Findings, progress, and lessons learned during the first 3 years of a student-led interprofessional health clinic in regional Australia

Figures & data

Table 1. Demographic information.

	Commenced n = 184 (%)	Completed n = 146 (%)
Age (years)
<45	20 (10.8)	13 (9.0)
45–54	34 (18.6)	25(17.1)
55–64	49 (26.4)	36 (24.6)
65–74	63 (34.3)	57 (39.0)
75+	18 (9.9)	15 (1.3)
	Average = 60.1	Average = 61.7
Sex
Male	56 (30.4)	44 (3.1)
Female	128 (69.6)	102 (69.9)
Other	-	-
Aboriginal and/or Torres Strait Islander Status
Yes	9 (4.9)	4 (2.73)

Table 2. Occasions of service (OOS) delivered for participants who completed the program (n = 146).

	No. OOS	% OOS
Type of OOS
Triage/intake/review/transition session	920	13.0
Physiological assessment session	487	6.9
Health education session	761	10.8
Group exercise session	2,475	35.1
Nursing session	172	2.4
Dietetics session	534	7.6
Physiotherapy session	359	5.1
Exercise physiology session	424	6.0
Social work session	275	3.9
Psychology session	513	7.3
6- or 12-month review session	140	2.0
Group or individual appointment
Group	3,568	50.5
Individual	3,492	49.5
Delivery method
Face to face	6,719	95.2
Telehealth	341	4.8

Table 3. Student placement disciplines and duration.

Discipline	No. placements (%)	No. placement weeks (%)	Mean placement weeks
Dietetics	30 (20)	193 (18)	6.4
Exercise Physiology	42 (29)	268 (25)	6.4
Nursing	29 (20)	137 (13)	4.7
Physiotherapy	23 (16)	114 (11)	5.0
Psychology	16 (11)	246 (23)	15.4
Social Work	7 (5)	102 (10)	14.6
Total	147 (100)	1,060 (100)	7.2

Table 4. Changes to health measures at program commencement and completion.

Health measure	Status	N*	Intake Mean (SD)	Transition Mean (SD)	Mean change (95% CI)†	p value §	Effect size Cohen’s d
Weight (kg)	Commenced	181	103.40 (25.97)	102.49 (24.98)	−1.52 (−2.13, −0.91)	<.001	0.42
	Completed	135	104.01 (25.66)
BMI (kg/m^2)	Commenced	179	37.77 (9.19)	37.55 (8.80)	−0.52 (−0.77, −0.28)	<.001	0.36
	Completed	135	38.07 (9.04)
Waist circumference (cm)	Commenced	164	114.13 (18.20)	109.05 (16.67)	−4.60 (−5.87, −3.34)	<.001	0.67
	Completed	117	113.61 (17.67)
6MWT (m)	Commenced	161	381.00 (101.27)	433.66 (120.13)	52.36 (38.62, 66.08)	<.001	0.71
	Completed	114	381.31 (103.05)
AQoL-Physical (worst = 0, best = 100)	Commenced	179	62.56 (16.37)	69.84 (16.28)	6.21 (4.52, 7.89)	<.001	0.61
	Completed	141	63.63 (15.82)
AQoL-Psychosocial (worst = 0, best = 100)	Commenced	179	61.91 (17.73)	71.00 (16.53)	6.52 (4.79, 8.25)	<.001	0.61
	Completed	141	64.48 (17.39)
AQoL-Quality-Adjusted Utility (worst = 0, best = 1)	Commenced	183	0.510 (0.211)	0.646 (0.220)	0.112 (0.090, 0.135)	<.001	0.84
	Completed	142	0.534 (0.209)

*N= commenced refers to participants who had a valid measurement at intake (regardless of whether they finished the program). N= completed includes participants who had a valid measurement at intake and transition.

† Refers to the mean change between intake and transition scores for participants who completed the program.

§ p value refers to whether the mean difference between intake and transition scores for participants who completed the program are statistically significant. p < .05 was considered statistically significant.

Table 5. Nine key challenges and lessons from HaWC implementation.

