Table 6 Summary of the outcomes of the studies on PHC models used by allied health professionals in non-metropolitan areas, n = 22^

Agostino J., et al. (2012) [35]

Description of Cape York Paediatric Outreach Clinic

N/A

N/A

Sustainability of model- effective way of maintaining staff & increasing services

FIFO currently used and associated with low staff turnover.

Authors suggest the ideal is locally based staff through training of community members to be indigenous health workers

Almeida PO., et al. (2021) [45]

RCT with intervention consisting of self-managed behavioural activation program supported by three 45-min phone sessions delivered by a trained psychologist over a period of 8 weeks. Also included self-help booklet.

309 older adults in regional, rural, remote areas of Western Australia who were screened for disordered mood.

Effective at decreasing the severity of depressive

and anxiety symptoms over a period of 12 months compared to controls who had no phone support or booklet with behavioural activation strategies.

N/A

Unable to establish the clinical significance of the improvement in depressive and anxiety symptoms. However this type of intervention may have a role in improving mental health outcomes for older people living in regional and remote areas.

Asaid A., et al. (2007) [31]

Description of the evolution of the “Elmore Model of Primary Health Care”

N/A

N/A

N/A

This model ensured all services available were being used, including government or privately funded services. The model combines the benefits of local coordination and integration of general practice and other primary health services, and places the community at the

centre of all development, planning, and service

delivery processes.

Battye KM., et al. (2003) [36]

Description of the establishment of a model including the steps:

Development of a planning matrix; Environmental scan (including mapping/gap analysis; Community consultation (Focus groups and interviews via telehealth or face to face) analysis of morbidity and mortality data);

Desktop analysis; Synthesis of information to develop a model

Members of the community

12 allied health professionals

N/A

N/A

Final model suggested was a hub-and-spoke model with allied health services outreaching from the hub (Mt Isa) into each of the three geographically separate areas (spokes). The effectiveness of the model has yet to be evaluated.

Bergin SM., et al. (2009) [32]

State-wide survey- Footcare Provider Survey sent to community health centres

n = 69 responses from community health clinics; n = 45 from rural and regional areas

N/A

Access to services– 88% provided ongoing podiatry care to individuals with diabetes, 8 (11.6%) indicated no clinical podiatry care was provided of which 7 were in rural or regional areas. 7 community health centers provided no podiatry services at all, of which 6 were rural or regional services.

Identified barriers to providing care included staffing issues, lack of resources or knowledge from health professions on a podiatrists role in managing diabetes related foot conditions.

Cairns A., et al. (2024) [37]

Description of a co-designed Integrated Allied Health Service model

N/A

N/A

N/A

There is a need for a more collective approach between health and social services to facilitate pooling resources in rural and remote communities with limited resources to delivery consistent quality care. Models that include student placements are both a rural workforce recruitment strategy and can address health service gaps in remote communities with a limited local allied health workforce.

Ervin K., et al. (2021) [33]

Electronic survey to understand telehealth practices, purposes and attitudes

n = 11 allied health

n = 13 community health

N/A

53% had reported starting to use telehealth as a result of COVID- 19.

58.3% (n = 14) agreed or strongly agreed that they feel telehealth will become a normal part of their work.

Respondents identified there is need for ongoing education and training when using telehealth. Telehealth should not be a replacement for face-to-face services, it should be supplementary.

Fairlamb J., et al. (2007) [41]

Description of current service

N/A

N/A

N/A

Systems and polices need to be developed to support the innovative work that is happening and to increase it in regard to mental health.

Goss PW., et al. (2010) [34]

Health measures & survey

n = 56 participants had access to the model of care in 2009, mean age of 14 years

Significant improvement in glycaemic control when compared with 2006 figures.

Satisfaction with service- 89% of participants felt more supported; 86% felt that their diabetes was more controlled with a team approach.

In a rural setting child and adolescent diabetes care can be provided by the multidisciplinary team to achieve positive outcomes, with results comparable to large metropolitan areas.

