Compression garment service model: Facilitating access to compression garments through workforce and service redesign

Fiona Hall DPsych, BPsych(Hons), GCAcuteCare, GDClinHyp1 | Susan Gordon PhD, BaAppSc(Physio), GCEd, GDMngt2,3 | Julie Hulcombe BSc, DNut&Diet, GDHlthEd, MHP4 | Catherine Stephens B.Phty, Gradcert Health Ser Mgt5. Aust. J. Rural Health. 2019;27:257-261

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Compression garment service model: Facilitating access to compression garments through workforce and service redesign

Fiona Hall DPsych, BPsych(Hons), GCAcuteCare, GDClinHyp1 |   Susan Gordon PhD, BaAppSc(Physio), GCEd, GDMngt2,3 |   Julie Hulcombe BSc, DNut&Diet, GDHlthEd, MHP4 |   Catherine Stephens B.Phty, Gradcert Health Ser Mgt5. Aust. J. Rural Health. 2019;27:257–261

Problem: Patients in Queensland have had difficulty in accessing lymphoedema services, particularly in rural and remote locations.

Design: The aim was to trial and evaluate a compression garment service model, to provide care for patients with lymphoedema closer to their homes. The service model trialled compression garment, selection, fitting and monitoring services for stabilised malignancy- related lymphoedema undertaken by generalist therapists.

Setting: Ten Hospital and Health Services in the Queensland public sector.

Key measures for improvements: The patients would have access to safe, quality services closer to their homes.

Strategies for change: The generalists were supported by telehealth coaching and supervision by lymphoedema therapists, an education program, resources and governance processes.

Effects of change: Compression garment selection, fitting and monitoring by generalists (physiotherapists and occupational therapists without Level 1 Lymphoedema training), as defined in the service model, was safe, effective and evaluated positively by patients and health professionals. There was increased access to compression garment services provided by generalist therapists in rural and remote locations.

Lessons learned: The service model implemented has the capacity to address workforce and service provision issues. It provides resources, education and training for clinicians to improve access to the provision of compression garment services.

Main findings

  • The service model established that compression garment selection, fitting and monitoring is within scope of the generalists’ practice and does not require completion of the Level 1 Lymphoedema Training Certificate.
  • Generalists in rural and remote regions can provide patients with stable lymphoedema, safe compression garment, selection, fitting and monitoring services, with most patients reporting no problems or discomfort with the fit of the garment.
  • The evaluation demonstrated the efficacy of telehealth in training and supporting generalists. The types of telehealth solutions were adequate to support the service model and elaborate telehealth equipment was not required.
  • The coaching model with LTs supporting generalists improved connections and communication between rural and metropolitan services that enhanced the understanding of service context and supported referral and continuity of care.
  • The service model implemented supported the intention of the guideline ie, providing care closer to patients’ homes. Although there were initial reservations from some clinicians about generalists providing garments for stabilised malignancy- related lymphoedema, the study has demonstrated that this is a safe and effective service delivery model that has benefitted all stakeholders, patients and clinicians.