#	Theme	Challenge	Lesson learned and/or solution implemented	Status
1	Referral and recruitment	Attracting and recruiting a sufficient number of participants for the program.	Growing community awareness of the health benefits conferred by the clinic and changes to triage (below) have contributed to increasing numbers for intake. Self-initiated referrals predominate, though a GP referral is required.	Resolved. Continuous monitoring/refinement.
2	Triage assessment and program suitability	Frequent and time-consuming phone conversations with the referring GP to evaluate program eligibility regarding relevant clinical measures and potential long-term commitment.	An in-person interprofessional interview and biopsychosocial needs analysis with qualified clinical educators and students has replaced the previous model. Prior to program intake, participants are given the opportunity to tour the clinic, meet the team of clinical educators and students, and in doing so are exposed to the level of engagement expected over the 16-week intensive program.	Resolved. Continuous monitoring/refinement.
3	Method of program intake	Student availability under a “rolling intake” model was inconsistent affecting the participant experience and staffing for the program.	Participants are no longer able to continuously enroll into the program. Rather, two blocks aligning with each semester comprising 25 places annually (i.e., total 50 per year) has been adopted. Social connections are now maintained long after the formal component of the program concludes under the new arrangement.	Resolved. Continuous monitoring/refinement.
4	Requirement for structured group education	Group education sessions were voluntary leading to reduced engagement.	Education sessions are integral to the core program and participants have to actively disenroll from sessions. The new “opt out” approach has enabled a higher proportion of participants to add not only new skills, but also knowledge to their toolkit for sustainable health behavior change. Smaller group and telehealth catch-up sessions have been introduced.	Resolved. Continuous monitoring/refinement.
5	Clinic software and data management	Proprietary clinic software is not designed nor suitable for interprofessional education and collaborative practice.	Clinic software has been modified to meet program requirements. Customisations have enhanced interprofessional data sharing, yet also contributed to instability in functionality (e.g., errors, slow down, missing data). Data collection, extraction and exporting for research purposes has been suboptimal, creating a requirement for excessive manual handling of data.	Not resolved. Whilst system stability has, to an extent been achieved, alternative software and further investigations to optimize data capture and recording are ongoing.
6	Transition to a telehealth model	In-person clinic activities had to be transferred into telehealth format during the COVID-19 lockdown.	All enrolled participants were invited to bring a preferred device (e.g., laptop, tablet) to the clinic in the leadup to lockdown. They were assisted by staff and students with the installation of the required software programs to enable HaWC program continuation via teleconsultation. Participants increased their skills in telehealth technology use and continue to apply them, however a small proportion opted out.	Resolved. Continuous monitoring and refinement.
7	Student allocation to interprofessional placements	Communicating with stakeholders about the benefit of a bespoke interprofessional placement opportunity, which still meets overall university program and discipline-specific requirements.	Each health discipline requires students to undertake placement to enhance evidence-based skills, knowledge and competencies. A tactful approach to redress traditional perspectives toward discipline-specific learning requirements has been taken. This has involved higher levels of negotiation, information sharing and clarification of how interprofessional education can add value to pedagogy and all health disciplines involved.	Not resolved. As interprofessional education and collaborative practice is proving to be the future and recommended direction for providing an optimal healthcare experience, it is likely that a placement of this kind becomes standard rather than the exception.
8	Incorporation of formal interprofessional education into student experience	Students on placement in the clinic were not provided formal interprofessional learning modules (available to other SQRH-supported placements), recognizing the additional opportunities available when working in a truly interprofessional environment.	Southern Queensland Rural Health (SQRH) coordinates a formal interprofessional learning course, an initiative that provides students with the knowledge and range of skills to become part of an interprofessional, practice ready, health workforce. The course is now delivered in modified form to students undertaking HaWC placement, contributing to a holistic educational experience, ensuring program inclusivity.	Resolved. Continuous monitoring and refinement.
9	Role of nursing in interprofessional clinic setting	There was a mismatch between nursing student placement requirements and the program.	Nursing student placements are undertaken primarily during initial program phases involving holistic health assessments (i.e., within interprofessional triage and intake), and specific cardiac reviews for participants determined to have a higher risk of heart disease. Additional placement opportunities are also offered toward the end of the program, during progress reviews and transitioning to completion of the intensive part of the program.	Resolved. Continuous monitoring and refinement.