Harris C., et al. (2005) [25]

Blood pathology changes over time (pre, 3-month, 6 month)

N = 20 Aboriginal participants with diabetes

Improved lipid levels

Improved Glycaemic control

All strategies were used by more than 50% of the participants. 66% of participants reported they were better able to self-manage their diabetes.

Management of complex and chronic conditions requires a shared care approach to improve outcomes. Camps are an effective way of increasing knowledge of diabetes and self-management strategies in the Aboriginal population.

Hawke M., et al. (2000) [42]

Description and evaluation of the model including service usage and group feedback sessions

Children aged 0–8 years with developmental delay for early intervention

N/A

78 referrals within first 12 months.

Sustainability of the model- project was deemed appropriate and efficient and received yearly funding to continue.

The program has emphasised the significance of maintaining a therapeutic relationship with parents in promoting developmental change. The effect of this

approach has been to broaden the scope of

families receiving services from the Southern Fleurieu Health Service with minimal additional costs.

Lewis P., et al. (2003) [43]

Interviews, questionnaires and observations

n = 16 care plans observed across three general practices

N/A

Patients reported better matching of health care services to need, improved quality of care and improved knowledge

Strategies aiming to increase the uptake of enhanced Primary Care items need to address efficiency and accessibility, as well as appropriate remuneration for health professionals.

Luscombe GM., et al.(2021) [26]

Qualitative Inquiry

using interviews with clinicians

N = 9 health professionals

N/A

Benefits to clinicians: positive benefits of development of professional skills and confidence, experiential learning, improved understanding of roles within an interdisciplinary team and relationship building;

Benefits for clients and families: access to a specialist service, convenience/reduced opportunity costs

Hub and spoke virtual model provides increased access to specialist care

Merritt et al. (2013) [46]

23 item survey with open and closed questions of private occupational therapy providers

n = 58 occupational therapists based in rural and remote areas

N/A

32 different specialty areas reported, no difference in services provided between outer regional and remote, however no access to neurological rehab, mental health and driving assessments in remote areas. 89% based in outer regional, 11% remote. Very remote towns received visiting services. Most respondents 72% visited 3 towns with one quarter visiting at least 5 towns.

Sustainability of model- main sources of income were DVA (68%), workers compensation authorities/insurers (60%), motor vehicle accident insurers (56%), Medicare CDM (56%) and private consultancy (52%). Nearly half the private OT workforce plan to leave private practice in the next 5 years.

Long term sustainability uncertain for OT private practice, potential market failure due to insufficient demand.

Hub-and-spoke model is proposed to address this issue.

Misan G., et al. (2018) [44]

Description of an intergenerational learning programs. Including: Literature review; individual survey and questionnaires; group education sessions

Whyalla men’s shed members (n = 50 members of which 25 are regular; number of participants not stated)

Improved knowledge on risk factors for chronic disease and strategies to reduce risk; including the importance of maintaining a healthy diet and regular physical activity.

Student benefits: improved knowledge on men’s health and older people and community consultation.

Student led health promotion programs appear to be well suited to this target group in order to increase health knowledge and empower the members.

Phillips D., et al. (2021) [38]^

Evaluation of an occupational therapy led paediatric telehealth burns review clinic

Including: using patient satisfaction surveys and number of clinical encounters

n = 28 paediatric burns patients attending clinic between Jan– June 2017

Rural children received review every 8 weeks (on average) increased from 20 weeks pre-trial. Travel time of 12 h per family saved.

1 child required surgical review (< 4%).

Satisfaction with service: time saving including no travel, less time off work for parents/school for children, continuity of care from same therapist.

Extended scope role for OT supported quality care while freeing up paediatric surgeons. Follow up appointment frequency improved.

Phillips D., et al. (2022) [40]^

Semi-structured interviews, qualitative approach

Eight family groups

Six clinicians

N/A

Four major themes were derived: continuity of care gave families confidence with service, family-centred care, technology and rural capacity building (for clinicians)

This advanced-scope, OT-led telehealth model provided quality patient-centred and expert clinical advice within local communities and builds the skill and capacity of local

clinicians.

