatic. So getting research into policy and being able to build relationships across the bureaucratic and academic divide is challenging and it does take time. So the pressure points I’ve seen is that policy makers often need answers much more quickly than researchers like and trying to find a compromise and a middle ground on that pace can be challenging. There’s a pressure point around balancing quality versus pace. So being pragmatic as a researcher you could provide the feedback of what is achievable and by when. For example can you use a more practical, perhaps a simplified design that will get you an answer much more quickly even if it’s not as academically complicated or as likely to end up in a journal publication.
Sometimes there’s a divergence of views in the academics. So often you’ll have a lot of conversation in the public sphere around a particular topic and that can be hard to manage when you’re in Government or in bureaucracy. So we obviously need academic rigour and independence but it is really hard to build and generate momentum on a particular topic if all of the public voices disagree on the issues that are being debated. And I guess a question is whether academics or researchers or clinician groups can form coalitions together to coordinate messaging and advocacy.
So an example from my time in the Medical Research Future Fund is in the area of rural health where a large number of rural research groups got together and clinical groups got together and advocated for funding for rural health research. And it was a really powerful united campaign across a number of clinical academic and service delivery groups. The result was that we were able in the Medical Research Future Fund to start allocating funding for research in rural areas focused on researchers based in rural areas, and we actually worked really closely with those groups to refine our eligibility and assessment criteria to ensure that funding actually supported projects that were important to rural communities and that build capacity amongst researchers based in rural areas.
So today I was to talk about how to align research with policy and I hope the four ideas that I worked through today will help you in that process. My key message is that relationships matter and that you can achieve a lot when you’re able to work collaboratively across that academic and the policy spectrum. Thanks Amber. Happy to take any questions or to move to the panel.
Amber Shuhyta:
I have a question before we move to the panel. I think there might be some Slido questions in the panel session. You’ve given some really great ideas in terms of building that relationship and I can hear a real focus in terms of what researchers can do to build that divide with bureaucrats. Given that we’ve got about a third of the people online who are policy makers is there one key tip for policy makers to also really focus on to bridge that divide and build that relationship with researchers?
Dr Masha Somi:
Thanks Amber. Yeah. I really think it’s relationships. I think that goes both ways. So some really, really simple things that bureaucrats or policy makers can do is go for a visit. Go and spend some time in the area that you have policy responsibility for. For example I’ve just started in primary care and I’m taking the time to go and visit lots of different types of primary care services. I’m going to spend time meeting with all of the key primary care academics who publish and work in this area so that I can understand the world from their perspective and see what it’s like to actually be delivering primary care services but also to be researching in this area, to learn about what’s at the cutting edge.
Part of that is taking my team along with me. So I think it’s important for people at all levels of the organisation to be having these conversations and these engagements and actually building our own knowledge and capability as well.
Amber Shuhyta:
Thank you so much. Thanks Masha. I think this is a nice segue into our panel discussion. That was really insightful what you were able to discuss with us all today.
So it is now time for our final agenda item and we’re going to draw together all the things that we’ve heard today for this panel discussion. Our keynote speakers Peter and Masha are here with us on the panel. And we’re joined by Jennifer Alison who was one of our abstract presenters today. And our final panel member is Dr Helen Benassi. I’ll let Helen introduce herself as we haven’t heard from you yet today. So I might just give you a few minutes to say hello to the forum.
Dr Helen Benassi:
Thanks Amber. Hi everyone. Thank you for the opportunity to participate in the forum today. So I am Director of Mental Health Surveys and Research in the Department of Health and Aged Care. And I’ve got I think nearly sort of 16/18 years of work in Government working kind of in – I liken my job to being kind of in between the research and the policy teams. So I’m a psychologist by background but I’ve worked in a number of roles that are focused on mental health data, collection and surveys and research. So prior to joining the Department of Health I worked in the Department of Defence on mental health research and resilience research within the ADF and also worked across the lines with DVA as well on that work. So I kind of sit in that translation space I guess, that knowledge mobilisation and translation space. So I’m really keen to be part of the panel today.
