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Guide to Allied

Health Professions

in the Primary Care

Setting

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Publication: Guide to Allied Health in the Primary Care Setting

Date: July 2013

ISBN: 978-0-9873577-5-5

Australian Medicare Local Alliance

Australian Medicare Local Alliance (AML Alliance) is a national, government funded not-for-profit company which spearheads the development of the primary health care system across the country through a network of 61 primary health care organizations called Medicare Locals (MLs). Together with Local Hospital Networks, MLs form a critical part of health care governance arrangements at a local level.

This guide has been developed to support MLs when engaging with Allied Health Professions.

Further information on the role of AML Alliance or MLs can be found at:

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Foreword

Over 90,000 Allied Health professionals work in Australia representing 20% of the country’s health workforce. As the third pillar of health care they are responsible for working with patients to alleviate the effects of illness or disability and to promote health and wellbeing within the population. They work in all care types, including primary, acute and chronic care; and in all health care settings – including GP clinics, aged care residences, schools and leisure centres. Their work is characterised by vast variation in their degree of autonomy, dependence on technology, regulation and required training.

With no consensus on what the term Allied Health encompasses, key decision makers such as Medicare Locals (MLs) are often unaware of the impact of their decisions on Allied Health, or the role of Allied Health in healthcare planning. This is set to be addressed to some degree with the appointment of the Government’s first Commonwealth Chief Allied Health Officer in 2013. Currently MLs are working towards providing high quality primary health and social care for our local community through tackling existing inequalities and introducing new opportunities to bring together all health care professions (GPs, Nurses, Allied Health etc). MLs have a responsibility to monitor the health workforce in their area and to align this to the population’s needs. A major challenge for MLs is how to fully understand the diversity in roles and services of the Allied Health professions. Collaboration with Peak bodies has been established as a critical factor to gain a deeper understanding of each profession.

Allied health professions for a long time have been delivering a range of specialist’s services within the primary care setting. It is hoped this guide will raise the awareness of the professions including recommendations of how to engage, collaborate, support and strengthen partnerships for the benefit of all patients.

This Guide has been produced on behalf of the Australian Medicare Local Alliance (AML Alliance) following consultations with both MLs on their information and support needs and Allied Health Peak bodies regarding the role of their respective professions. For further enquires please contact:

AML Alliance Emma Whitehead 02 6228 0800

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Acknowledgements

Australian Medicare Local Alliance gratefully acknowledges the financial and other support from the Australian Government Department of Health and Ageing.

We would like to acknowledge and thank all contributors from the Allied Health Professions in Australia for their support in providing information for the development of this guide.

Peak bodies include:

 Audiological Society of Australia: Audiology Australia (ASA)

 The National Aboriginal and Torres Strait Islander Health Worker Association (NATSIHWA)  The Chiropractors Association of Australia (CAA)

 Dietitians Association of Australia (DAA)

 Australian Diabetes Educators Association (ADEA)  Exercise and Sports Science Australia (ESSA)  Australian Music Therapy Association (AMTA)  Occupational Therapy Australia (OTA)  Optometrists Association Australia (OAA)

 Australian Orthotic Prosthetic Association (AOPA)  Orthoptics Australia (OA)

 The Australian Osteopathy Association (AOA)  Australian Physiotherapy Association (APA)  Australasian Podiatry Council (APodC)  The Australian Psychological Society (APS)  Australian Association of Social Workers (AASW)  Speech Pathology Australia (SPA).

In addition we would like to also thank other organisations that contributed to the development of the guide including:  Indigenous Allied Health Australia (IAHA)

 Services for Australian Rural and Remote Allied Health (SARRAH)  Allied Health Professions Australia (AHPA).

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Table of Contents

1. Introduction 8

2. Allied Health in Primary Care 12

3. Allied Health, Requirements and Regulations 19

4. Allied Health Professions 23

5. Allied Health Peak Bodies 43

6. Working Collaboratively to Achieve Integrated Care 50

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1

Introduction

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Introduction

As strategic Primary Health Care Organisations, MLs are tasked with orchestrating a local system of care spanning health promotion, prevention and primary care: bringing together service providers across the local health economy to achieve greater collaboration and integration for the benefit of patients and the health system alike. Allied Health clearly has an important contribution to make to the health and wellbeing of the local community and is a core component of integrated care at a primary care level. Increasing emphasis is being placed upon the role of Allied Health through for example, the appointment of the Government’s first Commonwealth Chief Allied Health Officer (2013). The Chief Allied Health Officer’s role is to raise the profile and strengthen the role of Allied Health and provide advice on how best to strengthen primary care provision.

It is essential that the unique depth and breadth of skills, knowledge and roles of Allied Health professions are understood, valued and appropriately utilised within the development and delivery of primary care.

This guide is developed by the AML Alliance to support MLs achieve their strategic objectives and is aimed at improving the understanding of the roles and services Allied Health currently offer.

Information detailed herein has been gathered from Allied Health Peak bodies and organisations who are keen to establish joint working relationships with MLs at national, jurisdictional and regional levels (as appropriate). The guide specifically encourages MLs to look beyond General Practice to foster greater understanding of, collaboration and integration with Allied Health services.

Making a Difference

A real difference to the quality of life and wellbeing of the local population can be achieved through working collaboratively with all relevant professions and organisations within primary care. The Allied Health professions look forward to working with MLs as equal partners to provide quality healthcare to all Australians. AHPA

Dietitians Association of Australia (DAA)

and MLs

DAA has set up a Medicare Local Discussion Group which communicates by email through a collected list including a new DAA Health Informatics Advisory Committee for e-health. Medicare Local events are posted on the DAA calendar of public events and circulated to the Medicare Local Discussion Group.

Information, and opportunities to participate in Medicare Local activities, can be shared with dietitians through DAA

networks.

Allied Health Profiles

MLs should not underestimate the importance of having an accurate profile of Allied Health professionals so GPs can promote timely and appropriate access to services and supports for patients. Audiology Australia

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Purpose of the Guide

This guide provides information for MLs who are looking to

increase their knowledge and understanding of the significant role and contribution of Allied Health professions. It aims to:  Educate and raise awareness of Allied Health professions,

their regulatory frameworks and associated peak bodies  Encourage greater involvement of Allied Health professions  Highlight examples of how Allied Health professions

contribute to better health within the primary care setting This guide provides the following information:

 Chapter 2 illustrates the role of Allied Health in primary care and their contribution to Chronic Disease Management  Chapter 3 sets out the role of Allied Health and the

associated Regulatory Framework

 Chapter 4 demonstrates the role and contribution of Allied Health professions including an outline of the services provided, professional credentials, top tips for engaging with the profession and links to further information

 Chapter 5 clarifies the role of associated peak bodies and summarises the services offered to members

 Chapter 6 suggests how MLs could achieve greater collaboration based upon feedback from Allied Health peak bodies

 Chapter 7 provides additional information for reference purposes.

