Published: December 2022
The following principles were derived from a number of sources, including a rapid evidence review by the ACI Evidence Generation and Dissemination Team, a series of consultations with existing paediatric outreach services in NSW and resources from the Australasian Faculty of Rehabilitation Medicine.1
Principle 1: Where possible, outreach should be provided in a face-to-face setting
Rehabilitation is a physical form of medicine, requiring hands-on examination of patients to determine care requirements.
Children requiring paediatric rehabilitation often require physical assessments and interventions, such as measurement of muscle strength, review fit of specialised equipment and injection of botulinum toxin.
While technology has huge potential to address issues of access to services in rural and regional communities, it is intended that ‘virtual care coexists as a complementary option for patients and communities in addition to face-to-face care. There will be situations where care and treatment require or benefits from face-to-face engagement’.2,3
It is further acknowledged that virtual care may pose cultural barriers for Aboriginal people. This is an important consideration when developing service models.4
NSW Health encourages equity of service delivery, particularly for those living in rural or regional areas.2
Principle 2: Outreach should be provided by a multidisciplinary team
Paediatric rehabilitation aims to enable the highest-level possible of physical, cognitive, psychological and social functioning.5 This is done through the provision of a multidisciplinary service, which includes medical, nursing and allied health professionals. Current PRS outpatient clinics operate in various multidisciplinary models.
People living in regional and rural areas of NSW have significantly poorer health outcomes and inferior access to services, as well as additional financial barriers to accessing services.6 To ensure equity and inclusion in service delivery and have meaningful impact on health outcomes, outreach clinics must provide the same level of service as current metropolitan clinics.
A higher level of service would potentially offset the current inequities of access for rural and regional families.
Therefore, outreach must provide access to the same multidisciplinary team offered to those attending regular clinics.
Principle 3: A consistent PRS care team should provide outreach at each location
The benefits for patients and families of having a consistent care team has been acknowledged for many years. When providing outreach clinics, continuity of care has added benefits for the local health services and teams.
Consistent teams visiting the same locations assists in the development of relationships and rapport with local services over time.7
This supports the achievement of minimum standard 3.2 – The PRS provide networked support, clinical advice and professional development support to level 4 and 5 paediatric medicine services.
Principle 4: Relevant documentation from outreach clinics should be provided to local clinicians
Providing clinic letters and other relevant documentation from outreach clinics to local care teams supports continuity of care and coordination between services. It helps to maintain strong communication links between all clinicians involved in the care of the child or young person, as well as supporting continuity for future clinics.
As per minimum standard 1.9 – PRS outpatient clinic letters are provided within two weeks of the appointment, with copies provided to the general practitioner and paediatric services at patient’s local level 4 or 5 paediatric medicine service. Copies of the clinic letter should also be provided to the child or young person’s general practitioner.
Principle 5: Outreach services should have a program coordinator or liaison officer who is responsible for the management and organisation of the clinics
Henry Review Recommendation 50 is focused on improved coordination of paediatric rehabilitation services across NSW. Care coordination is an essential part of this process. Documented models of care for outreach clinics have shown that the involvement of a program coordinator or liaison officer has benefits for both consumers and clinicians.7-9 This role would ensure integration between the services providing the outreach and those in the local location, as well as supporting strong communication between clinicians and consumers.9, 10-13
Principle 6: Consumers, including young people, should be involved in the development of outreach services
Co-design and the value of including those with a lived experience in the design of health services has been recognised across the world. Co-design provides the potential for treatment and care to be experience-focused, rather than protocol-driven, leading to better patient safety and outcomes.14 Development of outreach services should be no different. Evidence suggests that outreach services should be planned in genuine partnership and consultation with consumers, including children, young people and their families.7, 9-13, 15-19
Principle 7: All outreach clinics should include engagement with local care teams in the organisation and completion of the clinic
Engagement with local care teams is essential for provision of outreach clinics. This engagement should occur from the point of organisation through to the completion of the clinic and follow-up documentation. Outreach planning should include partnership and consultation with key stakeholders from regional and rural areas.7, 9, 11,12, 15-19 It is important to identify key local staff to act as champions for the model, who can support the process at a local level.18
LHD facilities are responsible for the provision of accessible treatment spaces to conduct outreach (Principle 9). This will need to be done in consultation with the PRS team or outreach coordinator. Local clinicians should be invited to attend relevant outreach clinic appointments of their patients.
This is described in minimum standard 2.2 – For all PRS outpatient appointments, it is recommended that families extend the invitation to their local care team. This attendance can be either face to face or via virtual care. Ensure the family is aware of any requirements related to NDIS therapist’s attendance, such as funding.
Engagement of local clinicians in outreach provides an opportunity for upskilling in specialist skills,which supports capacity building.12, 19, 20 This can be completed through a number of avenues outlined in Principle 8.
Principle 8: Educational opportunities for local health district clinicians should be provided in conjunction with the outreach clinics
Provision of outreach clinics provides an excellent opportunity to upskill local clinicians and build capacity within health services.
Options for education provision during outreach clinics may include face-to-face education during clinics, after-hours workshops, forums or in-services.
Compliance with this principle would also result in the achievement of minimum standard 3.2 – PRS provide networked support, clinical advice and professional development support to level 4 and 5 paediatric medicine services.