Amber Shuhyta:
Thank you. I’m going to start by asking a few questions. But while I’m asking these questions and the panel is discussing I really encourage all attendees to post questions that you have for the panel in the Slido function on the screen and please for other participants to upvote those questions that you see posted that you’d like to hear our panel discuss. So I encourage you to start doing that now.
So just to start the discussion I would actually really love to hear from the panel what were the key themes you heard come through today’s abstract presentations and are there any presentations that stood out as policy ready? And can you comment on those and why?
I’m going to open that to whoever wants to jump in.
Professor Peter Bragge:
Well I’m going to give a bit of a fluffy answer because I don’t want to pick winners out of the presentations. But I think firstly it’s an incredible body of work that’s been presented this afternoon and there were lots of compelling things. I’m a review scientist so I’m always drawn to reviews and guidelines. I think just to reinforce some general principles from my experience. Certainly research that shows quantifiable outcomes, in particular return on investment or demonstrates an empirical value, particularly if it’s part of a continuum, as in a line of research, or is part of a body of research, that from a first principles point of view is more compelling than an individual study. And I’m interested in what Masha and the others say but I think it’s also perceived to be less risky than sort of a standalone study that might be very interesting, inherently interesting as a piece of work, but just doesn’t have that context as I talked about in my presentation earlier today.
Amber Shuhyta:
Thank you. Jennifer would you like to comment on some key themes and what stood out?
Professor Jennifer Alison:
Thanks Amber. And I agree with you Peter. There were some fantastic presentations and really interesting work being done by allied health. So I’d like to say congratulations to all. And these were chosen from a larger group of other excellent abstracts that were submitted so there’s a lot happening out there in allied health. To me there were probably three key themes. One was the implementation of established evidence-based interventions into primary care. So there were a number of abstracts I thought that covered that, things like the medication review, exercise therapy after breast cancer, the pulmonary rehab presentations etcetera. I thought they fell into that kind of theme.
And then there were ones that were I thought improving efficiencies in service delivery, things like reorganising the multidisciplinary team for stroke assessments and simplifying medications administration, so changing services. And then I thought there was another grouping which is around implementing new models of care, things like for pain management or obsessive compulsive disorder or for mild cognitive impairment and some of the musculoskeletal ones or malnutrition in aged care or opioid tapering, all things that had some evidence but probably aren’t necessarily in guidelines yet or as in evidence.
So I thought that there was a nice combination. The difficulty really I think for us as researchers in this – and that’s probably the angle I come from – is knowing how much is enough to be policy ready. And I think from what I’m hearing from you Peter and Masha was around really being able to do the economics of what we’re talking about and also to show that it’s feasible in primary care. Because a lot of the things we do are not necessarily research in primary care. They’re randomised controlled trials and may not be primary care randomised controlled trials that’s where the evidence is. But the next stage is then do we need to do implementation science interventions to show that they are feasible in primary care and cost effective and so on and so on. Where is the limit before you go to the policy makers and Government to say we’ve got enough evidence to be able to sort of ask about could this be funded in the big picture?
So I suppose they were some of my thoughts around that. I often think – and I know I probably shouldn’t say this – but for the allied health physical interventions that we have, which a lot of them were today presented, we don’t have a funding model in primary care. We’ve got the five allied health. That’s hardly enough. But we have a Pharmaceutical Benefits Scheme so I keep thinking is there something around having some physical benefit scheme that could fund interventions that are shown to be highly effective. So they were just some of my thoughts hearing all those different presentations, and some of them were at different levels. I wouldn’t like to pick one. I’d love to hear what the policy people say about which ones were more policy ready.