Ultimately the purpose of this guide is to promote greater collaboration across primary health care professions to assist patients achieve optimum health and wellbeing.

The guide augments the work of the AHPA, peak bodies and organisations that are critically important in supporting Allied Health professions.

Why is it important Medicare

Locals engage with Allied Health?

• A well coordinated health service provides a comprehensive and continuous experience for the patient

• More effective and cost efficient service provision Service Coordination

• Better long-term outcomes for the patient • Increased focus on prevention, self -care and

independence

Patient-centred care

• Facilitate earlier discharge from hospital and prevent re admission

• More creative usage of services to deliver efficient and accessible service

Reduced reliance on inpatient care

• Wider and more flexible treatment choice for the patient • Improved used of existing skills with the primary

care setting

Provision of alterative treatment options

• Promote early referrals and timely interventions • Better case management and communication

between professions

Improved understanding of Allied Health roles and expertise

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2

Allied Health in

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Allied Health in the Primary

Care Setting

There is robust evidence supporting the contribution that Allied Health makes

to local community health as partners in the delivery of a patient-centred,

seamless system of care.

Allied Health professions have a longstanding and significant role within the primary care setting. In primary care, Allied Health professions can work individually or as part of a multi-disciplinary team alongside GPs, nurses, social care staff and others to provide access and effective care for patients. Referrals to these services come from a variety of settings including clinics, schools, other Allied Health professionals, GPs and residential care.

Allied Health professions contribute across the full scope of primary care activities from needs assessment, health promotion and community development, through to direct provision of specialist treatment and rehabilitation services. These professions help people manage their physical and/or mental health condition, overcome barriers related to disability and live as independently as possible. In addition to their general role in promoting health and the prevention of associated problems, each Allied Health profession has an educational role in promoting self-care. This involves advising and supporting individuals and their families to gain the maximum benefit from the services provided.

Allied Health is a core component of a patient centred primary health care system achieved through the provision of integrated health care. Whilst MLs have a responsibility to improve the patient journey through developing better coordinated and integrated services, trying to achieve this within a local health economy can often prove challenging. Many MLs have utilised the Patient Centred Health System model to promote service integration. This has been demonstrated to be highly effective in addressing health needs and also enhancing the patient experience (See

Aboriginal Health Partnership in Primary Care

By liaising with local GPs and other health services Aboriginal and/or Torres Strait Islander Health Workers (AIHWA) run various programs aimed at supporting and advising patients who require assistance with a variety of health promotion topics including: smoking cessation advice, drug and alcohol issues and other support like healthy eating. The AIHWA’s patients may also be directed to other programs or initiatives when needed. For example, the Aboriginal Maternal Health program which aims to support Aboriginal mothers, their partners and families through pregnancy. They are also a valuable resource for GPs to help with identification of Medicare item numbers.

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Allied Health Programs in the

Primary Care Setting

There are a number of primary health care programs currently delivered by Allied Health professions (see examples below). To fully utilise and coordinate services offered by Allied Health at a local level for the benefit of patients and the health care system alike, further initiatives are needed to better link services at a local level.

Access to Allied Psychological Services (ATAPS)

The ATAPS initiative is a Commonwealth Mental Health program that funds the provision of short term psychology services for people with Mental Health disorders. ATAPS enables GPs to refer patients with mild to moderate (high prevalence) disorders to Allied Health professionals for six sessions of evidence based mental health care. An option of a further six sessions exists pending a mental health review by a referring GP.

Rural Primary Health Services (RPHS)

The RPHS is a Department of Health and Ageing funded program that allows eligible participants to employ, contract or fund Allied Health professionals in rural communities. The aim is to increase the number and range of Allied Health services delivered in rural communities. It promotes an integrated approach to care by linking General Practice and Allied Health.

Wellness Centres

Wellness Centres aim to provide the highest quality exercise physiology and dietetics services to clients by providing support and education to promote active and healthy lifestyles and/or to support recovery from injury. All

consultations are delivered by Accredited Exercise Physiologists (EPs) and an Accredited Practicing Dietitian (APD). Streams of care can include:

 exercise rehabilitation which promotes the activities of daily living and building confidence

 chronic and complex disease prevention and management aimed at improving physical condition, stamina and pain management techniques.

Clinical Care Pathways

Through engagement with local Allied Health peak bodies this ongoing project maps clinical pathways between primary, secondary and tertiary care using an innovative online tool. Local clinicians from General Practices and public and private hospitals, Allied Health professionals and relevant organisations are involved in improving the patient’s path between services. This prevents professionals working in silos and creates simple and more efficient care pathways. Many Allied Health professions are especially keen to be involved.

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Allied Health in Chronic

Disease Management

Allied Health Professions are key contributors in health promotion and disease

prevention

Primary health care has an important role in assessing, preventing and managing chronic disease. Despite the evidence of how to prevent chronic disease in the community there remains gaps and barriers in health promotion and preventative practices. The role of MLs is to facilitate change by developing partnerships with Allied Health professions and to coordinate and broker new preventative services and programs for the community.

Primary health care providers have a central role in assessing population health needs and identifying at risk patients. While

there has often been a tendency to provide short term interventions and follow up, intensive education and support through community based programs that include Allied Health, is recommended. Facilitating this is an important role of the Medicare Local which is reflected in their population health planning and service commissioning activity. Further information can be found at:

http://www.cdm.ahpa.com.au

Diabetes Co ordination and Assessment Service (DCAS)

Diabetes Management can be delivered across all levels of care: intensive, active, proactive and preventative. To promote care across all these levels a number of Allied Health professions are involved, with services provided at a single diabetic clinic. The clinic can consist of a dietitian, diabetes educator, exercise physiologist, podiatrist and psychologist. Specific treatments include: acute diabetic foot wound management, functional foot assessments, education and prevention strategies and control of diabetes. Medicare Local funding has enabled improved access to these services and reduced waiting lists for clients with musculo-skeletal and orthopaedic conditions.

