In October, I visited the congress of the Australian Physiotherapy Association (APA) as an invited keynote speaker in the area of gerontology. It was a well-organized event with lots of interesting talks.
Kathryn Devereux, acting deputy director for ambulatory care of North Metropolitan Area Health Service in Perth, gave a talk about Community Physiotherapy Services (CPS), which delivers programs developed for people with chronic conditions that have been identified in the research as benefiting from physical activity and/or specific rehabilitation programs. CPS delivers clinical interventions according to condition-specific, evidence-based guidelines and incorporates targeted physical activity and education to empower the client to better manage their own health. CPS receives in excess of 1,800 referrals per year. Referrals are received from numerous sources including primary care, tertiary and secondary hospitals, specialist physicians, community services and the private sector. CPS delivers more than 190 rehabilitation classes per week across the Perth metropolitan area, servicing more than 2,500 clients.
Clients range in age from 33 to 98, and the average age is 73. People are referred with respiratory, cardiovascular, orthopaedic, and neurological conditions as well as age-related deconditioning. Programs are supervised by senior physiotherapists and conducted in community-based settings such as recreation centres. Specific exercise groups have been designed for falls prevention and clients with conditions such as strokes, Parkinson’s disease, diabetes, heart failure, chronic obstructive pulmonary disease (COPD), and arthritis.
In delivering an evidence-based, cost-effective service, CPS aims include reducing health care utilisation, supporting the clients’ transition from hospital-based care to community care, minimising the complications associated with chronic conditions, and improving quality of life. Cost effectiveness for some conditions is measured by reduction in emergency department presentations, avoidable hospitalization, and length of stay in hospital. Cost effectiveness is also achieved by delivering interventions in groups as opposed to individual rehabilitation.
I asked Devereux to explain more about the Perth initiative.
Do your physiotherapists receive special education to deliver these classes?
Our physiotherapists are trained to deliver condition-specific groups in a self-management framework and have evidence-based resource manuals to support them. Education and resources ensure that the physiotherapists are familiar with relevant assessment and exercise prescription and home programs for each medical condition. They are also competent in disease-specific protocols such as oxygen and medication management for COPD or hypoglycaemia management for clients with diabetes.
Each staff member has group facilitation training to help clients maximize their independence and self-manage their conditions. Knowledge of other community-based physical activity options and health related agencies is also vital to ensure clients become connected to other physical activity options.
Are the clients satisfied with the quality of the programs, and do you perform evaluation research on the health outcomes?
Client satisfaction surveys are completed across all our groups. This provides continuous feedback for quality improvement. Satisfaction with the service is high. Our programs are built on a strong research base.