Amber Shuhyta:
Thank you Jennifer and Peter. Masha and Helen I might jump into the Slido questions and then you can incorporate some of your insights into the presentations when we start answering some of the attendees’ questions. The top one there is:
Q: Can you talk about how we might embark on consumer driven research agendas and priorities? And that’s particularly important for consumer focused policy work.
Maybe Masha or Helen you’d like to start us off with that.
Dr Masha Somi:
I guess I can talk about just my time and experience with the Medical Research Future Fund. And we’ve got so many great resources available on the Medical Research Future Fund website. There’s some principles that the Consumer Advisory Panel prepared that gives a how to guide in how to include consumers in all stages of research. We’ve done webinars with experts who work really closely with consumers and they’ve talked about their experiences and the sorts of things that they have been able to do working closely with consumers and also kind of the gap that researchers have been able to sort of fill in terms of close partnerships.
I guess in saying that though I think it’s important to acknowledge it is really hard to do consumer led research and by that I mean research where consumers have an influence and a capacity to impact the program of research because you have to include those and have had those conversations right from the start. What consumers say and I think policy makers say is sometimes people have gone and got a grant and they’ve got this great idea and then they come and say ‘Well how do we implement it’ and the consumer and the policy maker might say ‘Well I wouldn’t have started there or I might have done something completely different’. But what I guess academics say to us is they’re not funded for that early part of those conversations and it’s really hard to have the resources to be able to have really meaningful long term engagement when there isn’t grant funding able to support that.
So I guess what I would say is there’s lots of resources out there. Not only on the Medical Research Future Fund. There’s lots of organisations that do training and support and development for consumers and also for academics. So you’re not alone. But also just want to acknowledge that it is a really, really difficult thing to do.
Amber Shuhyta:
Any of the other panel members want to comment on consumer driven research agenda?
Professor Peter Bragge:
I agree it is very difficult. It’s also something that universities are not very good at administering. I’ve had some funding where paid consumer involvement has been part of the project but it’s just been incredibly difficult to get it through the university system. So I don’t think that our systems are really well geared for it. But the flipside of it is that there are less formal ways to test ideas and there’s always the idea that we’re all actually consumers of healthcare at some point. And having conversations with people who are potentially impacted by your research whether it’s family or friends or just sense testing ideas, most really robust research ideas have been sense tested at every stage. And whether that’s through formal funded work or just saying ‘Listen I know that you’ve got diabetes. What do you think of this idea or what have been your experiences of trying to access this service?’ And so those informal conversations. I agree with what Masha’s saying. It’s actually very difficult to build it in and bake it in in a formal way but it’s also less difficult to just have some conversations with people and say ‘Would you do this?’ or ‘Would you use this device?’ just to help you refine ideas at the early stages.
Dr Helen Benassi:
I was also going to jump in because I agree absolutely with Masha and Peter around the difficulty. I have seen places where it’s worked well and in particular the Centre for Mental Health Research at ANU, they have a lived experience research team and that lived experience research team includes those who are employed as part of that team have lived experience as well. So there are different ways of achieving that but also engaging with the lived experience networks and consumer networks and checking in early with the work that you’re doing and the ideas that you have.
Amber Shuhyta:
Thank you.
Jennifer?
Professor Jennifer Alison:
I was going to say I think the issue of codesign is really important. And that’s why I think clinician researchers are also vital, that they’re on the ground seeing the patients, hearing what they’re saying and driving the research agenda. So again I think we all are duty bound to partner with our consumers initially before we really go anywhere. It’s not that easy and I think we’re all working hard to figure out what the best way is. And the remuneration is an issue because that’s important. Thanks.
Amber Shuhyta:
Thank you. We have a few questions in the Slido bar that are similar to each other and they’re bouncing around in terms of priorities. They’re about:
Q: What is the key or best way to reach out to policy makers we don’t know? How can we work collaboratively with the Department to partner to deliver policy ready research? And what’s the most effective way to communicate research findings? How do we get research work under the noses of policy makers?