Connecting Care Program

The Connecting Care Chronic Disease Management Program is a NSW Health initiative that aims to link appropriate primary health care services to deliver more effective health management for patients with severe chronic disease, who are at high risk of unplanned hospital or ED presentation. The program delivers an integrated, patient-centred, holistic approach that addresses the patient’s clinical and non-clinical needs.

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Allied Health in the Medicare

Benefits Schedule

There are a number of Medicare item numbers that allow people to access Medicare

rebates for Allied Health services following referral by a GP. The Allied Health

services can fit under a variety of item numbers. For further information please liaise

with the relevant Allied Health Peak Body (see section 5). Examples include, but are

not limited to:

1. Chronic Disease

Management (CDM)

Medicare Benefits

Schedule (MBS)

The Chronic Disease Management (CDM) Medicare items on the Medicare Benefits Schedule (MBS) provide GP referral pathways to Allied Health

professions, facilitating multidisciplinary team care arrangements to provide shared care for patients with chronic and complex conditions. These include the following professionals:

 Aboriginal Health Worker  Audiologist

 Chiropractor  Dietitian

 Exercise Physiologist  Mental Health Worker  Osteopath  Podiatrist  Psychologist  Speech Pathologist  Occupational Therapist  Diabetes Educator  Physiotherapist.

As part of the Australian Better Health Initiative, AHPA developed a Chronic Disease Management resource package. This clarifies roles of selected Allied Health professions in chronic disease management, communication tips, schematics, templates and the MBS item numbers.

www.cdm.ahpa.com.au/LinkClick.aspx?file ticket=cu5JtKD%2f0Mg%3d&tabid=137& mid=982

2. Rural Primary Health

Services (RPHS) program

The RPHS program aims to improve access to a range of primary allied health care services and activities for rural and remote communities. This program gives community-based primary health care services greater flexibility in the range of services they can offer, including health promotion and preventative health activities. The RPHS brings together the:

 More Allied Health Services program  Regional Health Services program  Multipurpose Centre program  Building Healthy Communities in

Remote Australia program.

Further information on the Rural Primary Health Services (RPHS) program can be found at: www.health.gov.au/internet/main/publish ing.nsf/Content/Rural-Primary-Health-Services-Program

3. Speciality Medicare

Rebates

These items are specialty specific with eligibility criteria set out under different initiatives including for example:  Better Start for Children

with Disability

 Better Access to Mental Health  Allied Health Follow Up Services for

People of Aboriginal and Torres Strait Islander descent

 Access to Allied Psychological Services (ATAPS)

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Medicare Australia – Eligible Allied

Health Professionals

Below is a list of the Allied Health professions that are able to register with Medicare Australia and therefore eligible to rebates if they meet specific criteria:  Aboriginal and Torres Strait Islander

health practitioners  Aboriginal health workers  Audiologists

 Chiropractors  Diabetes educators  Dietitians

 Exercise physiologists  Mental health workers

 Accredited mental health social workers  Occupational therapists  Osteopaths  Physiotherapists  Podiatrists  Psychologists  Speech pathologists.

Further information can be found at: www.health.gov.au/internet/main/ Publishing.nsf/Content/health-medicare-health_pro-gp-pdf-allied-cnt.htm

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Pharmacy

Pharmacists play a critical role in an integrated primary health care system as both a service provider and a trusted advisor to the community; and as such a signpost to appropriate services. It is important that MLs understand the role of pharmacists and establish effective working relationships with this profession.

The classification system of pharmacy includes the following categories:  Hospital pharmacist; with the sub

categories of hospital pharmacists and pharmacy officer (for military based services)

 Industrial pharmacist

 Retail / community pharmacist; with the sub categories of retail/ community pharmacist and consultant pharmacist. The tasks and activities undertaken by pharmacists (with the exception of industrial pharmacists) can be considered in the following categories:  Quality use of medicines activities

(e.g. medication safety, institutional medicines policy management)  Clinical services (e.g. medication

review, pharmacist clinical interventions)

 Medicines procurement and distribution (e.g. purchasing, extemporaneous compounding)  Teaching and research (e.g.

undergraduate and post-graduate teaching)

 Administration and pharmacy management (e.g. resource and contract management, quality). Contemporary health care requires that the range of services offered by pharmacists needs to go beyond the ‘traditional’ supply role. This can be seen in the following web links:

 Guiding principles for medication management in residential aged care facilities (RACF) www.health.gov.au/internet/main/publishi ng.nsf/Content/D9282D3CCC0BF2BCC A257AA00007134A/$File/Guiding%20pri nciples%20for%20medication%20manag ement%20in%20residential%20aged%2 0care%20facilities.pdf

 The provision of pharmacy services in Aboriginal and Torres Strait Islander health services settings

www.psa.org.au/download/standards/ser vices-for-indigenous-health-services.pdf Pharmacists have a role across the continuum of care between MLs and Local Hospital Networks, particularly in servicing patients with acute, chronic and complex disease.

Pharmacists within MLs could provide patient-specific services such as:  Identifying and addressing medication

related problems (e.g. pharmacist clinical interventions)

 compilation of complete and accurate medication histories

 identification of patient-specific factors that affect their medication adherence/ assessment of a patient’s current medication regimen (e.g. through Meds Check, Diabetes Meds Checks) In addition these pharmacists could provide support to other members of the healthcare team by:

 acting as a resource about the use of medicines

 developing relevant protocols and guidelines

 providing education about medicines to other health professionals

 Pharmacists are required to undertake continuing professional development training under AHPRA and the Pharmacy Board of Australia (PBA)

registration requirements. Pharmacists can become “accredited” to deliver medication review services in RACFs and the home environment (Home Medicine Reviews – HMRs) and need to meet specific eligibility

requirements, be able to register with Medicare Australia and claim for these clinically focused services. In

hospitals, pharmacists can work in a general dispensing and entry-level clinical roles, or seek additional training and education in order to work and practice at a more advanced or specialised level.

 QCPP Accreditation administered by the Pharmacy Guild of Australia allows for additional incentives to be paid to pharmacies.

Top Tip

Encouraging GP’s to reach out to Pharmacists

As the medicines expert of the patient-care team, pharmacists contribute to decisions about patients' treatment by reviewing their medicines, monitoring their progress and making sure they understand how to take their medicines correctly. Doctors can ask pharmacists for advice on the most appropriate dose or form of medicine or for their opinion about the use of certain medicines in a person with a particular clinical problem.