Principle 9: Local health districts should provide appropriate and accessible facilities for conducting outreach clinics
The importance of outreach being a shared partnership between PRS and LHD services is outlined in Principle 7. The provision of clinical treatment space for outreach is the responsibility of the LHD service involved. Ensuring outreach clinics are held in spaces which are accessible and acceptable to consumers is important.17, 21
It is essential that collaboration and communication occurs between teams to determine how visiting staff will be able to use shared spaces, equipment and information technology for both clinical and administrative purposes.7, 17
Considerations for service planning
The following is a non-exhaustive list of suggested items which the PRS may need to consider in planning outreach services.
- Further interrogation of local data to determine cohort, potential locations for outreach clinics and frequency
- Financial analysis of service provision, including staff transport and/or accommodation costs and long-term sustainability
- Determination of clinic planning process and time points for liaison with local teams and services
- Establishment of triage process to prioritise outreach appointments, as demand is likely to exceed capacity
- Review of credentialling process for PRS staff to attend each identified outreach location
- Coordination of clinic logistics such as scheduling, information technology access, transport and/or accommodation of staff
- Process for tracking patient experience and outcomes and pathway for consumer engagement in design of outreach services.
- NSW Agency for Clinical Innovation. Paediatric rehabilitation outreach models: Evidence check . Sydney: ACI; 2022.
- NSW Ministry of Health. Future Health: Guiding the next decade of care in NSW 2022-2032. Sydney: NSW Ministry of Health; 2022 [cited 16 Sep 2022].
- Reid JN, Ethans KD, Chan BC. Outreach physiatry clinics in remote Manitoba communities: an economic cost analysis. CMAJ Open. 2021 Jul-Sep;9(3):E818-e25. DOI: 10.9778/cmajo.20200234
- NSW Government. Government response: inquiry into health outcomes and access to health and hospital services in rural, regional and remote New South Wales. Sydney: NSW Government; 2022 [cited 3 Nov 2022].
- Australasian Faculty of Rehabilitation Medicine. Standards for the provision of paediatric rehabilitation medicine inpatient services in public and private hospitals. Sydney: Royal Australian College of Physicians; 2015.
- Legislative Council Portfolio Committee No. 2 - Health. Health outcomes and access to health and hospital services in rural, regional and remote New South Wales. Report no. 57. Sydney: NSW Parliament; 2022 [cited 16 Sep 2022].
- Child Development Service Townsville. Providing a contemporary child development service to children and families living in rural and remote communities across North Queensland: The evidence for a new model of care. Queensland: Queensland Health; 2016 [cited 15 Aug 2022].
- Major N, Rouleau M, Krantz C, et al. It's About Time: Rapid Implementation of a Hub-and-Spoke Care Delivery Model for Tertiary-Integrated Complex Care Services in a Northern Ontario Community. Healthc Q. 2018 Jul;21(2):35-40. DOI: 10.12927/hcq.2018.25624
- National Rural Health Alliance. Models of Specialist Outreach Services for rural, regional and remote Australia. Australia: National Rural Health Alliance; 2004 [cited 16 Aug 2022].
- Dew A, Bulkeley K, Veitch C, et al. Addressing the barriers to accessing therapy services in rural and remote areas. Disabil Rehabil. 2013 Aug;35(18):1564-70. DOI: 10.3109/09638288.2012.720346
- Agostino J, Heazlewood R, Ruben A. Cape York Paediatric Outreach Clinic. Aust Fam Physician. Aug 2012;41(8):623-5
- Services for Australian Rural and Remote Allied Health. Models of Allied Health Care in Rural and Remote Australia. Australia: SARRAH; 2016 [cited 16 Aug 2022].
- The Royal Australasian College of Physicians. Reaching out to Mums, Bubs and Children in ‘Top End’ Communities. Australia: The Royal Australasian College of Physicians; 2018 [cited 15 Aug 2022].
- Dimopoulos-Bick TL, O'Connor C, Montgomery J, et al. “Anyone can co-design?”: A case study synthesis of six experience-based co-design (EBCD) projects for healthcare systems improvement in New South Wales, Australia. J Patient Exp. 2019; 6(2):93-104. DOI: 10.35680/2372-0247.1365
- Mundy L, Hewson K. Thinking outside the system: the integrated care experience in Queensland, Australia. Aust J Prim Health. 2019 Oct;25(4):303-9. DOI: 10.1071/py18161
- Gillett J. The Pediatric Acquired Brain Injury Community Outreach Program (PABICOP) - an innovative comprehensive model of care for children and youth with an acquired brain injury. NeuroRehabilitation. 2004;19(3):207-18
- University of Minnesota Rural Health Research Center and NORC Walsh Center for Rural Health Analysis. Access to Care for Rural People with Disabilities Toolkit. United States: Rural Health Information Hub; 2016 [cited 15 Aug 2022].
- Birmingham Women’s and Children's NHS Foundation Trust. Redesigning paediatric neurological rehabilitation pathways in the West Midlands: A system wide approach to improving outcomes for children and young people. United Kingdom: National Institute for Health and Care Excellence; 2019 [cited 15 Aug 2022].
- Bohanna I, Harriss L, McDonald M, et al. A systematic review of disability, rehabilitation and lifestyle services in rural and remote Australia through the lens of the people-centred health care. Disability and Rehabilitation. 2021:1-12. DOI: 10.1080/09638288.2021.1962992
- Royal Far West. Supporting childhood development in regional, rural and remote Australia. Australia: Royal Far West; 2017 [cited 15 Aug 2022].
- Rajan P, Hiller C, Lin J, et al. Community-based interventions for chronic musculoskeletal health conditions in rural and remote populations: A systematic review. Health Soc Care Community. 2021 Nov;29(6):1621-31. DOI: 10.1111/hsc.13263