Raynor AJ., et al. (2024) [47]

Prospective cohort study; measures included 19 individual items organised across seven domains

117 adult participants (99 were included in analysis − 31 males and 68 females); mean age of 59.5 years

The program showed a strong positive effect on participants’ readiness to change, level of physical activity and mental wellbeing

N/A

The provision of a free community-based program was beneficial for those who attended more than 50% of the sessions. The mental health version of the standard HEAL™ program can be used to enhance the engagement and participation of individuals in physical activity.

Saini B., et al. (2008) [27]

Non-randomised controlled trial. Patients visited the pharmacy at baseline, 1, 3 and 6 months after baseline. Questionnaire and asthma severity score was completed.

Intervention pharmacists (n = 12) trained to deliver RAMS model, and control pharmacists (n = 8) providing standard asthma care from 6 to 8 pharmacies in each site.

51 and 39 patients were recruited by intervention & control pharmacists

Intervention group had significant change in asthma severity score from severe to a moderate.

Intervention pharmacists delivered 362 interventions at the baseline visit (7.7 intervention per patient) and 44 interventions at the final visit (1.0 intervention per patient) spending a mean time of 41.2 +/- 11.5 min per patient at baseline and 15.6 +/− 7.2 min per patient at the final visit.

Sustainability of the model- cost savings to the health care system based on a change in severity was estimated to be for the intervention group $5632.70 monthly.

The RAMS model may increase access to services for individuals who have asthma in the primary health care setting. This would improve individual’s ability to self-manage their asthma, as well as allowing for a collaborative approach between the patient and health professional.

Skinner J., et al. (2021) [28]

Online survey with oral health therapists and supervisors in the Dalang Project

15 oral health therapist graduates between 22–28 years of age (13 female, 1 male, 1 other)

4 of the 15 respondents were originally from rural or regional areas.

Improved oral health status and oral hygiene behaviours

A total of 63 schools, 21 preschools and 15 community health services received regular dental health education through the Dalang Project.

The Dalang Project was well received by both the oral health professionals and the Aboriginal community controlled health sector (ACCHSs).

The Dalang Project is an example of a successful co-designed project that has positively impacted oral health service delivery for Aboriginal children and has provided a valuable experience for new graduate oral health therapists working in Aboriginal Community Controlled Aboriginal Health Services

Taylor S., et al. (2021) [39]

Pilot mixed method study based on PRECEDE-PROCEED model. Planning, piloting and process evaluating a community pharmacy project for participants with ear complaints.

n = 18 adults participants with ear complaints, average age 44 years, two thirds of participants were female.

At seven day follow up, 5 participants symptoms had resolved, 3 were improving and 1 was not improving. 5 participants were referred to GP.

33% couldn’t see GP about ear complaint prior to attending pharmacy, 72% would have attended GP if pharmacy service was not available

Participants recommended service and would go to pharmacy first before seeing a GP for future ear complaints

Vines RF., et al. (2004) [29]

Cohort study: Measures of level of psychological dysfunction assessed before and after the intervention using the DASS, GHQ and GWBI scales.

n = 276 general practice patients with mental illness receiving collaborative treatment from GPs and clinical psychologists in comparison with a normative sample of n = 198 patients attending the same GP surgeries.

Treatment scores of the intervention group had improved significantly on all DASS, GHQ, and GWBI measures, indicating a positive change in mental health status of the patients.

N/A

Findings suggest that shared care involving GPs and psychologists leads to an improved mental health status in patients.

Warner P., et al. (2010) [30]

Interviews were conducted as well as a questionnaire for students

n = 524 adult participants ranging in age from mid- 40’s to mid- 80’s.

n = 20 students (from nursing and podiatry disciplines)

N/A

Sustainability of model- had been running for four years at the time of publication with participants attending on more than one occasion.

Students felt the experience was worthwhile for practicing skills and improving knowledge

Community engagement project has displayed its sustainability and therefore may be used by other Universities as a template to develop a similar program