Pharmacists working in both the community and hospital setting are available to be approached by healthcare professionals, patients and their families about how to use medicines safely and effectively.

Further

Information

Society of Hospital Pharmacist of Australia www.shpa.org.au Pharmaceutical Society of Australia www.psa.org.au

The Pharmacy Guild of Australia www.guild.org.au YouTube: Pharmacy www.youtube.com/watch?v =2EnQUKgv1YM&list=SP08 91268A1E8EBD03

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3

Allied Health,

Requirements

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What is Allied Health?

Although it is recognised the Allied Health workforce in Australia is comprised of a

range of Allied Health practitioners who are each critical to the health of patients, for

the purpose of this guide only Allied Health professions who work in Primary Care

have been included.

Allied Health is an umbrella term used to describe individuals who are trained to work individually or with others to support individuals achieve optimal health. Allied Health professions are distinct from medical, nursing or dental professionals. Their aim is to support diagnosis, recovery and quality of life. Access to Allied Health care can increase a person’s mobility, independence and ability to care for themselves. It can also help reduce the risk of complications in chronic conditions, illness or injury. There are a wide range of services and supports available from a wide range of Allied Health professions which can often make it difficult to gain a full appreciation of the work of Allied Health. The term ‘Allied Health’ can be used

interchangeably to describe:  The range and type of service/s

provided (or not)

 The range of diagnostic, therapeutic or support provided (or not)

 The professional scope of practice. While there is no consistent definition of ‘Allied Health,’ it is recognised that the Allied Health workforce in Australia is comprised of Allied Health professions and other Allied Health workers including technicians, assistants and support workers who all together help transform people’s lives.

Allied Health

Professionals

Allied Health Professionals are qualified to apply their skills to retain, restore or gain optimal physical, sensory, psychological, cognitive, social and cultural function of clients, groups and populations. Allied Health Professionals (eg: Physiotherapist,

Audiologist, Dietitian) hold nationally

accredited tertiary qualifications enabling eligibility for membership of their national self-regulating

professional association or registration with their national Board. The identity of Allied Health has emerged from these Allied Health professions client focused, inter-professional and collaborative approach that aligns them to their clients, the community, each other and their health

professional colleagues. Within these professions there are however still significant differences in 2 critical areas:

 Allied Health Regulation (see page 17)  Allied Health Medicare eligibility

(see page 12).

Allied Health Workers

Allied Health workers (eg: Health

Promotion officers, Alcohol and Drug workers, Allied Health Assistants)

provide vital support to clients and may or may not require academic

qualifications. These workers operate alongside Allied Health professionals within a multidisciplinary team to support a person’s health care.

There are more than 90,000 Allied Health

professionals (AHPs) working

in Australia today, many of these highly

trained professions work alongside doctors

and nurses, providing quality primary health

care for Australians. This represents 20% of

the country's healthcare workforce – a

sizeable proportion which continues to grow.

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Allied Health Regulation

Regulation is a system used to control

standards of education and practice of a profession. The need for regulation is based solely on the need to provide quality practices and protect members of the public from harm. To be regulated, a profession must meet six criteria adopted by the Australian Health Minister’s Advisory Council (AHMAC). Regulation may take one of several forms including: Registered, Self regulated,

Negative licensing.

Registered – otherwise known as

Statutory Regulation, is a form of regulation by an Act of Parliament. Only

practitioners who have completed recognised educational qualifications and are bound by an enforceable code of ethics and code of practice can identify themselves as a practitioner. This provides the highest level of protection for members of the public.

The registered professions are part of the Australian Health Practitioner Regulation Agency (AHPRA). The purpose of which is to protect the public by ensuring that only “health practitioners

who have the skills, qualifications and knowledge to provide safe care are registered”. Under this national scheme practitioners once registered, renew yearly and can practice anywhere is Australia delivering benefits for both the public and practitioners.

Self Regulated – Self regulation is

a system of controlling the activities of a profession by a governing body set up by the profession. This form of regulation is predicated on a single body setting

There is however no enforcement to become a member of a respective peak body once qualified. This is one of the main reasons the National Alliance of Self-Regulating Health Professions (NASRHP) has called for a single regulatory system and model of

authorised self-regulation (March 2012). One of the key pillars of the proposed model for all self regulating bodies is to ensure professionals can gain licensing without the current membership obligation, with a view to better protect the public through mitigating any risk to patient safety.

Negative Licensing – Negative

licensing is a system where a practitioner can be banned from practicing by direction of the Health Care Complaints Commission after a complaint against a practitioner has been proven. This is a

system that has been adopted in NSW and is under consideration in South Australia and Victoria. The NSW scheme is called a ‘negative licensing’ scheme as it does not require unregistered

practitioners to hold a license or pay a license fee but allows for action to be taken where an unregistered health practitioner has acted in a way that breaches the NSW code of conduct. Details of the NSW Code of Conduct for unregistered health practitioners, along with prohibition orders issued by the Health Care Complaints Commissioner can be accessed at the following address:

www.hccc.nsw.gov.au/Information/Inform

ation-for-Unregistered-Currently the regulatory status for Allied Health Professions (which includes all professions in this guide) fall into 2 categories:

Australian Health Practitioner

Regulation Agency (AHPRA)formed in

July 2012. Its operations are governed by the Health Practitioner Regulation National Law, which is in force in each state and territory (the National Law). This law means that, health professions are regulated by nationally consistent legislation under the National

Registration and Accreditation Scheme (see www.ahpra.gov.au).

The National Alliance of Self-Regulating Health Professions

(NASRHP) formed in 2007. It aims to

seek clarity regarding regulation for their respective professions and benchmark their self-regulatory environment. Table 1 highlights the regulatory status of those Allied Health professions which are included in Chapter 4.

