A Review of Specialist Parkinsons Nurses in New South Wales - - PowerPoint PPT Presentation

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A Review of Specialist Parkinsons Nurses in New South Wales - - PowerPoint PPT Presentation

Nov 13, 2022 253 likes •706 views

A Review of Specialist Parkinsons Nurses in New South Wales Research Team Charles Sturt University School of Nursing, Midwifery & Indigenous Health Associate Professor Rachel Rossiter rrossiter@csu.edu.au Associate

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A Review of Specialist Parkinson’s Nurses in New South Wales

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Research Team

Charles Sturt University School of Nursing, Midwifery & Indigenous Health

  • Associate Professor Rachel Rossiter rrossiter@csu.edu.au
  • Associate Professor Marguerite Bramble
  • Dr Annabel Matheson
  • Rosemary Phillips (Research Assistant

School of Accounting & Finance

  • Dr Alfred Wong

Mid North Coast Local Health District

  • Vincent Carroll

Debbie Schwebel

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Overview

  • Briefly review 2018 presentation
  • Report on the findings from the completed

projects

  • Where to from here
  • Questions

A Review of Parkinson's Specialist Nurses in New South Wales

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Stage 1: Literature Review Stage 2A: Comparing two different models Stage 2B: Cost effectiveness of MNCLHD model

A Review of Parkinson's Specialist Nurses in New South Wales 4

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Support Group Leader’s Conference October 2018

Creating a supportive nurse-led model for improved outcomes for people living with Parkinson’s and their families and carers.

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To provide evidence to support the advocacy role of Parkinson’s NSW with State and Federal Governments drawing attention to the deficit in specialist Parkinson’s nursing services in rural and regional areas of NSW.

Research commissioned by Parkinson’s NSW and conducted in partnership with our Research Team from CSU

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Research addresses Four of the Six pillars supporting the Parkinson’s NSW community 2017/18 and into the future

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Why is this research needed?

  • Currently, no national policy framework in this

country addressing the needs of people living with Parkinson’s disease.

  • The lack of policies and a coherent approach to

providing integrated specialist nursing care is particularly noticeable in regional, rural and remote areas.

  • People living in these areas have lower health-

related quality of life and poorer management of Parkinson’s disease when compared with those living in urban areas.

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Stage 1 (completed) Research title

Building evidence to support Parkinson's NSW advocacy for specialist Parkinson’s nurses in rural and remote New South Wales

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Stage 1

A comprehensive review of the existing research evidence to identify:

  • Best practice nursing services for people

living with Parkinson’s disease, and

  • Measures of sustainability for recruitment and

retention for rural and remote area nurses.

Bramble, M., Carroll, V., & Rossiter, R. (2018). Evidence based models that support best practice nursing services for people with Parkinson’s disease in regional NSW: An integrative literature review. Australia: Charles Sturt University. https://researchoutput.csu.edu.au/ws/portalfiles/portal/22332462/Literature_Review_Evidence_based_models _for_nursing_services_2018.pdf

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Developing specialist PD nursing models of practice

Integrated care delivered across services General Practice Acute/Subacute Community Residential Care Palliative Care

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Outcome from Literature Review

Specialist services that:

  • Maximise the scope of the nursing role
  • Incorporate access to a multidisciplinary

team

  • Use the latest technological advances

Are more likely to be sustainable and cost effective for service providers and people living with Parkinson’s disease in regional communities.

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Stage 2 (was underway) Research title

Evaluating the impact of two specialist Parkinson’s nurse positions in regional NSW

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Additional team member for Stage 2A: Dr Annabel Matheson - SNMIH Charles Sturt University

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Shoalhaven & Coffs Harbour Listening to: People living with Parkinson’s Carers/Family Health Professionals PD nurse specialists Data analysis in progress

2A

Mid North Coast Local Health District Cost effectiveness of the Parkinson’s nurse specialist position: A retrospective analysis Ethics approval obtained

2B

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Specialist Parkinson’s Nurses

Stage 2A and 2B Findings

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Shoalhaven & Coffs Harbour Listening to:

People living with Parkinson’s Carers/Family Health Professionals Specialist Parkinson’s nurses

2A

Mid North Coast Local Health District Cost effectiveness of the specialist Parkinson’s nurse position: A retrospective study

2B

Two discrete projects

Led by: Associate Professor Marguerite Bramble Dr Alfred Wong joined this team

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Stage 2A: Comparing two different models Stage 2B: Cost effectiveness of MNCLHD model

A Review of Parkinson's Specialist Nurses in New South Wales 17

Rossiter, R., Bramble, M., Matheson, A., Carroll, V., & Phillips, R. (2019). Evaluating the impact of two specialist Parkinson’s disease nurse positions in regional New South Wales, Australia: A qualitative descriptive study. Australia: Charles Sturt University. https://researchoutput.csu.edu.au/en/publi cations/evaluating-the-impact-of-two- specialist-parkinsons-disease-nurse-

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Study design and methods

Data collection Data analysis Participant Demographics (Consumer & Carers) Full Transcription of Audio Recordings Semi-structured Interviews (audio recorded, face to face and telephone) NVivo 10 – qualitative analysis software Three Participant Groups:

  • Consumers and Carers
  • Health Service Providers
  • Specialist Parkinson’s Nurses

Yin’s (2010) framework of ‘Five phases of analysis’ guided the qualitative analysis Interview Questions focused on

  • btaining participants’

perspectives on the impact of the Specialist Parkinson’s nursing services. Three members of the research team analysed data to reduce bias and enhance qualitative analysis Two-site case study design; qualitative, descriptive study.

