Centre for Health System Reform and Integration PhD Top-Up Scholarship

With rising demand for outpatient services across Australia, patients are experiencing excessive delays for specialist input, linked with subsequent deterioration in health. eConsultant is an outpatient substitution model that has been implemented internationally and provides a digital, provider-to-provider advice service, giving general practitioners (GPs) remote access to specialist support for patient care within 3-business days. GPs send a Request-for-Advice to the specialist and advise patients to schedule a timely follow-up appointment to discuss the eConsultant advice. Our centre is evaluating the implementation of the eConsultant service to determine if it improves access and is more efficient to deliver than a traditional outpatient service.

Using mixed methods, the PhD candidate will:

• Use patient case studies to examine how eConsultant improves equity of access for vulnerable patient groups (e.g. remote, frail elderly, in poverty, and CALD).
• Analyse service data to understand outpatient avoidance.
• Conduct a costing evaluation from a societal perspective to estimate the costs and potential savings associated with the eConsultant service versus traditional outpatient appointments.

The increasing number of older adults with frailty is placing a heavy demand on our healthcare system. With a growing body of evidence indicating that frailty can be treated and improved, there is a need for a simple low-cost strategy that healthcare policy makers can easily adopt. Frailty identification is not routine in general practice. Early identification of those older adults with risk of frailty in the community, and provision of targeted community-based interventions or therapies has been shown to decrease the negative outcomes associated with being frail.

The FRAIL Scale tool is a recognised method of assessing for risk of frailty and our work to date has demonstrated feasibility and acceptability for use in general practice. Our centre is evaluating the broader implementation of the tool.

Using mixed methods, the PhD candidate will:

• Determine barriers and enablers to implementation of the tool in general practice using qualitative interviews with stakeholders.
• Develop tailored implementation strategies to enhance implementation.
• Evaluate adoption, effectiveness, and sustainability of the FRAIL Scale.

Virtual Integrated Practice (VIP) was co-designed in partnership with rural general practices, with a focus on accessible rural continuity of primary care. Through the VIP Program, rural general practices are joined by an urban Vocationally Registered General Practitioner who provides ongoing care to patients via telehealth. A key feature of this Program is that GPs are known to the practice and fully embedded in the practice team for a minimum of 18 months, despite working remotely, to promote continuity of care. Since the Program was implemented, over 1900 services have been provided to rural and remote patients in Western Queensland, including acute care, chronic disease management, mental health, and others. VIP is expanding to additional vulnerable practices located across the geographies of Queensland. Using a rigorous evaluation framework, the effectiveness and implementation of the Program including its sustainability, barriers and enablers to implementation, and key criterion for broader scale up will be evaluated. Using mixed methods, the PhD candidate will: 

• Use qualitative interviews/surveys with stakeholders to understand acceptability and sustainability of the VIP service, and barriers and enablers to implementation.
• Analyse service data to understand outpatient avoidance.
• Conduct a costing evaluation to inform a sustainable funding model.