Feasibility and Acceptability of a Pilot Knowledge Translation Telementoring Program for Allied Health Professionals

Purpose: Knowledge translation (KT) in the health system is critical for the delivery of evidence-based practice. Supporting allied health professionals to plan and implement KT, using strategies that broadly reach across multiple geographical locations of the workforce, are needed. We piloted KT group telementoring via videoconference as an innovative solution to support and empower a vastly dispersed workforce. Methods: The 6-month Knowledge Translation Support Service (KTSS) involved monthly, one-hour, virtual group-based support of clinician-led KT projects within state-run hospital and health services. Supported by an independent facilitator, a panel of KT experts and health service leaders provided constructive critique and KT support for four projects from various disciplines (dietetics, nursing, occupational therapy, physiotherapy and social work) and health districts. Process evaluation included an assessment of program fidelity, dose delivered and engagement. Program acceptability (participants and panel members) was assessed after each session through online surveys. Effectiveness was captured by survey of KT confidence and qualitative interviews of participants perceived benefits of participation. Results: All project leads attended each meeting, with 1-2 specific projects discussed each month. On completion, participants reported high program satisfaction and felt that the KTSS met their expectations and learning needs. Overall the participants described beneficial gains with confidence in KT skills. Conclusions: The telementoring offered exposure to a breadth of expertise not normally accessible, successfully built a team environment in the virtual space and had a positive impact on project progression. Future directions include investing in scalability and sustainability of telementoring strategies for KT support

Starting, building and sustaining a program of research in emergency medicine in Canada

Objective: To develop pragmatic recommendations for starting, building and sustaining a program of research in emergency medicine (EM) in Canada at sites with limited infrastructure and/or prior research experience. Methods: At the direction of the Canadian Association of Emergency Physicians (CAEP) academic section, we assembled an expert panel of 10 EM researchers with experience building programs of research. Using a modified Delphi approach, our panel developed initial recommendations for (1) starting, (2) building, and (3) sustaining a program of research in EM. These recommendations were peer-reviewed by emergency physicians and researchers from each of the panelist’s home institutions and tested for face and construct validity, as well as ease of comprehension. The recommendations were then iteratively revised based on feedback and suggestions from peer review and amended again after being presented at the 2020 CAEP academic symposium. Results: Our panel created 15 pragmatic recommendations for those intending to start (formal research training, find mentors, local support, develop a niche, start small), build (funding, build a team, collaborate, publish, expect failure) and sustain (become a mentor, obtain leadership roles, lead national studies, gain influence, prioritize wellness) a program of EM research in centers without an established research culture. Additionally, we suggest four recommendations for department leads aiming to foster a program of research within their departments. Conclusion: These recommendations serve as guidance for centres wanting to establish a program of research in EM

Evidence to service gap: cardiac rehabilitation and secondary prevention in rural and remote Western Australia

Abstract Background Cardiovascular disease (CVD), a leading cause of morbidity and mortality, has similar incidence in metropolitan and rural areas but poorer cardiovascular outcomes for residents living in rural and remote Australia. Cardiac Rehabilitation (CR) is an evidence-based intervention that helps reduce subsequent cardiovascular events and rehospitalisation. Unfortunately CR attendance rates are as low as 10–30% with rural/remote populations under-represented. This in-depth assessment investigated the provision of CR and secondary prevention services in Western Australia (WA) with a focus on rural and remote populations. Methods CR and Aboriginal Community Controlled Health Services were identified through the Directory of Western Australian Cardiac Rehabilitation and Secondary Prevention Services 2012. Structured interviews with CR coordinators included questions specific to program delivery, content, referral and attendance. Results Of the 38 CR services identified, 23 (61%) were located in rural (n = 11, 29%) and remote (n = 12, 32%) regions. Interviews with coordinators from 34 CR services (10 rural, 12 remote, 12 metropolitan) found 77% of rural/remote services were hospital-based, with no service providing a comprehensive home-based or alternative method of program delivery. The majority of rural (60%) and remote (80%) services provided CR through chronic condition exercise programs compared with 17% of metropolitan services; only 27% of rural/remote programs provided education classes. Rural/remote coordinators were overwhelmingly physiotherapists, and only 50% of rural and 33% of remote programs had face-to-face access to multidisciplinary support. Patient referral and attendance rates differed greatly across WA and referrals to rural/remote services generally numbered less than 5 per month. Program evaluation was reported by 33% of rural/remote coordinators. Conclusion Geography, population density and service availability limits patient access to CR services in rural/remote WA. Current inadequacies in delivering comprehensive centre-based CR in rural/remote settings impedes management of cardiovascular risk and opportunities for event reduction. Health pathways that ensure referral and continuity of care are needed, with emerging technology-based CR support to supplement centre-based CR services requiring assessment. Implementing systematic data collection across services to establish benchmarks and enable service monitoring and evaluation is needed

Deficit discourse – the ‘regime of truth’ preceding the Cape York Welfare Reform

The Cape York Welfare Reform (CYWR) income management regime commenced in 2008. While this regime was supported and funded by the Queensland and federal governments, it was essentially developed by the Cape York Institute for Policy and Leadership (CYI), which was known as an Aboriginal policy development think tank. Income management in Cape York involves quarantining between 60% and 90% of a person's social security payment, if the person is deemed to have breached particular social responsibilities. The decision to income manage social security payments of CYWR community members, was based on a belief and writings by the CYI that there was a social norms deficit in Cape York communities, which income management could play a role in addressing. The language used by the CYI to describe Cape York community life was negative in the extreme, dramatic and evocative. This language, which I describe as deficit discourse, commanded a response to what was described as a dire situation. This article frames this deficit discourse in the broader and continuing context of colonisation. This discourse has been applied consistently throughout Australia's colonial history, perpetuating racial discrimination and justifying continuous governmental intervention into Aboriginal and Torres Strait Islander people's lives