Speech pathology prescribing in the outpatient setting: A review of requirements, considerations and barriers.

BACKGROUND: As health systems face increasing demands, non-medical prescribing is a workforce redesign strategy adopted within some services. Despite successful implementation in other professional groups, non-medical prescribing within speech pathology (SP) has not yet been described. AIMS: To provide a descriptive account of the development and planned implementation of two SP prescribing models. METHODS & PROCEDURES: The evolution of two SP-led prescribing models, including relevant training and credentialing, for use of (1) nystatin oral drops (100,000 units/mL); and (2) lidocaine (lignocaine) and phenylephrine nasal spray (5 mg/500 µg/spray), in the outpatient setting is detailed. Challenges to implementation are outlined. MAIN CONTRIBUTION: The development of relevant governance structures, a research evidenced-based project evaluation framework, and an overview of training pathways and credentialing was successfully completed. However, implementation of the models was unable to be achieved. A thorough review of the requirements and a discussion of contextual considerations that had a negative influence on the implementation of SP-led prescribing within this specific service context is provided. CONCLUSIONS & IMPLICATIONS: The successful implementation of SP-led prescribing is complex and highly context dependent. This work offers a discussion and review of the complexities of introducing a non-medical prescribing model in an outpatient hospital setting. WHAT THIS PAPER ADDS: What is already known on the subject Allied Health prescribing is an emerging practice area aiming to reduce current pressures on health services. SP-led prescribing has not been thoroughly investigated in the Australian context. What this study adds to existing knowledge This study describes the development of a SP-led prescribing process in the outpatient setting, and a thorough review and discussion of the drivers and barriers to the model's implementation. What are the potential or actual clinical implications of this work? The successful implementation of SP-led prescribing was identified to be complex from a legislative and operational perspective, as well as being highly context dependent. This study further highlights the importance of a thorough context evaluation and workflow mapping prior to full-scale implementation of SP prescribing trials.

Review article: Topical antibiotic treatments for acute otitis externa: Emergency care guidelines from an ear, nose and throat perspective.

Acute otitis externa (AOE), also known as 'swimmer's ear', is a common acute problem. It is one of the most common ED presentations. Atypical organisms, recalcitrant disease and antibiotic options contribute to making AOE a clinical challenge. There are a number of red flags associated with AOE which require consideration when treating patients with AOE. We discuss an evidence-based approach to management of AOE in the emergency setting, with indications for specialist referral.

Multidisciplinary clinic care improves adherence to best practice in head and neck cancer.

PURPOSE: Multidisciplinary team (MDT) care is widely accepted as best practice for patients with head and neck cancer, although there is little evidence that MDT care improves head and neck cancer related outcomes. This study aims to determine the impact of MDT care on measurable clinical quality indicators (CQIs) associated with improved patient outcomes. MATERIALS AND METHODS: Patients treated for head and neck cancer at Ipswich Hospital from 2001 to 2008 were identified. Comparisons were made in adherence to CQIs between patients treated before (pre MDT) and after (post MDT) the introduction of the MDT. Associations were tested using the Chi-square and Whitney U-test. RESULTS: Treatment post MDT was associated with greater adherence to CQIs than pre MDT. Post MDT had higher rates of: dental assessment (59% versus 22%, p<.0001), nutritional assessment (57% versus 39%, p=.015), PET staging (41% versus 2%, p<.0001), chemo-radiotherapy (CRT) for locally advanced disease (66% versus 16%, p<.0001) and use of adjuvant CRT for high risk disease (49% versus 16%, p<.0001). The interval between surgery and radiotherapy was shorter in the post MDT group (p=.009) as was the mean length of hospitalization (p=.002). CONCLUSIONS: This study highlights the measurable advantages of MDT care over the standard, less formalized, referral process.

Non-market valuation of off-highway vehicle recreation in Larimer County, Colorado: Implications of trail closures.

Few economic studies are available to measure off-highway vehicle recreation benefits foregone when trails must be closed to protect the environment. This paper estimates the non-market benefits associated with off-highway vehicle (OHV) recreation on National Forest lands in Larimer County, Colorado. We use a contingent valuation model (CVM) to estimate benefits to OHV users, which includes dirt bike riders, all terrain vehicle (ATV) riders, and 4-wheel drive (4x4) users. Using CVM we find the mean consumer surplus estimates to be $78 per person per day. These results are consistent with the few previous estimates of OHV recreation benefits. This equates to a per trail per summer consumer surplus of at least between $219,467 and $296,876, and a county level surplus per summer to be at least between $796,447 and $1,077,367. These benefits can be compared to environmental costs to obtain a more complete picture of the effects of trail closure, as well as the negative spillovers to non-motorized users.