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AHPRA Registered NASRHP Regulated Aboriginal and Torres Strait Islander Health Practitioner Audiologist

Psychologist Dietitian

Chiropractor Diabetes Educator

Occupational Therapist Exercise Sport Scientist

Optometrist Orthotist & Prosthetist

Osteopath Social Worker

Pharmacist1 Speech Pathologist

Physiotherapist Podiatrist

Table 1: Allied Health Regulation

Despite the different regulation requirements it should be recognised that all Allied Health professions are striving for the same goal “that patients have access to the right practitioners at the right time and in the right place to ensure they receive

the most appropriate health service for the benefit of patients”. Both regulated and self-regulated professions offer a high standard of unique skills in the primary care setting, however, this mix of accreditation can lead to unintended confusion, potential exclusion and a lack of clarify amongst stakeholders including patients, GPs and MLs. Options to overcome this confusion include:

 MLs ensuring that self-regulated professions receive the same acknowledgement as registered professions, thereby helping to reduce the unintentional two tier regulatory framework which does not support best practice in health service delivery

 All Allied Health professions - both registered and self-regulated - are included in ML workforce planning, innovation and reform initiatives. This includes NASRHP self-regulated Allied Health professions being allowed to participate in the governance of MLs, such as by sitting on boards and committees

 MLs supporting projects that encourage the progression of self-regulated professions.

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4

Allied Health

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Allied Health Professions

Introduction

Allied Health professions as discussed in this chapter are a core component of primary health care. They are an integral part of the multidisciplinary team which supports people with chronic and enduring heath problems and works toward better health and wellbeing.

Definition

As mentioned there is no one universal definition of an Allied Health profession but the following definition is widely

accepted in Australia and has formed the basis for this guide. An Allied Health profession is one that has:

 a direct patient care role and may have application to broader public health outcomes

 a national professional organisation with a code of ethics/conduct and clearly defined membership requirements

 university health sciences courses (not medical, dental or nursing) at AQF Level 7 or higher accredited by their relevant national accreditation body

 clearly articulated national entry level competency standards and assessment procedures

 a professionally defined and a publicly recognised core scope of practice robust and enforceable regulatory mechanisms.

and has Allied Health professionals who:  are autonomous practitioners

 practise in an evidence-based paradigm using an internationally recognised body of knowledge to protect, restore and maintain optimal physical, sensory,

psychological, cognitive, social and cultural function  may utilise or supervise assistants, technicians and

support workers. (AHPA)

Allied Health Professions Australia (AHPA) is the national voice for Allied Health and has members from both registered and self-regulated professions. It aims to represent its members through delivering high quality, competent and informed advice to government.

Further Descriptions

This chapter provides information on each Allied Health profession listed over-page including:

 those services the profession offer  credentials required by the profession

 top tip for engaging with the profession following feedback from the respective Peak body

 links to Peak bodies and other links for further information. A combination of the key challenges for these Allied Health professions and the identified enablers to support integration of Allied Health and MLs can be found in chapter 6.

Table 2 is a list of those Allied Health professions included in the guide, their regulatory status and confirmation of whether they are members of AHPA.

Aboriginal Health Worker Orthotist/ Prosthetist Audiologist Orthoptist Chiropractor Osteopath Diabetes Educator Physiotherapist Dietitian Podiatrist Exercise and

Sport Scientist Psychologist

Music

Therapist Social Worker

Occupational Therapist

Speech Pathologist Optometrist

Key: AHPA member Self regulated Registered

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Aboriginal and Torres Strait Islander Health Workers (ATSIHWs) play a vital role in the primary health workforce. They provide clinical and primary health care for individuals, families and community groups including specialty areas of drug and alcohol, mental health, diabetes and eye and ear health. Their common objective is to assist the Aboriginal and Torres Strait Islander communities to take a strong role in controlling and managing their own health and lifestyles.

Services

An Aboriginal and/or Torres Strait Islander Health Worker (ATSIHW) is an Aboriginal and/or Torres Strait Islander person who is in possession of a minimum qualification (cert III) within the fields of primary health care work or clinical practice. ATSIHWs may perform a broad range of tasks including:  the treatment of disease or injuries and maintaining health

records

 acting as communicator and interpreter on behalf of clients and other health workers

 taking part in case management and follow up, either independently or with other health care providers  providing health education to individual clients and health

staff

 providing cultural education to people outside the cultural community

 providing life skills education, counselling and referral for crisis intervention in the community they serve

 providing input into the planning, development,

implementation and monitoring and evaluation of all health programs in the community.

ATSIHW are a unique profession where workers are able to do a variety of jobs which is often essential in rural and remote areas. They not only perform a comprehensive primary health care role (including clinical assessment, monitoring and intervention activities; health promotion and chronic disease management services) but also provide culturally safe health care suited to local health needs.

Credentials

The Aboriginal and Torres Strait Islander Primary Health Care qualification is nationally recognised and encompasses different levels (including cert II III IV) and varying requirements.

Registered Training Organisations which provide the Certificate IV or higher in Aboriginal and Torres Strait Islander Health Practice must have the course accredited with the Aboriginal and Torres Strait Islander Health Practice Board of Australia, in order for participants to be registered with the AHPRA Board. This includes the Aboriginal and/or Torres Strait Islander Primary Health Care Practitioner (clinical role).

Top Tip for Engaging with Aboriginal

Health Workers

Actioning the recent recommendations from “Growing Our Future – Health Workforce Australia”.

Factors include:

 recognition of the Aboriginal and Torres Strait Islander Health Worker workforce as a core part of the primary health care workforce

 prioritise the Aboriginal and Torres Strait Islander Health Worker workforce within Aboriginal and Torres Strait Islander health initiatives

 increase the Aboriginal and Torres Strait Islander Health Worker workforce to meet demand.

Further information

Peak Body - National Aboriginal and Torres Strait Islander Health Worker Association

www.natsihwa.org.au

Aboriginal

(27)

Audiologists are hearing specialists who manage hearing health. They specialise in assessment, prevention and management of hearing loss, deafness and related conditions, including tinnitus and balance disorders. Audiologists provide assessment to all ages, from infants to adults, and help through the application of technology, rehabilitation and therapy. Many Audiologists are also involved in research, helping to develop new hearing devices.

Services

Audiologists provide clinical services in hospitals and

community health centres, hearing aid clinics, private practice, university clinics, and in some medical practices. They offer a range of services as seen in the table below:

SPECIALIST Performed by Audiologists

Advice to organisations and to other professionals, about hearing care Assessment for sensory aids, cochlear implants and other surgically

implanted devices

Assessment and therapy for people with tinnitus (noises in the ear or head) Counselling, and plans, to assist

communication when hearing loss is present Complex assessments of:

 auditory neural pathways  balance system of the ears  central auditory processing  hearing when other disabilities

are present

Full hearing assessments for babies and children

Specialist hearing aid practice with children and people with complex hearing problems Specialist rehabilitation programs for people with complex hearing problems

BASIC Performed by Audiologists and other practitioners

Hearing aid fitting

Standard audiometry tests

Provision of hearing protection devices Noise measurement

Workplace hearing tests Preliminary hearing checks

Credentials

Audiology is a self regulated profession. There are mandated Continuing Professional Development (CPD) requirements to obtain a CCP (clinical certificate) which is audited every 2 years. Professionals are also required to practice with the Code of Ethics for Audiologists.

