Allied health group interventions for the management of adults with chronic conditions. An umbrella review of systematic reviews

Conference: 
SAPC ASM 2024 - Bristol
Talk Code: 
8E.7
Presenter: 
Sarah Dennis
Twitter: 
@SDennis_USYD
Co-authors: 
Professor Sarah Dennis 1,2,3 Ms Wing Kwok 1,4,5 Professor Jennifer Alison 1,5 A/Professor Leanne Hassett 1,3,4 A/ Professor Gillian Nisbet 1 Professor Kathryn Refshauge 1 Professor Cathie Sherrington 1,4 Professor Anna Williams 6
Author institutions: 
1. Faculty of Medicine and Health, University of Sydney 2. Ingham Institute of Applied Medical Research 3. South Western Sydney Local Health District 4. Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District 5. Allied Health, Sydney Local Health District 6. Faculty of Nursing and Midwifery, Western Sydney University

Problem

Primary health care in Australia is a fee for service model. GP visits are subsidised by Medicare Benefit Schedule (MBS) but there are limited Medicare subsidies for people with chronic conditions requiring allied health interventions which means patients face out of pocket costs impacting equity and access to allied health services. Currently, MBS subsidised allied health interventions are only available to group programs provided for people with type 2 diabetes by exercise physiologists or dietitians. Allied health services at no cost to patients are available in public hospital outpatient departments but waitlists are long. This umbrella review was initiated in response to the findings of the MBS Review Taskforce Report on Primary Care 2020. The recommendation to extend MBS subsidies for allied health group interventions was not supported, concluding that more research was needed to demonstrate effectiveness. The research question was: What is the effectiveness of allied health group therapy services to improve the health-related outcomes for community dwelling adults with one or more chronic conditions?

Approach

An umbrella review of systematic reviews was conducted between April and July 2022, searching eight library databases. Systematic reviews were eligible if they reported randomised controlled trials (RCTs) or quasi-RCTs, published in English after 2000, included community dwelling adults aged ≥18, at least one chronic condition (eligible for GP Management Plan), and group intervention in scope for an allied health professional. Studies were excluded if inpatients of hospital or aged care facility were included, or interventions were out of scope for allied health, or unsupervised.

Findings

2385 systematic reviews were identified: after screening and full text review 154 were included and data extracted from 90. The chronic conditions included: cancer (n=15), cardiovascular disease (n=6), mixed chronic conditions (n=3), kidney disease (n=1), low back pain (n=12), respiratory disease (n=8), diabetes (n=14), heart failure (n=9), risk of falls (n=5), hypertension (n=4), osteoarthritis (n=6) and stroke (n=8). Most group interventions included exercise and were in scope for physiotherapists and exercise physiologists. Overall, a group exercise program of 45-60 minutes per session, 2-3 times per week for 12 weeks for community dwelling adults improved health outcomes for most of the chronic conditions. Lifestyle education and support for people with type-2 diabetes improved glycaemic control.

Consequences

A large number of systematic reviews confirm that prescribed group exercise delivered by allied health professionals significantly improves health outcomes for community dwelling adults with a broad range of chronic conditions. This evidence supports expanding the existing Medicare funded allied health items to include group exercise sessions for a range of chronic diseases to reduce disease burden and overall healthcare costs.

Submitted by: 
Sarah Dennis
Funding acknowledgement: 
No funding