They’re all very similar questions. So I’m going to open that up. I know one of them was directed to you Masha but I’m sure the other panel members also have some insights there. But I’ll throw to you first Masha.
Dr Masha Somi:
Thanks. And I guess my heart out to all of you who asked that question because I do sometimes feel like it’s a bit of a black wall behind us. There’s sort of like this façade of the Department or whatever and it feels like is there a human behind there. And I appreciate it can be really, really frustrating. And to be frank, like Amber you sort of said, there’s a really important role for bureaucrats to open the door, to demystify ourselves, and to create those opportunities for conversation. So I would encourage you just to send an email or just reach out to people and just ask for a short meeting and just an opportunity to talk about the work that you’re doing, why it’s important or why you think it’s important, and to be able to share your knowledge and expertise. We don’t know what you know and there’s so much opportunity for us to learn about what you’re doing and why it’s important and for us to be able to try to make those connections to other pieces of work that we’re doing.
I think all of the sort of things I talked about in my talk around trying to find common language, trying to understand the operating context. Peter talked about this a lot as well. Kind of know the circumstance that the people are working in. I remember the President or the Chair of ACTA said ‘Lots of people ask me how to get politicians to listen and my answer to you is give them a solution to a problem they’ve got’. And I think that’s really kind of very frank advice from an academic and a clinician. And so I think that’s sort of the easy case where you’ve got an answer to a problem they’ve got. The harder one which I think people are grappling with a little bit in some of those questions is what if you’ve got a really important thing that maybe isn’t a priority at the moment or maybe there isn’t the opening in Government and in policy to bring that forward. And I think all I can say is just build the relationships and keep reaching out and know that on the inside we’re all working to try to open the doors and encourage our colleagues to open the doors as well so that we can have those conversations.
Amber Shuhyta:
Thank you.
Professor Peter Bragge:
Really quickly I was really impressed when I was looking through the abstracts that people were making connections to known policy initiatives. So there’s references to the Strengthening Medicare Taskforce, there was a reference to Queensland Health’s Allied Health Workforce Plan, and there was one other one around quality indicators and stuff. So that really shows policy makers that you’re thinking in terms of the problems that they’re facing. And as I said it’s always easier to help someone solve a problem that they have rather than to try and sell a new answer. And the other thing that I thought about as part of that network building is if you know people who are working or have worked with Government departments that are in your zone, setting up some mentor relationships with those researchers is also another strategy.
Professor Jennifer Alison:
I was just going to add to that that I suppose one way – just my personal experience – is working through NGOs who have links with the bureaucrats. So for example I work with Lung Foundation Australia so they have links into knowing people in Government which enables the things that the Lung Foundation would like to achieve be heard and then we the researchers support those initiatives. So it sometimes might be – I don’t know Masha and Peter or Helen what you think but sometimes I think working that way rather than making our own representations may be an easier route. Don’t know if you want to - - -
Dr Helen Benassi:
I think I agree Jennifer. I was just thinking actually about also collaborating with researchers or others who already have relationships with Government, and as you mentioned Peter mentoring. I think just make use of every opportunity that you have and don’t assume that it won’t – it may not lead to something. I think Masha said be patient. It may not lead to something. The hardest thing is getting your foot in the door and then once you do and you build that relationship it’s often that policy makers will come back to you and if you’re available to them to answer questions that’s of real value to us in what sometimes is a really rapid cycle. I shouldn’t maybe call it a policy cycle really because it’s not that simple.
But I’ll give you an example of one situation where we recently I guess started a new engagement with researchers. They invited us to the release of a special issue of a journal that they were doing and it just happened that that work was really I think influential at the time but it also met some of our policy needs that were upcoming. And so we were able to kind of link in with the researchers through that. So don’t be afraid to invite policy makers where you’re presenting to and offer to go to them to present as well. And probably sending a large report or some information probably isn’t the way to go. You really do want a short conversation or something that really is respectful of people’s time as well. So you want a conversation with the policy makers.