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A Review of Parkinson's Specialist Nurses in New South Wales 19

Topics explored with each group of participants

Specialist Parkinson’s nurse

  • Model of care
  • Clinician

perspective

  • Connection with

support groups

Consumer & carer perspectives

  • Engagement

with specialist Parkinson’s nursing service

  • Impact on

disease management

  • Benefits
  • Possible

improvements.

Health professional perspectives

  • Role of specialist

Parkinson’s nurse in management of Parkinson’s disease

  • Reasons for

referral

  • Benefits of the

specialist nursing role

  • Possible

improvements.

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Remember

  • The focus of this component of the

research was to evaluate the model of care.

  • The results are not an evaluation of the

individual nurse at each site.

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Demographics: Consumer and Carer Participants

Coffs Harbour Shoalhaven Consumers N=10 Carers N=12 Consumers N=13 Carers N=8 Female Male 5 5 9 3 8 5 3 5 Age Range (years) 57-82 32-82 47-79 50-75 Time since diagnosis (range) 1-14 years 2 months – 11 years

Health Professionals interviewed:

  • Coffs Harbour N=9
  • Shoalhaven N=1
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Similarities

‘Invaluable’

Psychosocial support

Disease specific education

Advice

Unanimous appreciation for the specialised services Strongly connected to Parkinson’s NSW support groups

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Of note

Generous with their time, far in excess

  • f paid hours

Aware and responsive to needs of consumers and carers Person centred

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Discernible differences were apparent in the

  • range
  • depth of impact and
  • effectiveness of services between the two

models of care

Contrasts

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  • The specialist

Parkinson’s nurse position is embedded within the Local Health District.

  • Enables working as an

integral member of a multidisciplinary team of health professionals and across the continuum of care (acute, community and aged care).

Nurse-led The glue in the team Patient- centred Following the person across the continuum

  • f care

Coffs Harbour

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  • The specialist

Parkinson’s nurse position is nominally linked with the Primary Health Network (PHN).

  • The PHN provides the

specialist Parkinson’s nurse with a shared

  • ffice space; however

there is no administrative support, access to e-health records, or formal links with other service

Sole- practitioner Informal links with GPS and allied health Community- focused Responds to requests,

  • ften at

times of crisis

Shoalhaven

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A Review of Parkinson's Specialist Nurses in New South Wales 27

Coffs Harbour

Position sitting within LHD Location enables 'greater reach' Easier communication and access to electronic records and communiques Multi-disciplinary connections well- developed and utilised E-referral systems, development of new models of delivery including tele-health & Skype

Shoalhaven

Position loosely attached to PHN Informal links with acute care services No access to electronic records and communiques Multi-disciplinary connections more difficult to develop and use No access to use tele-health or

  • ther internet based communication

systems

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Demonstrated The value of a nurse-led model

  • f Parkinson’s disease care

Highlighted The complexity of Parkinson’s disease management

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What did this research project reveal?

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Ongoing, sustainable funding for specialist Parkinson’s nurses in rural and regional areas

Parkinson’s nurses with advanced nursing practice competencies Role embedded within local health districts; rather than limited to the primary health network Delivery of supports and services across the entire disease continuum

To effectively address the needs of people living with Parkinson’s disease and their carers, the following are needed:

A Review of Parkinson's Specialist Nurses in New South Wales 29

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Stage 2A: Comparing two different models Stage 2B: Cost effectiveness of MNCLHD model

A Review of Parkinson's Specialist Nurses in New South Wales 30

Bramble, M., Wong, A., Rossiter, R., Carroll, V., & Schwebel, D. (2019). Exploring the cost effectiveness of the Parkinson’s Specialist Nurse in the Mid North Coast Local Health District of New South Wales. Australia: Charles Sturt University.

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2B

Building Evidence To Support Best Practice Specialist Nursing Services For People With Parkinson’s Disease In Regional NSW: A Retrospective Analysis

Cost Effectiveness

Research Question:

  • Does analysis of service usage data from the

MNCLHD describe the economic impact of the Specialist PD Nurse position on hospital costs?

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Contextual challenges

  • The complex nature of Australia’s two tiered

health system presents challenges to researchers undertaking studies on costs associated with Parkinson’s disease.

  • The Specialist Parkinson’s Nurse position in

the MNCLHD is co-funded by NSW Health and Parkinson’s NSW.