Full membership of the Audiology Society of Australia requires proof of a certified university graduate certificate with tertiary qualifications in Audiology.

Most job vacancies require a CCP for employment.

Top Tip for Engaging with Audiology

Raised awareness and increased knowledge on the impact of hearing loss.

Audiology should be included in the development of Health Pathways as a high percentage of elderly patients will at some point require audiology services for hearing loss management.

Further information

Peak Body – Audiology Australia www.audiology.asn.au

YouTube – Audiologist

www.youtube.com/watch?v=3tjovzqTNCs

Over 98% of profession hold

membership of the peak body

(28)

A chiropractor is a government-registered and regulated, university-trained Allied Health care professional. Chiropractors complement medical services and promote general health by providing a primary contact with specific diagnostic focus on disorders relating to the spine and nervous system and advice on self care in lifestyle & movement factors.

Services

Chiropractic is a health care discipline based on the scientific premise that the body is a self-regulating, self-healing organism. They provide drug-free and manual therapies that can open collaborative opportunities for better patient outcomes.

A chiropractor conducts thorough general examinations with particular focus on spinal and

neuromusculoskeletal systems. They work with GPs in multidisciplinary settings to care for people with a wide range of acute or chronic disorders including neuromusculoskeletal disorders, such as:

 Acute or chronic back pain  Extremity pain and dysfunction  Poor mobility

 Degenerating posture  Migraine headaches  Osteoarthritis.

Trigger points for referring patients to chiropractors include symptoms that may be of spinal origin, such as spine related pain, motion restriction and postural distortion. Chiropractors also place significant emphasis on wellness and prevention through provision of specialist lifestyle advice and movement.

Referrals can therefore also be made to

Credentials

For registration to practice, chiropractors must study full time at University for a minimum of 5 years, graduating with a 3year Bachelor degree followed by a Masters degree or a 5 yr double degree in Chiropractic Science and Clinical Science. To maintain quality and safety, chiropractors complete continuing professional development courses and seminars to upgrade and maintain their skills. These are essential according to required AHPRA registration standards.

Top Tip for Engaging with

Chiropractors

Increased understanding of the benefits chiropractic services offer

Improved engagement at a practitioner level and Peak body level. This improvement and collaborative working would enable a greater understanding of the benefits and services leading to better informed decisions when

developing and designing services in the MLs area.

Further information

Peak Body - Chiropractors Association of Australia www.chiropractors.asn.au Case study: Straighten Up Australia

Straighten Up Australia is an ongoing community service initiative of the CAA, and is an easy and enjoyable everyday program to improve your health and the way your body functions.

Consisting of a set of simple exercises and taking just three minutes to complete, Straighten Up Australia will help improve posture, stabilise core muscle groups, enhance health and prevent spinal disability.

The exercises can be undertaken by Australians of all ages with a special program tailored for children. Further information can be found at:

www.chiropractors.asn.au/AM/Templat e.cfm?Section=SUA

(29)

Diabetes educators specialise in the provision of diabetes self-management education for people with diabetes. The discipline is about assisting people with diabetes, their families and carers to gain the knowledge, skills, motivation and

confidence to manage their condition. Diabetes education assists people with diabetes to – Know what to do, Know how to do, Want to do it , Be able to do it, Recognise when to seek assistance.

Services

Diabetes Educators provide support and education for people with diabetes (including gestational diabetes) integrating clinical care,

self-management education, skills training and disease specific information to motivate patients to:

 understand diabetes and make informed lifestyle and treatment choices

 incorporate physical activity into daily life

 use their medications effectively and safely

 use glucometers and monitor and interpret blood glucose levels  manage hypoglycaemia and

hyperglycaemia

 initiate and manage safe and effective insulin pump therapy.

It is recommended that GPs refer a patient for diabetes education when:  They are first diagnosed with diabetes  Starting blood glucose monitoring

at home

 Introducing diabetes tablets or insulin therapy

 Having difficulties reaching treatment targets and management goals such as blood glucose

 Having frequent or severe episodes of low or high blood glucose levels  Lifestyle or life stage changes such as

when starting an exercise program, planning to travel or starting school  Planning pregnancy, during

pregnancy and after delivery  Feeling stressed or ‘burnt out’

by diabetes.

Credentials

Diabetes educators who meet all the requirement of the Credentialling Program are recognised for their commitment to ongoing professional development and for their knowledge, skills, expertise and experience in the field of diabetes education by being awarded status as a Credentialed Diabetes Educator (CDE) for three (3) years. CDEs who meet the

Re-Credentialing Program’s prescribed criteria can apply to have their CDE status renewed for another three (3) years.

A CDE is one who meets the Australian Diabetes Educators Association (ADEA) standards of practice, has completed a post graduate certificate in diabetes education and management from an ADEA accredited University, complies with the ADEA professional development and clinical experience requirements and is eligible to practice in their primary discipline as:

 Registered Nurse

 Accredited Practising Dietitians  Registered Medical Practitioners  Registered Pharmacists accredited

to conduct medication management reviews

 Registered Podiatrists

 Accredited Exercise Physiologists.

Top Tip for engaging with

Diabetes Educators

Support in establishment of appropriate referral pathways

To support implementation of referral pathways for GP’s to Diabetes Educators including promotion of their valuable services offered. This will facilitate innovative health partnerships to improve health outcomes and reverse the impact of preventable chronic disease in the communities, (especially obesity leading to type II diabetes).

Further information

Peak Body - Australian Diabetes Educators Association www.adea.com.au

100% of credentialed

professionals hold

membership of the

peak body

Diabetes

Educator

(30)

Accredited Practising Dietitians (APDs) are experts in food and nutrition. They can advise patients on the specific nutritional management of many heath conditions such as diabetes, overweight and obesity, cancer, heart disease, renal disease, gastro-intestinal diseases and food allergies. Timely intervention by a dietitian can reduce the risk of developing chronic disease.

