Professional Academic Unit, Peninsula Health, Monash University, Frankston, VIC, 3199, Australia.
Department of Physiotherapy, Peninsula Health, Monash University, Frankston, VIC, 3199, Australia.
BMC Health Serv Res. 2020 Jun 3;20(1):491. doi: 10.1186/s12913-020-05312-4.
Allied health assistants (AHAs) are support staff who complete clinical and non-clinical tasks under the supervision and delegation of an allied health professional. The effect of allied health professional delegation of clinical tasks to AHAs on patient and healthcare organisational outcomes is unknown. The purpose of this systematic review was to investigate the effect of allied health professional delegation of therapy to AHAs on patient and organisational outcomes.
A systematic review and meta-analysis was conducted. Databases MEDLINE (Ovid), Embase (Ovid), Informit (all databases), Emcare (Ovid), PsycINFO (Ovid), Cumulative Index to Nursing and Allied Health Literature [CINAHL] (EbscoHost) and the Cochrane Database of Systematic Reviews were searched from earliest date available. Additional studies were identified by searching reference lists and citation tracking. Two reviewers independently applied inclusion and exclusion criteria. The quality of the study was rated using internal validity items from the Downs and Black checklist. Risk ratios (RR) and mean differences (MD) were calculated for patient and organisational outcomes. Meta-analyses were conducted using the inverse variance method and random-effects model.
Twenty-two studies met the inclusion criteria. Results of meta-analysis provided low quality evidence that AHA supervised exercise in addition to usual care improved the likelihood of patients discharging home (RR 1.28, 95%CI 1.03 to 1.59, I = 60%) and reduced length of stay (MD 0.28 days, 95%CI 0.03 to 0.54, I = 0%) in an acute hospital setting. There was preliminary evidence from one high quality randomised controlled trial that AHA provision of nutritional supplements and assistance with feeding reduced the risk of patient mortality after hip fracture (RR 0.41, 95%CI 0.16 to 1.00). In a small number of studies (n = 6) there was no significant difference in patient and organisational outcomes when AHA therapy was substituted for therapy delivered by an allied health professional.
We found preliminary evidence to suggest that the use of AHAs to provide additional therapy may be effective for improving some patient and organisational outcomes.
CRD42019127449.
辅助卫生人员（AHAs）是在辅助卫生专业人员的监督和委托下完成临床和非临床任务的支持人员。辅助卫生专业人员将临床任务委托给 AHAs 是否会对患者和医疗组织的结果产生影响尚不清楚。本系统评价的目的是调查辅助卫生专业人员将治疗任务委托给 AHAs 是否会对患者和组织结果产生影响。
进行了系统评价和荟萃分析。检索了 MEDLINE（Ovid）、Embase（Ovid）、Informit（所有数据库）、Emcare（Ovid）、PsycINFO（Ovid）、护理和联合健康文献累积索引[CINAHL]（EbscoHost）和 Cochrane 系统评价数据库，从最早可用的日期开始。通过搜索参考文献列表和引文跟踪，确定了其他研究。两名审查员独立应用纳入和排除标准。使用 Downs 和 Black 清单的内部有效性项目对研究质量进行评分。使用逆方差法和随机效应模型计算患者和组织结果的风险比（RR）和平均差异（MD）。
22 项研究符合纳入标准。荟萃分析的结果提供了低质量证据，表明 AHA 监督锻炼加上常规护理可提高患者出院回家的可能性（RR 1.28，95%CI 1.03 至 1.59，I=60%），并缩短急性医院环境中的住院时间（MD 0.28 天，95%CI 0.03 至 0.54，I=0%）。一项高质量随机对照试验的初步证据表明，AHA 提供营养补充剂和协助喂养可降低髋部骨折后患者死亡的风险（RR 0.41，95%CI 0.16 至 1.00）。在少数研究（n=6）中，当 AHA 治疗代替辅助卫生专业人员提供的治疗时，患者和组织结果没有显著差异。
我们发现初步证据表明，使用 AHAs 提供额外的治疗可能对改善某些患者和组织结果有效。
CRD42019127449。