Amber Shuhyta:
I know from experience here research institutions sharing embargoed reports before they’re published with Government really builds that very dynamic relationship. And knowing the policy cycle I suppose, that week after Federal Budget is announced we’re all starting to advise on what happens in next year’s Budget. So sending your abstracts through like what was presented today, and a lot of them had those funding implications already built in, is really good to think about early in the financial year rather than the week before Budget giving Government something to consider for Budget. And that’s a really practical thing that some people have taken up on.
In terms of that there was a question there that:
Q: Some of the presentations did comment on funding implications for Government. To what extent do you think this should be considered in presenting research findings?
Does anyone want to comment on that?
Dr Masha Somi:
I might start with that and also I guess one of my reflections on the presentations is the challenge of the scale up. So one of the things with research that I’ve noticed is research versus policy, is with research you often have to really kind of refine your question so it’s bite sized, you can define a methodology around it that answers a sort of question, and it’s usually a very sort of truncated part of the healthcare that a person might need. And that’s really critical to get a robust research methodology. The challenge then is kind of integrating it into a complex kind of interaction that might be happening within the health system or with the provider. And so you might be dealing with sort of a diabetes kind of intervention but really what happens in practice is a conversation with a person with multiple morbidities and with a GP that’s maybe having to bring in a team, an allied health team into it. So it’s quite a complicated kind of interaction. And then even then scaling it up. So a lot of interventions once you sort of scale it up, there’s significant issues about costs but also workforce, particularly some of the ones that I saw that were really around multidisciplinary models of care that require sort of the allied health support to be able to implement. And we kind of know from our view of the world or of the primary care system is there’s sort of significant issues around kind of workforce shortages and workforce challenges.
So I think it’s really important to think about it not only in presentation but also in the design and the development and the pitching of your project, how you implement it, and then also then yes, how you present the outcomes. Because if you kind of come up with a really amazing, highly effective intervention that only works in a kind of very – and I’m not saying any of the projects today do that – that works in a really limited setting that requires a high level of kind of availability and accessibility of allied health and costs a lot of money, it’s just not going to be possible to implement in the real world. And so it’s really critical to think about that kind of throughout the kind of project.
Amber Shuhyta:
Any of the other panellists want to jump in on that?
Professor Jennifer Alison:
Sorry Masha. I was just going to follow up to say that’s kind of real implementation science stuff isn’t it, that we know that it’s messy and complex and when we do try and implement stuff into the real world we’re not choosing just the patients who fit that criteria or anything. And so I mean that’s why implementation science – and that’s what I was going to sort of ask, is although a lot of the presentations today showed things were effective, then do you think policy makers need to wait for the next stage that it’s shown that when you try to implement it it does work? I mean there was the pharmacy one across a lot of arches that really actually probably did that in a way, that was implementing something – I don’t know what your thoughts are about that – and showed that that did work in sometimes difficult environments. Is it that level of implementation that you think needs to be seen to be able to maybe make a case for an intervention to be enabled in some way or funded?
Dr Masha Somi:
I thought that was a really interesting one because it had a positive MSAC recommendation. So in a sense it’s kind of just ready to be implemented isn’t it because they’d built all of the evidence and could prove the cost effectiveness of the intervention and also how it could be implemented in the real world. And so like you’re saying Jennifer it’s a really neat example of kind of a package, a research package that kind of ticks all the boxes all the way through.
Professor Peter Bragge:
The other option which is a third way which can be quite complicated but it is possible is partnering on the scale up opportunity. So one thing that Governments and big organisations do have access to is defined populations that they might be able to roll out something in a progressive way and evaluate it as they’re going. It does depend a little bit on the appetite in particular areas of Government for testing and trialling which does vary. But we’ve done some statewide trials on really simple nudge strategies for things like immunisation reminders. We’ve done some letter trials with our Roads Authority about how can you encourage people to pay their registration on time. They’re very simple and cheap interventions and I know that’s not possible for allied health interventions, but some Governments do have an appetite to partner on the actual evaluation of something as a research project. So that’s a third way which can work in some circumstances.