Services

APDs working in the primary care setting offer a broad range services. These may include:

Community and Public health Nutrition including consultation to residential aged care facilities, child care centres and group homes for people with disability regarding clinical care, staff training, menu assessment and planning and compliance monitoring of therapeutic diets  Medical Nutrition Therapy

(clinical care) with patients including assessment and nutritional

education/counselling, enteral / parenteral nutrition monitoring and evaluation

Food service Management which can be at Community Health centres running nutrition education sessions ( such as supermarket tours, cooking classes, diabetes education and cardiovascular education). Although there are a wider range of triggers for referring patients to a dietitian key factors include:

 Significant weight change  Failure to meet nutrition needs  Recent poor food intake, poor

appetite, or difficulty preparing or eating food

 Changes in medication

Credentials

To be eligible to provide services under the CDM Medicare items, a dietitian needs to be an APD as recognised by the Dietitians Association of Australia (DAA).

Please note: Qualifications in human

nutrition science alone are not sufficient to meet the APD program requirements as they do not include training in all three dominant areas of practice i.e. individual case management of medical nutrition therapy (clinical care), community and public health nutrition, and food service management. Dietitians may call themselves nutritionists, but the reverse is not true in Australian practice.

APD must uphold the following requirements to maintain registration:  Australian recognised

dietetic qualifications

 Completion of a minimum of 30 hours per year of continuing professional development

 Commitment to the DAA code of professional conduct and statement of ethical practice

 Agreement to comply with auditing of APDs.

Top Tip for engaging

with Dietitians

MLs to apply for more relevant community grants

MLs could be a focus for integrated multidisciplinary community projects led by APDs which would meet unmet nutritional needs of the community by attracting community grants. Examples of these include:

 Malnutrition screening and assessment of older people in the community

 Nutrition programs for the homeless. The disciplines involved could include APDs, GPs, nurses, care workers, food service, and other Allied Health. A collaborative care model could include a few or many organisations.

Further information

Peak Body – Dietitians Association of Australia

www.daa.asn.au

Dietitian

(31)

Exercise physiologists (EPs) provide exercise and lifestyle support for chronic diseases and injuries. The primary aim of service delivery is to encourage lifestyle changes that are sustained in the long term. EP’s must be accredited with ESSA to enable them to access Medicare and Private Health funds etc.

Services

EPs offer a range of services which include individual and group based lifestyle counselling, self-management support, exercise advice and monitoring of behaviour changes with a view to promoting independent lifestyle management. The primary modes of treatment for EPs are behavioural coaching, health education, exercise counselling and physical rehabilitation. EPs specialise in exercise prescription including individualised exercise programs, promoting leisure-time and incidental activity, and counselling to reduce sedentary behaviours. Initially a range of assessments would be conducted to ensure the activity

prescription is safe, effective and likely to be maintained in the long term. The patient will then be given the option of receiving a home based program, ongoing support in an exercise clinic, or a referral to an appropriate local physical activity provider with follow up help provided by the EP.

EPs work with people on a range of conditions, including:  Cardiovascular disease  Diabetes  Osteoporosis  Depression  Cancer  Arthritis

 Chronic obstruction pulmonary disease (COPD)

 Chronic Pain.

An EP could be referred to either at the point of initial diagnosis, following the identification of risk factors or for promoting general wellbeing.

Credentials

EPs undertake mandatory continuing education every year to retain accreditation with ESSA. All exercise physiologists receive specialist training in chronic disease management and behaviour change.

EP's must be accredited with Exercise & Sports Science Australia (ESSA) to enable them to access Medicare, Private Health funds, DVA etc. To become accredited, on completion of their degree, EPs must meet the accreditation requirements and hold a current First Aid and CPR certificate. To maintain accreditation, they must complete yearly continuing education and hold a current CPR certificate.

Top Tip for Engaging with

Exercise Physiologist

Support business practices understanding Medicare rebates By providing local one-to-one business education on item numbers/funding available, this will support and increase the understanding of what businesses can claim in meeting the patients health needs.

Further Information

Peak Body - Exercise and sport Science Australia

www.essa.org.au

YouTube – AEP’s and MLs

www.youtube.com/watch?v=DMqFZ4U3 BH4

More than 70% of the

profession hold peak

body membership

Exercise

(32)

Music Therapy is a research-based practice and profession in which music is used to actively support people as they strive to improve their health and wellbeing.

Music therapy is the intentional use of music by a University trained professional who is registered with the Australian Music Therapy Association Inc. Registered Music Therapists draw on an extensive body of Research and are bound by a code of ethics that informs their practice.

Music therapists are committed to supporting people of any age and ability regardless of musical skill, culture or background.

Services

Music Therapists incorporate a range of music making methods within and through a therapeutic relationship. They are employed in a variety of sectors including health, community, aged care, disability, early childhood, and private practice. Music Therapy is different from music education and entertainment as it focuses on health and wellbeing. Music Therapists do not provide a primary care diagnosis. They do, however, work as part of an Allied Health team in a variety of settings including hospitals, nursing homes, schools and the community, delivering tailor-made programs to meet specific needs. When working with all populations, music therapists use music-based interventions to provide a range of cognitive, physical and socio-emotional goals which are determined through an assessment by the RMT. These interventions may include song writing, improvisation, receptive listening, and other specialty techniques. Sessions may be individual or group including; writing songs for or with clients, playing instruments and improvising to create original pieces, listening to music or singing.

Areas of care that regularly utilise music therapy services include:

Credentials

Registration with the Australia Music Therapy Association (AMTA) is granted when applications prove their Bachelor or Masters degree from the relevant accredited universities. RMTs must participate in Continuing Professional Development which is monitored by AMTA Inc. CPD points must be submitted every 5 years and ongoing registration depends on these submissions.

Top Tip for engaging with

Music Therapists

Collaborative approach to development of strategic priorities

MLs to consult broadly with Allied Health, to prevent any assumptions being made and enable a clear understanding of how Allied Health fit into their equation. A clear understanding of the breadth and depth of treatment offerings are critical to decision making.

Further Information

Peak Body - Australian Music Therapy Association

www.ausmta.org.au

Membership is especially high due to employers insisting on correct qualifications and membership with AMTA.

Music

(33)

Occupational therapists (OTs) assist people of all ages to overcome limitations caused by injury or illness, psychological or emotional difficulties, developmental delay or the effects of aging. They assist people to move from dependence to independence, maximising personal capability. Occupational therapists often work in a multidisciplinary team, assisting people to overcome a wide range of conditions including: diabetes, CVD, stroke, arthritis and stress.