Building Evidence To Support Best Practice Specialist Nursing Services For People With Parkinson’s Disease In Regional NSW: A Retrospective Analysis

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Mid North Cost Local Health District (MNCLHD)

Building Evidence To Support Best Practice Specialist Nursing Services For People With Parkinson’s Disease In Regional NSW: A Retrospective Analysis

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Preliminary Data Mid North Coast Local Health District

Prior to this study, hospitalisation data including the total number of Parkinson’s patient admissions and total length of stay from 2013 to 2017 for the Coffs Harbour Health Campus (CHHC) was obtained from the MNCLHD Health Information Exchange (HIE). This preliminary data from patient admissions and total length of stay from 2013 to 2017 were coded and analysed by MNCLHD HIE staff

Building Evidence To Support Best Practice Specialist Nursing Services For People With Parkinson’s Disease In Regional NSW: A Retrospective Analysis

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A Review of Parkinson's Specialist Nurses in New South Wales 36 5.6 5.8 6 6.2 6.4 6.6 6.8 7 7.2 7.4 7.6 Pre-2015

Average Length of Stay (LOS) Pre/Post Nurse Intervention

Post - 2015

LOS decreased drastically by 42% for patients who were admitted with a primary diagnosis of Parkinson’s disease.

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Research Question and Methodology

Does analysis of service usage data from the MNCLHD describe the economic impact of the Specialist Parkinson’s Nurse position on hospital costs?

Building Evidence To Support Best Practice Specialist Nursing Services For People With Parkinson’s Disease In Regional NSW: A Retrospective Analysis

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Results – Patient Demographics

Building Evidence To Support Best Practice Specialist Nursing Services For People With Parkinson’s Disease In Regional NSW: A Retrospective Analysis

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Results - Cost-benefit Analysis

Building Evidence To Support Best Practice Specialist Nursing Services For People With Parkinson’s Disease In Regional NSW: A Retrospective Analysis

*Costings provided by MNCLHD Finance ^Examples of costing models as applied in 3 different hospitals

The cost-benefit analysis employed across three hospital scenarios resulted in a ratio well above 1.0, supporting the net dollar benefit calculation associated with the employment of the specialist Parkinson’s nurse. These cost-benefit ratios ranged from 5.34 to 7.82, significantly outweighing the total hospital cost for PD patient care.

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What did this study show?

Statistical findings demonstrate a reduction in hospital length of stay post the establishment of the specialist Parkinson’s nurse role, reducing long term expenditure on hospital costs. The cost benefit analysis showed a net dollar benefit, or savings in hospital costs, of up to $8,600.00 per person over a three year period, as a result of the specialist Parkinson’s nurse intervention.

A Review of Parkinson's Specialist Nurses in New South Wales

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Significance of this research

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  • Widespread benefits for people living with Parkinson’s

disease and carers.

  • Increased clarity as to the most effective model of care
  • Demonstrated reduction in length of stay with a

resultant cost saving

What do these two projects tell us about the specialist Parkinson’s nurses?

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Thank-you to Parkinson’s NSW for the opportunity to partner together to undertake this research that has provided the research evidence needed to advocate for access to Specialist Parkinson’s nursing services in regional and rural New South Wales. Thank-you to Mid North Coast Local Health District for their cooperation and assistance with this research. Thank-you to all who so generously gave their time and shared their stories to make this research possible. Thank-you to colleagues from NSW Health, South Australia and Tasmania for their support and advice.

Acknowledgements

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Thank you

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References

Australian Bureau of Statistics (ABS). (2018). 2071.0 - Census of Population and Housing: Reflecting Australia - Stories from the Census, 2016 Belconnen ACT: Commonwealth of Australia Retrieved from http://www.abs.gov.au/websitedbs/D3310114.nsf/home/Home Australian Government, & Department of Health. (2017). Australia's health landscape infographic In Australia's Health Landscape: Australian Government, Department of Health. Bramble, M., Carroll, V., & Rossiter, R. (2018). Evidence based models that support best practice nursing services for people with Parkinson’s disease in regional NSW: An integrative literature review. Australia: Charles Sturt University. Bramble, M., Wong, A., Rossiter, R., Carroll, V., & Schwebel, D. (2019). Exploring the cost effectiveness of the Parkinson’s Specialist Nurse in the Mid North Coast Local Health District of New South Wales. Australia: Charles Sturt University. Brent, R. (2006). Applied Cost-benefit Analysis (2nd ed.). United Kingdom: Edward Elgar Publishing. Husereau, D., Drummond, M., Petrou, S., Carswell, C., Moher, D., Greenberg, D., . . . Loder, E. (2013). Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Cost Effectiveness & Resource Allocation, 11(1), 6. doi:10.1186/1478-7547-11-6 NSW Agency for Clinical Innovation. (2013). Understanding the Use of Health Economics: An ACI Framework [1.0]. Retrieved from https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0008/192437/Framework-Program- Evaluation.pdf Rossiter, R., Bramble, M., Matheson, A., Carroll, V., & Phillips, R. (2019). Evaluating the impact of two specialist Parkinson’s disease nurse positions in regional New South Wales, Australia: A qualitative descriptive study. Australia: Charles Sturt University. Yin, R. K. (2010). Analyzing Qualitative Data, I: Compiling, Disassembling, and Reassembling In Qualitative Research from Start to Finish (1st ed., pp. 176-204): Guilford Publications.