Amber Shuhyta:
Thank you everyone. I think I’m going to squeeze in one last question because we’re coming to time. The top one on Slido to end the session is:
Q: Is it important to show policy makers the negative impact of policy ready research evidence not being translated into services to be made available in clinical practice? In the field of dementia this is really evident.
Does anyone want to comment on that?
Professor Peter Bragge:
I can just say that it is a reframing of the argument around I guess opportunity cost. I don’t know how compelling it is from a policy maker perspective but certainly one of the other strategies is to put it out in the discourse in other ways. So for example the conversation is a really good avenue for sort of having public conversations about things where they’re ideas. That usually requires it to be connected to something newsworthy. So the Aged Care Royal Commission probably the opportunity for sharing research findings that pertain to that. But yeah I think certainly from a research perspective the cost of not doing anything is definitely a potentially powerful argument.
Dr Helen Benassi:
And I think it is a powerful argument. It’s a little bit of a challenging one I think potentially with policy makers. Because of the environment we work in, if it becomes something that is quite – sometimes it’s really useful to have something that’s really clear and open and saying hey this is a real risk, but in other times it can actually detract and we end up doing a whole lot of work explaining why we’re doing what we’re doing instead of kind of focusing on where we need to be making changes. And so it’s a tricky one and I do think it is important but I think also sometimes it might be challenging to then say well what your solution is in comparison to another solution, what’s the difference? So not doing this at all as opposed to not doing this or – sorry. My words are failing me. But business as usual. Kind of comparing to that business as usual. That’s probably where it would have value.
Dr Masha Somi:
If I can just add a really kind of interesting element to that question – sorry to divert Amber – is often when you’ve got a good idea and you want to change the world or change the system the kind of bar that we hold change to is much higher than kind of maintaining the status quo. So we’ll be saying well have we thought about this group or what about equity for that or what about all these other kind of considerations. So new ideas tend to have a really high threshold kind of applied to them and a really important question I think we should always ask ourselves is what are some of the challenges in the current setting? It’s not like the current setting is perfect and this is trying to improve on perfect. So I guess it’s sort of an interesting, slightly different way of asking the question. Because I do think as policy makers and as I guess humans I think when something new comes along and we’re asked to change we often hold it to a much higher standard than perhaps the current setting.
Amber Shuhyta:
Thank you. And Jennifer did you want to have one last comment before we wind up?
Professor Jennifer Alison:
No. I think you’ve covered that. I don’t need to add to that. I agree with you. I think it’s a difficult area. I think you need to be on the front foot positive if you’re going to do these things and that’s the message that I would say. Thanks.
Amber Shuhyta:
Thank you. Thank you so much to our panel members and again thank you to everyone who presented today in the forum. It brings us to the end of our virtual research forum today.
[End of Transcript]
Presented by:
Chair:
- Amber Shuhyta – Assistant Secretary, Allied Health and Service Integration Branch, Australian Government Department of Health and Aged Care
Presentations:
- Professor Peter Bragge
- Dr Masha Somi
- Dr Angela Burge (presented by Dr Narelle Cox)
- Dr Simone De Morgan
- Ms Megan Tremlett
- Ms Aleysha Martin
- Dr Katelyn Dyason
- Associate Professor Janet Sluggett
- Professor Jennifer Alison
- Dr Jonathan Foo
- Dr Marie-Claire O’Shea
- Dr Jonathan Penm
- Professor Sandi Hayes
- Dr Alex Bahar-Fuchs
- Professor Nadine Foster
Panel Members
- Professor Peter Bragge
- Dr Masha Somi
- Professor Jennifer Alison
- Dr Helen Benassi