Michelle Currin

Problems with a great idea: referral by prehospital emergency services to a community-based falls-prevention service

Background and aim Falls are the leading cause of injury in older adults. Identifying people at risk before they experience a serious fall requiring hospitalisation allows an opportunity to intervene earlier and potentially reduce further falls and subsequent healthcare costs. The purpose of this project was to develop a referral pathway to a community falls-prevention team for older people who had experienced a fall attended by a paramedic service and who were not transported to hospital. It was also hypothesised that providing intervention to this group of clients would reduce future falls-related ambulance call-outs, emergency department presentations and hospital admissions. Methods An education package, referral pathway and follow-up procedures were developed. Both services had regular meetings, and work shadowing with the paramedics was also trialled to encourage more referrals. A range of demographic and other outcome measures were collected to compare people referred through the paramedic pathway and through traditional pathways. Results Internal data from the Queensland Ambulance Service indicated that there were approximately six falls per week by community-dwelling older persons in the eligible service catchment area (south west Brisbane metropolitan area) who were attended to by Queensland Ambulance Service paramedics, but not transported to hospital during the 2-year study period (2008–2009). Of the potential 638 eligible patients, only 17 (2.6%) were referred for a falls assessment. Conclusion Although this pilot programme had support from all levels of management as well as from the service providers, it did not translate into actual referrals. Several explanations are provided for these preliminary findings.

Factors associated with quality of life and caregiver strain amongst frail older adults referred to a community rehabilitation service: implications for service delivery.

Purpose. To identify factors contributing to reduced quality of life and increased caregiver strain in an older population referred to a community rehabilitation team and to recommend service delivery models. Methods. Analytical cross-sectional study arising from baseline assessments from 107 subjects drawn from a randomised controlled trial of community rehabilitation service delivery models. Setting. A community rehabilitation team based in Brisbane, Queensland, Australia. Measures. Primary outcome variables include quality of life (EQ-5D & VAS) and Carer Strain Index. Predictor variables include participation in functional activities, history of falls, number of medications, number of co-morbidities, depression, environmental hazards, physical function and nutrition. Association between variables assessed using linear regression. Results. Major factors contributing to reduced quality of life were having reduced participation in daily activities, depression, and having poor vision. Having poor nutrition and no longer driving also contributed to poor quality of life. The major factor contributing to increased caregiver strain was reduced participation in daily activities by the older person. Conclusions. Community rehabilitation services working with older populations must adopt models of care that screen for and address a wide range of factors that contribute to poor quality of life and caregiver strain.

Embedding Socio-Behavioral Frameworks in Community Rehabilitation: Evaluation of a Service Change Program

ABSTRACT Background: Paradigms which emphasize the social determinants of health and client self-management, and approaches which promote health behavior change, are rarely operationalized within rehabilitation settings. The aim of this study was to investigate the processes required for this model of care change within an existing allied health community rehabilitation service. Methods: The service change program consisted of training elements in the areas of the social determinants of health, client self-management and health behavior change techniques as well as associated operational changes to reflect this paradigm shift. Results: The training packages implemented appear to have improved staff knowledge and skills within these socio-behavioral areas. Clinicians self-reported improvement with client care; however, these changes were not reflected in the chart audit. Conclusions: Clinician training is required to build both knowledge and skills in the areas of the social determinants of health, client self-management and health behavior change principles. In addition, clinicians should be equipped with frameworks to assist with operationalizing these principles.