Services

Within the primary health care sector occupational therapists offer services to patients in the community through a variety of avenues including: private practice, GP/other health care practice or Medicare Locals as contractors or employees. They can also be accessed through community managed

organisations (non-Government organisations) or outreach from a public health facility where community health services are provided.

Occupational therapists provide services across the life span. They work in the primary health care setting to provide services in chronic disease

management, rehabilitation, mental health, and physical disability. Services may include specialised assessment, intervention / therapy, and team consultation.

Services can vary depending on the occupational therapist’s area of practice. Examples include:

 activities of daily living and functional assessment  driving assessment

 equipment prescription and training  environment modification

 specialised intervention, e.g. child development (motor skills, cognitive skills, play skills, specific skills, e.g. handwriting)

 rehabilitation (functional and occupational rehabilitation)  mental health intervention (FPS)  post hospital discharge follow up  cognitive assessment

and intervention.

Occupational therapists work within a bio psychosocial framework addressing a range of components including motor (gross / fine / balance/biomechanics), cognitive, social, psychological abilities.

Credentials

Occupational therapists are required to complete mandatory continuing professional development according to AHPRA registration requirements. AHPRA has determined specialised professional "accreditation" is not available for occupational therapists however, occupational therapists claiming Medicare rebates require "accreditation" as follows:

 Focussed psychological strategies (FPS) under Better Access

requirements. The requirements for the Better Access program are to have registration without restrictions (AHPRA), satisfactory evidence of two years supervised practice as an occupational therapist working in mental health. Satisfies the competency units described in the OTA Australian Competency

Standards for Occupational Therapists in Mental Health 1999

 CDM requirements – Chronic Disease Management. Allied Health

professionals need to meet specific eligibility requirements, be in private practice and register with

Medicare Australia.

Top Tip for engaging with

Occupational Therapist

Local engagement with

occupational therapist

Research and provide information to local GPs on OT services that are available in the area to ensure GPs have the correct contact details and what programs they offer for whom.

Further Information

Peak Body – Occupational Therapy Australia www.otaus.com.au YouTube – Because of Occupational Therapy www.youtube.com/watch?v= Ud5Fp279g4Y

Occupational

Therapist

(34)

An osteopath provides manual therapy to treat a wide variety of musculoskeletal problems and other functional disorders of the body, taking a ‘whole of body’ approach. Osteopaths are primary care practitioners, and are trained to be able to recognise conditions that require medical referral. They are also trained to carry out standard medical examinations of the cardiovascular, respiratory and nervous system.

Services

Osteopathy is a form of manual healthcare which recognises the important link between the structure of the body and the way it functions. Osteopaths focus on how the skeleton, joints, muscles, nerves, circulation, connective tissue and internal organs function as a holistic unit.

Using skilled evaluation, diagnosis and a wide range of hands-on techniques, osteopaths can identify important types of dysfunction in your body. Osteopathic treatment uses techniques such as stretching and massage for general treatment of the soft tissues (muscles, tendons and ligaments) along with mobilisation of specific joints and soft tissues. In Australia, osteopaths are university trained in anatomy, physiology, pathology, general medical diagnosis and osteopathic techniques. Osteopaths are primary healthcare practitioners and are trained to recognise conditions which require medical referral. They are also trained to perform standard medical examinations of the musculoskeletal, cardiovascular, respiratory and nervous systems.

Although there are currently no specialties for osteopaths; as musculoskeletal practitioners many osteopaths have undertaken further training and have clinical interests in pain management, sports, paediatrics and rehabilitation.

Credentials

In Australia, all osteopaths are required to be government registered practitioners under the national registration scheme APHRA. As such they are required to comply with all the codes and guidelines associated with such registration.

Top Tip for Engaging with

Osteopaths

Information Technology Support

Assistance around e-health requirements and infrastructure including: access to shared resources for improvement of service provision, directories and infrastructure.

Further Information

Peak Body – Australia Osteopathic Association www.osteopathy.org.au

YouTube – What is Osteopathy? www.youtube.com/watch?v=nFQyPvZv3 UI

(35)

Optometrists are registered health professionals concerned with the health of the eyes and related structures. They are trained to prescribe spectacles and contact lenses to improve vision, and to assess, diagnose, manage and treat various eye conditions and diseases. All practising optometrists in Australia must be registered with the Optometry Board of Australia (OBA).

Services

Optometrists provide a broad range of primary eye care services, including:  refractive testing and comprehensive

vision checks

 prescription of glasses or contact lenses

 assessment, management and referrals of ocular conditions such as dry eye and allergy

 assessment and treatment of vision problems in children

 co-management, primary care monitoring and treatment of patients with ongoing eye conditions, such as those caused by diabetes

 testing and monitoring: visual acuity testing, slit lamp examination, visual fields testing

 assessment and reporting on fitness to drive.

Registered optometrists with correct training are able to prescribe specific topical medications for the management of ocular conditions or disease. These optometrists can work within a broader scope of practice including:

 examining patients for signs of ocular disease, including superficial infection and anterior eye disease, and where necessary, treating or referring  treating ocular conditions such as dry

eye and allergy

 managing glaucoma (often done in co-management with Ophthalmologists)  providing after-care for

cataract surgery.

Optometrists work with and refer to ophthalmologists, GPs, or low vision services as required in the community. Many optometrists do additional training and have special expertise in areas including:

 Paediatric optometry  Vision therapy in children  Contact lenses

 Colour vision

 Occupational vision testing  Rehabilitation for vision problems.

Credentials

In Australia, all optometrists are required to be government registered practitioners under the national registration scheme APHRA. As such they are required to comply with all the codes and guidelines associated with such registration. These include: adherence to practice

requirements; possession of appropriate professional indemnity insurance; meeting specified continuing professional development requirements; maintaining good character; and regular

cardiopulmonary resuscitation training.

Top Tips for Engaging

with Optometrists

Increased networking and inter-disciplinary education opportunities These would support and strengthen networks and collaboration between optometrists and other relevant primary care providers (optometrists primarily work with GPs and pharmacists at a primary care level) and encourage locally-relevant referral pathways relevant to primary eye care to be established and adhered to.

Further Information

Peak Body – Optometrists Association Australia www.optometrists.asn.au

Optometrist

References

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